TY - JOUR AU - Jitwiriyanont, Sujinat AU - Rawan, Rattanasuwan AU - Narajeenron, Khuansiri PY - 2025/4/21 TI - Advancing Politeness and Assertive Communication Through Tone of Voice in Crisis Team Situations: Pre-Post Acoustic Analysis Study of Team and Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) Virtual Simulation for Interprofessional Education in Health Care Undergraduate Students JO - J Med Internet Res SP - e66988 VL - 27 KW - virtual simulation KW - TeamSTEPPS KW - acoustic analysis KW - prosodic features KW - interprofessional education KW - politeness, assertive communication, tone of voice, confident, respect N2 - Background: Effective interprofessional communication, including politeness, respect for coworkers, and self-control, is crucial in emergency care. These values are emphasized by both Thai and US cultures. Notably, nurses place greater significance on respect and self-control than physicians, underscoring the need for physicians to recognize and adopt these attributes, especially in interactions with nursing staff. To develop these competencies, interprofessional education (IPE) programs are essential, with simulation-based IPE, particularly virtual simulations, showing promise in enhancing teamwork and communication. However, research on the tone of voice in emergency communication is limited, especially in Thailand, where standardized IPE curricula are lacking. Objective: This study aimed to assess the effectiveness of Team and Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) virtual simulation IPE, using a 3D computer-based or virtual reality (VR) approach, in enhancing interprofessional communication among health care students, focusing on politeness and assertiveness in the tone of voice. Methods: An experimental design was used with 30 health care students from 5 disciplines, including medical, nursing, medical technology, radiological technology, and pharmacy students. Participants were recorded during pretraining and posttraining TeamSTEPPS sessions. Acoustic analysis focused on 3 cues: duration, intensity, and fundamental frequency (F0). Duration measured the length of utterances, whereas intensity (loudness) and F0 (pitch) were analyzed using parameters, such as maximum, minimum, mean, SD, and range. In total, 5663 utterances were analyzed, providing a dataset for identifying significant shifts in vocal delivery after training. Using the Wilcoxon signed-rank test, these 11 acoustic parameters were extracted and statistically analyzed to compare pre- and posttraining differences. Results: Significant improvements in the tone of voice were observed. Medical and nursing students exhibited changes in pitch (SD and mean of F0; P<.001) and loudness (mean of intensity, P<.001), suggesting more attentive communication. The increased utterance duration in core team members suggests that they engaged in more elaborate information sharing and verification, critical for patient safety. Medical technology and radiological technology students showed reduced pitch (mean of F0; P<.05 in medical technology students and P<.01 in radiological students) and intensity (mean of intensity; P<.01 in medical technology students), reflecting calmer, more controlled communication. Pharmacy students showed minor changes. Conclusions: TeamSTEPPS virtual simulation IPE, using a 3D computer-based or VR approach, effectively enhances interprofessional nonverbal communication by improving key acoustic features related to politeness and assertiveness within the Thai culture context. Medical and nursing students showed the most notable gains, whereas quieter more controlled communication styles emerged among the other groups. The results demonstrate the ways in which vocal modulations can reflect role-specific responsibilities and interpersonal sensitivity in clinical interactions. These findings highlight the significance of tailored virtual simulation IPE programs for improving teamwork and patient outcomes across health care disciplines. UR - https://www.jmir.org/2025/1/e66988 UR - http://dx.doi.org/10.2196/66988 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66988 ER - TY - JOUR AU - Ogunsanmi, Deborah AU - Chambers, Jerica AU - Mahmood, Asos AU - Pakker, Reddy Avinash AU - Kompalli, Anusha AU - Kabir, Umar AU - Surbhi, Satya AU - Gatwood, Justin AU - Mahmud, Sultan Md AU - Bailey, E. James PY - 2025/4/18 TI - Technical Requirements, Design, and Automation Process for a Statewide Registry-Based Tailored Text Messaging System: Protocol for a Longitudinal Observational Study JO - JMIR Res Protoc SP - e62874 VL - 14 KW - text messaging KW - clinical informatics KW - chronic disease KW - telehealth KW - telemedicine KW - electronic health records N2 - Background: Tailored text messaging is a low-cost mobile health intervention approach shown to effectively improve self-care behaviors and clinical outcomes for patients with chronic cardiometabolic conditions. Given the ubiquitous nature of mobile phones, text messages have the potential to reach a large audience. However, automating and disseminating tailored text messages to large populations at low cost presents major logistical challenges that serve as barriers to implementation. Objective: This study aimed to describe the protocol for a longitudinal observational study designed to assess the feasibility of an innovative approach for automating and disseminating personalized and tailored text messages to large populations at risk of cardiovascular events using a low-cost registry-based tailored text messaging system known as the Heart Health Messages (HHM) program. Further, it describes the technical requirements, architectural design, automation process, and challenges associated with program implementation. Methods: Patients at high risk of cardiovascular diseases are identified using a statewide population health registry known as the Tennessee Population Data Network. Tailored invitation messages and enrollment surveys are sent to eligible patients via Twilio. Upon completion of the receipt of consent and enrollment forms, participants receive tailored text messages from a library of generic messages based on participant-selected frequency of message delivery (daily or every other day). In addition, participants receive monthly text-based check-in survey messages designed to assess intervention adherence and improvement in self-care. Participants are also sent quarterly follow-up surveys to update enrollment information and preferences. All enrolled participants will receive tailored text messages for a 12-month intervention period. Results: Since the start of the program, 18,974 patients from 2 major health systems have met the inclusion criteria and were eligible for the HHM program. A total of 3 phases of HHM 1.0 have been implemented so far, reaching 225 eligible patients in phase 1, a total of 5288 patients in phase 2, and 13,461 patients in phase 3, with an enrollment of approximately 2% (n=4/225), 3% (n=137/5228), and 3% (n=350/13461), respectively. Efforts are underway to implement strategies in collaboration with the health systems to enhance the HHM program rollout and patient participation. Conclusions: The HHM program is a low-cost tailored text messaging intervention set for broader dissemination and potential replication. The program has the capacity to improve outcomes for people with chronic medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/62874 UR - https://www.researchprotocols.org/2025/1/e62874 UR - http://dx.doi.org/10.2196/62874 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62874 ER - TY - JOUR AU - Madabhushi, Sankirth AU - Nguyen, M. Andrew AU - Hsia, Katie AU - Kher, Sucharita AU - Harvey, William AU - Murzycki, Jennifer AU - Chandler, Daniel AU - Davis, Michael PY - 2025/4/17 TI - Effect of Smartphone-Based Messaging on Interns and Nurses at an Academic Medical Center: Observational Study JO - JMIR Med Inform SP - e66859 VL - 13 KW - secure messaging KW - alert fatigue KW - burnout KW - clinical communication KW - TigerConnect KW - healthcare communication KW - text KW - texting KW - messaging KW - app KW - application KW - smartphone KW - digital health KW - digital technology KW - digital intervention KW - medical informatics KW - messaging patterns N2 - Background: Digital communication between nurses and medicine interns plays a crucial role in patient care. However, excessive messaging may contribute to alert fatigue, potentially affecting workflow efficiency and clinical decision-making. Although prior research has examined general messaging behaviors among clinicians, few studies have specifically analyzed messaging patterns between nurses and interns, who serve as primary points of contact in inpatient care. Objectives: This study aims to quantitatively characterize messaging patterns between the primary nurse and primary provider (ie, medicine intern) of hospitalized patients at an academic medical center in order to identify communication burdens and potential inefficiencies. By identifying trends in message volume, timing, and response rates, we seek to inform strategies to optimize communication workflows and mitigate alert fatigue. Methods: At a large academic hospital (Tufts Medical Center, Boston, MA), we analyzed secure messaging transactions between internal medicine interns and nurses across three medical-surgical units over 6 months. Transaction metadata, time stamps, and unique message tokens were extracted. Data processing was performed using Python, Microsoft Excel, and R. Message volume, interaction frequencies, and response times were analyzed using measures of central tendency and statistical tests of significance. Results: A total of 61,057 unique messages were exchanged between interns and nurses, with interns exchanging 2.5 times more messages per day with nurses than vice versa (P<.001). Messaging volume exhibited diurnal variation, indicating periods of increased communication burden. Interns read messages from nurses within a median of 35 (range: 0?3589) seconds, whereas nurses read messages from interns within a median of 26 (range: 0?3584) seconds (P<.001). The longest message response delays occurred at 4 AM, whereas the shortest occurred at 8 AM. Conclusions: Interns experience a significantly higher messaging burden than nurses, with distinct peaks in message volume during morning rounds and overnight shifts. These findings suggest a need for interventions such as optimized digital communication protocols to reduce nonessential messaging and alert fatigue. Future research should explore the effectiveness of these interventions in enhancing workflow efficiency and the development of both in-person and digital interventions to optimize communication workflows and mitigate alert fatigue. UR - https://medinform.jmir.org/2025/1/e66859 UR - http://dx.doi.org/10.2196/66859 ID - info:doi/10.2196/66859 ER - TY - JOUR AU - Graever, Leonardo AU - Mafra, Cordeiro Priscila AU - Figueira, Klein Vinicius AU - Miler, Navega Vanessa AU - Sobreiro, Lima Júlia dos Santos AU - Silva, da Gabriel Pesce de Castro AU - Issa, Castro Aurora Felice AU - Savassi, Monteiro Leonardo Cançado AU - Dias, Borges Mariana AU - Melo, Machado Marcelo AU - Fonseca, da Viviane Belidio Pinheiro AU - Nóbrega, da Isabel Cristina Pacheco AU - Gomes, Kátia Maria AU - Santos, dos Laís Pimenta Ribeiro AU - Lapa e Silva, Roberto José AU - Froelich, Anne AU - Dominguez, Helena PY - 2025/4/17 TI - Telehealth Support From Cardiologists to Primary Care Physicians in Heart Failure Treatment: Mixed Methods Feasibility Study of the Brazilian Heart Insufficiency With Telemedicine Trial JO - JMIR Cardio SP - e64438 VL - 9 KW - heart failure KW - telemedicine KW - telehealth KW - intersectoral collaboration KW - primary health care KW - low- and middle-income countries KW - family practice N2 - Background: Heart failure is a prevalent condition ideally managed through collaboration between health care sectors. Telehealth between cardiologists and primary care physicians is a strategy to improve the quality of care for patients with heart failure. Still, the effectiveness of this approach on patient-relevant outcomes needs to be determined. Objective: This study aimed to assess the feasibility of telehealth support provided by cardiologists for treating patients with heart failure to primary care physicians from public primary care practices in Rio de Janeiro, Brazil. Methods: We used mixed methods to assess the feasibility of telehealth support. From 2020 to 2022, we tested 2 telehealth approaches: synchronous videoconferences (phase A) and interaction through an asynchronous web platform (phase B). The primary outcome was feasibility. Exploratory outcomes were telehealth acceptability of patients, primary care physicians, and cardiologists; the patients? clinical status; and prescription practices. Qualitative methods comprised content analysis of 3 focus groups and 15 individual interviews with patients, primary care physicians, and cardiologists. Quantitative methods included the baseline assessment of 83 patients; a single-arm, before-and-after assessment of clinical status in 58 patients; and an assessment of guideline-directed medical therapy in 28 patients with reduced ejection fraction measured within 1 year of follow-up. We integrated qualitative and quantitative data using a joint display table and used the A Process for Decision-Making After Pilot and Feasibility Trials framework for feasibility assessment. Results: Telehealth support from cardiologists to primary care physicians was generally well accepted. As barriers, patients expressed concern about reduced direct access to cardiologists, primary care physicians reported work overload and a lack of relative advantage, and cardiologists expressed concern about the sustainability of the intervention. Quantitative analysis revealed an overall poor baseline clinical status of patients with heart failure, with 53% (44/83) decompensated, as expected. Compliance with guideline-directed medical therapy for the treatment of heart failure with reduced ejection fraction after telehealth showed a modest improvement for ?-blockers (17/20, 85% to 18/19, 95%) and renin-angiotensin-aldosterone system inhibitors (14/20, 70% to 15/19, 79%) but a drop in the prescription of spironolactone (16/20, 80% to 15/20, 75%). Neprilysin and sodium-glucose cotransporter 2 inhibitors were introduced in 4 and 1 patient, respectively. Missing record data precluded a more precise analysis. The feasibility assessment was positive, favoring the asynchronous modality. Potential modifications include more effective patient and professional recruitment strategies and educational activities to raise awareness of collaborative support in primary care. Conclusions: Telehealth was feasible to implement. Considering the stakeholders? views and insights on the process is paramount to attaining engagement. Missing data must be anticipated for future research in this setting. Considering the recommended adaptations, the intervention can be studied in a cluster-randomized trial. UR - https://cardio.jmir.org/2025/1/e64438 UR - http://dx.doi.org/10.2196/64438 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64438 ER - TY - JOUR AU - de França, Galvão Caroline Villela AU - Segalla, Boaro Paola AU - Reis, Assis Felipe Sebastião de AU - Pereira, Silveira José Ricardo AU - de Mattos, Oliveira Alexandre AU - Ferron, Moura Roberta de AU - de Oliveira, Zanardo Cleyton AU - Borges, Bassani Jéssica AU - Hoffmann, Quintal Lilian AU - Caboclo, Giaimo Edmundo Di PY - 2025/4/16 TI - Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study JO - JMIR Hum Factors SP - e55430 VL - 12 KW - telemedicine cabin KW - telehealth KW - teleservice KW - e-health KW - connected offices N2 - Background: Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. Objective: This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Beneficência Portuguesa de São Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. Methods: A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. Results: The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. Conclusions: The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care. UR - https://humanfactors.jmir.org/2025/1/e55430 UR - http://dx.doi.org/10.2196/55430 ID - info:doi/10.2196/55430 ER - TY - JOUR AU - Wang, Yi AU - Tyagi, Shilpa AU - Ng, Liang David Wei AU - Teo, Ying Valerie Hui AU - Kok, David AU - Foo, Dennis AU - Koh, Choon-Huat Gerald PY - 2025/4/15 TI - Primary Technology-Enhanced Care for Hypertension Scaling Program: Trial-Based Economic Evaluation Examining Effectiveness and Cost-Effectiveness Using Real-World Data in Singapore JO - J Med Internet Res SP - e59275 VL - 27 KW - telehealth monitoring KW - hypertension KW - cost-effectiveness analysis KW - real-world data KW - Singapore KW - telehealth KW - cost-effectiveness KW - blood pressure monitoring KW - health care KW - teleconsultation KW - chatbot KW - regression analysis KW - medical cost N2 - Background: Telehealth interventions are effective in hypertension management. However, the cost-effectiveness of using them for managing patients with hypertension remains inconclusive. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting. Objective: The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) scaling program, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The program comprises remote blood pressure (BP) monitoring at home, health care team support through teleconsultations, and in-app support with a digital chatbot. This study aimed to evaluate the program?s effectiveness and cost-effectiveness. Methods: For patients under the PTEC-HT scaling program, BP readings over 6 months and 12 months, age, and gender were collected within the program. Health care use, health care cost, and patient ethnicity were extracted from the National Healthcare Group Polyclinics. For patients in the usual care group, demographic information, clinical data, health care use, and health care costs were extracted from the national claims records. Comparing the PTEC-HT scaling program with usual care, a trial-based economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effectiveness over time horizons of 6 months and 12 months. The health care system?s perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and the usual care group. Results: For the 6-month analysis, 427 patients were included in the PTEC-HT group, and 64,679 patients were included in the usual care group. For the 12-month analysis, 338 patients were included in the PTEC-HT group, and 7324 patients were included in the usual care group. Using exact matching plus regression, in the 6-month analysis, the probability of having controlled BP was 13.5% (95% CI 6.3%-20.7%) higher for the PTEC-HT group compared to the usual care group. In the 12-month analysis, the probability of having controlled BP was 16% (95% CI 10.7%-21.3%) higher for the PTEC-HT group. Without considering the cost of the BP machine and program maintenance cost, the direct medical cost was S $57.7 (95% CI 54.4-61.0; a currency exchange rate of S $1=US $0.74 was applicable;) lower per patient for the PTEC-HT group in the 6-month analysis and S $170.9 (95% CI 151.9-189.9) lower per patient for the PTEC-HT group in the 12-month analysis. With the cost of the BP machine and program maintenance considered, compared to usual care, the PTEC-HT program reached breakeven at around the sixth month and saved S $52.6 (95% CI 33.6-71.6) per patient at the 12th month. Conclusions: Implemented in a real-world setting in Singapore, our study showed that the PTEC-HT scaling program is more effective in controlling BP status with lower cost compared to the usual care over 12 months. UR - https://www.jmir.org/2025/1/e59275 UR - http://dx.doi.org/10.2196/59275 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59275 ER - TY - JOUR AU - Tsou, Christina AU - Yeung, Justin AU - Goode, Melanie AU - Mcdonnell, Josephine AU - Williams, Aled AU - Andrew, Colin Stephen AU - Tetlow, Jenny AU - Jamieson, Andrew AU - Hendrie, Delia AU - Reid, Christopher AU - Thompson, Sandra PY - 2025/4/15 TI - Perceived Risks, Mitigation Strategies, and Modifiability of Telehealth in Rural and Remote Emergency Departments: Qualitative Exploration Study JO - JMIR Hum Factors SP - e58851 VL - 12 KW - emergency telemedicine KW - implementation effectiveness KW - clinical effectiveness KW - risk aversion KW - risk mitigation KW - rural and remote KW - emergency departments N2 - Background: Telehealth is a recognized and rapidly evolving domain in the delivery of emergency medicine. Research suggests a positive impact of telehealth in patients presenting for emergency care; however, the regional challenges of acute telemedicine delivery have not been studied. The WA Country Health Service (WACHS) established the Emergency Telehealth Service (ETS) in 2012 to provide telehealth and other technology-enabled services to regional Western Australian hospitals and clinics. The WACHS ETS supports 87 rural and remote WACHS-operated hospitals as well as 10 non-WACHS health clinics via high-definition audio-visual equipment installed in the resuscitation bay of the emergency department (ED) at each site. This 12-year practical application of emergency telemedicine offers a unique opportunity to explore the experiences and perceptions of clinicians delivering virtual care to rural and remote communities. Objective:  This study explores the perceptions of ETS clinicians regarding acceptability, appropriateness, and clinical decision-making when delivering emergency telemedicine in rural and remote settings. Methods: This qualitative study used semistructured interviews to explore the perspectives of ETS clinicians regarding the factors influencing their clinical decision-making. It explored how ETS clinicians determine and modify clinical risks associated with using audio-visual equipment to deliver care. Emerging themes were compared with the concepts arising from the interim guidance of the Medical Board of Australia, and both the Australian and New Zealand, and American Colleges of Emergency Medicine. Results: Overall, 16 doctors, 4 clinical nurse coordinators, and a nurse educator from WACHS ETS provided their experiences and perspectives. Accurate clinical decisions, especially regarding patient disposition, were crucial to virtual care. Timeliness and accuracy were enhanced through a mutual learning model grounded in the local context. Mitigation strategies such as improvisation and flexible technology use compensated for technological barriers. Nonmodifiable risk factors included patients? presenting complaints, clinical urgency of presentation, ED capability, clinician scope of practice, and, if a transfer was required, the distance between the ED of original presentation and the hospital of definitive care. Conclusions: Telehealth can enhance clinical decision-making in rural and remote EDs, and ETS clinicians can prioritize patient safety through a lens incorporating both local hospital capabilities and community contexts. Even for the most experienced clinicians, telehealth was not comparable to face-to-face communication in all circumstances. The impact of the ETS on the scope of the regional emergency medicine practice and on the building of clinical skills warrants further study in relation to its overall effectiveness and cost-effectiveness in rural and remote EDs. These findings identify areas for further qualitative research while providing a rich contextual background for rigorous quantitative analysis of the effectiveness of the ETS. UR - https://humanfactors.jmir.org/2025/1/e58851 UR - http://dx.doi.org/10.2196/58851 UR - http://www.ncbi.nlm.nih.gov/pubmed/40232817 ID - info:doi/10.2196/58851 ER - TY - JOUR AU - Nair, Subjagouri Rakhi Asokkumar AU - Hartung, Matthias AU - Heinisch, Philipp AU - Jaskolski, Janik AU - Starke-Knäusel, Cornelius AU - Veríssimo, Susana AU - Schmidt, Maria David AU - Cimiano, Philipp PY - 2025/4/14 TI - Summarizing Online Patient Conversations Using Generative Language Models: Experimental and Comparative Study JO - JMIR Med Inform SP - e62909 VL - 13 KW - patient experience KW - online communities KW - summarizing KW - large language models N2 - Background: Social media is acknowledged by regulatory bodies (eg, the Food and Drug Administration) as an important source of patient experience data to learn about patients? unmet needs, priorities, and preferences. However, current methods rely either on manual analysis and do not scale, or on automatic processing, yielding mainly quantitative insights. Methods that can automatically summarize texts and yield qualitative insights at scale are missing. Objective: The objective of this study was to evaluate to what extent state-of-the-art large language models can appropriately summarize posts shared by patients in web-based forums and health communities. Specifically, the goal was to compare the performance of different language models and prompting strategies on the task of summarizing documents reflecting the experiences of individual patients. Methods: In our experimental and comparative study, we applied 3 different language models (Flan-T5, Generative Pretrained Transformer [GPT], GPT-3, and GPT-3.5) in combination with various prompting strategies to the task of summarizing posts from patients in online communities. The generated summaries were evaluated with respect to 124 manually created summaries as a ground-truth reference. As evaluation metrics, we used 2 standard metrics from the field of text generation, namely, Recall-Oriented Understudy for Gisting Evaluation (ROUGE) and BERTScore, to compare the automatically generated summaries to the manually created reference summaries. Results: Among the zero-shot prompting?based large language models investigated, GPT-3.5 performed better than the other models with respect to the ROUGE metrics, as well as with respect to BERTScore. While zero-shot prompting seems to be a good prompting strategy, overall GPT-3.5 in combination with directional stimulus prompting in a 3-shot setting had the best results with respect to the aforementioned metrics. A manual investigation of the summarization of the best-performing method showed that the generated summaries were accurate and plausible compared to the manual summaries. Conclusions: Taken together, our results suggest that state-of-the-art pretrained language models are a valuable tool to provide qualitative insights about the patient experience to better understand unmet needs, patient priorities, and how a disease impacts daily functioning and quality of life to inform processes aimed at improving health care delivery and ensure that drug development focuses more on the actual priorities and unmet needs of patients. The key limitations of our work are the small data sample as well as the fact that the manual summaries were created by 1 annotator only. Furthermore, the results hold only for the examined models and prompting strategies, potentially not generalizing to other models and strategies. UR - https://medinform.jmir.org/2025/1/e62909 UR - http://dx.doi.org/10.2196/62909 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62909 ER - TY - JOUR AU - Kim, Jeonghyun Grace AU - Namkoong, Kang PY - 2025/4/14 TI - Developing the Digital Health Communication Maturity Model: Systematic Review JO - J Med Internet Res SP - e68344 VL - 27 KW - digital health KW - maturity model KW - integrated model KW - digital health communication KW - health communication KW - systematic review KW - model development KW - health care innovation KW - digital transformation KW - organizational readiness KW - evaluation metrics KW - health care technology KW - digital strategy N2 - Background: Digital health has become integral to public health care, advancing how services are accessed, delivered, and managed. Health organizations increasingly assess their digital health maturity to leverage these innovations fully. However, existing digital health maturity models (DHMMs) primarily focus on technology and infrastructure, often neglecting critical communication components. Objective: This systematic review addresses gaps in DHMMs by identifying deficiencies in user communication elements and proposing the digital health communication maturity model (DHCMM). The DHCMM integrates critical health communication dimensions such as satisfaction, engagement, personalization, and customization to provide a comprehensive evaluation framework. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to conduct a systematic review of studies selected from 3 databases: EBSCO, PubMed, and ProQuest. Studies were screened and included based on their focus on digital health maturity and communication elements, with the final selection limited to English-language research addressing DHMMs. Results: Of the 1138 initially identified studies, 31 (2.72%) met the inclusion criteria. Current DHMMs heavily emphasize infrastructure while overlooking user engagement and communication; for instance, only 35% (11/31) of the reviewed models incorporated user satisfaction, and less than one-fifth (6/31, 19%) addressed personalization or customization. The DHCMM addresses these gaps with 7 maturity levels, ranging from initial to engaged, and emphasizes user-centered metrics and governance. Quantitative analysis showed substantial variations in communication metrics, with satisfaction metrics incorporated at an average rate of 22% (7/31) across the reviewed models. Conclusions: The DHCMM shifts the focus of digital health maturity assessments by emphasizing communication and user engagement. This model provides health care organizations with a structured framework to enhance digital health initiatives, leading to better patient outcomes and system-wide efficiencies. The model delivers actionable insights for organizations aiming to achieve advanced digital maturity by addressing underrepresented dimensions. Future research should implement and refine the DHCMM across diverse health care contexts to enhance its effectiveness. The adoption of this model could result in more equitable, user-centered health care systems that integrate technological advancements with human-centered care. UR - https://www.jmir.org/2025/1/e68344 UR - http://dx.doi.org/10.2196/68344 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68344 ER - TY - JOUR AU - Martinez, Jacob AU - Cordero, I. Jacquelin AU - Whitney, Meagan AU - LaRoche, L. Katie AU - Frietze, Gabriel AU - Moya, M. Eva AU - Gosselink, Kristin PY - 2025/4/3 TI - Web-Based Human Papillomavirus Education and Professional Skills Intervention for Health Care Providers: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60790 VL - 14 KW - human papillomavirus KW - randomized controlled trial KW - HPV knowledge KW - HPV vaccine KW - health care provider KW - provider recommendations KW - communication strategies KW - Hispanic N2 - Background:  The human papillomavirus (HPV) vaccine is an effective way to prevent HPV and its associated cancers. Provider recommendation has been shown to be one of the most successful strategies for increasing the uptake of the HPV vaccine; however, more training and resources are needed to help boost health care providers? confidence and communication skills in recommending the HPV vaccine to their patients, particularly in underserved Hispanic communities where vaccination rates among all ages are lower. Objective:  This study aims to compare HPV educational and professional skills intervention effectiveness on improving provider recommendations and patient communication strategies with health care providers serving the El Paso United States?Mexico border region. Methods:  We will conduct a randomized, blinded, multiple posttest-only controlled behavioral trial using a parallel group design that will examine the effectiveness of a fully automated, web-based, culturally tailored HPV education and professional skills intervention containing unique reading material and video role-play, as compared to a standard Centers for Disease Control and Prevention fact sheet and video about general communication skills. Participants were recruited using a purposive sampling technique, both internet-based and in-person outreach events. Study data are being collected and managed using REDCap (Research Electronic Data Capture; Vanderbilt University) hosted at the University of Texas at El Paso. Chi-square analyses, ANOVA, and other statistical tests will be used with 2-tail ? to reject null hypotheses at .05 to analyze the self-assessed outcome data. The Mauchly test of sphericity for each ANOVA and the Huynh-Feldt epsilon test or Greenhouse-Geisser correction to the degrees of freedom of the F-ratio will be reported for each significant effect. We may use multiple imputation procedures to handle the missing data (if applicable). This study is being conducted in the west Texas or southeast New Mexico region of the United States. Chi-square analyses will be used to assess associations between variables reported on the baseline provider knowledge, attitudes, and practice scales. We seek to examine self-assessed changes in provider attitudes and behaviors regarding HPV vaccine recommendation 1 month after receiving our unique multimedia and culturally tailored intervention. Results:  Research and data collection for this clinical trial began in December 2023. Participant recruitment was closed by May 2024 (N=128), with final data collection expected to be completed by December 2024. Conclusions:  This study team decided to report on the intervention protocol to help ensure transparency in the research process and facilitate the improvement of the research design. Tailored web-based educational programs for health care professionals, designed to address regional and patient population characteristics, may be a promising approach to enhancing the real-world implementation of clinical practice guidelines. Trial Registration: ClinicalTrials.gov NCT05120869; http://clinicaltrials.gov/ct2/show/NCT05120869 International Registered Report Identifier (IRRID): PRR1-10.2196/60790 UR - https://www.researchprotocols.org/2025/1/e60790 UR - http://dx.doi.org/10.2196/60790 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60790 ER - TY - JOUR AU - Norberg, Lønnebakke Børge AU - Austad, Bjarne AU - Kristiansen, Eli AU - Zanaboni, Paolo AU - Getz, Okkenhaug Linn PY - 2025/3/27 TI - The Dynamics of Doctor-Patient Communication During Remote Consultations: Qualitative Study Among Norwegian Contract General Practitioners JO - J Med Internet Res SP - e57679 VL - 27 KW - remote consultations KW - digital consultations KW - telemedicine KW - eHealth KW - communication KW - safety KW - general practice KW - family medicine KW - focus groups KW - telehealth KW - digital health KW - relationship KW - patient-physician KW - general practitioner KW - thematic analysis KW - qualitative analysis N2 - Background: Patient consultations in general practice are undergoing a digital transformation, embracing diverse modalities such as video, text-based, and telephone consultations. The quality of communication in medical consultations is pivotal for successful outcomes, necessitating a comprehensive assessment of the impact of this transformation on doctor-patient communication and interaction. Objective: This study aims to explore general practitioners? (GPs?) perspectives on how the communication between Norwegian contract GPs and patients has been affected by the large-scale implementation of remote consultations following the onset of the COVID-19 pandemic. Methods: Five focus groups, comprising 18 purposefully recruited GPs from diverse settings and geographical regions in Norway, were carried out in 2022. We applied thematic analysis guided by the framework proposed by Braun and Clarke. Results: Six themes resulted from the analysis. First, suitability regarding remote communication is context-dependent: knowing the characteristics of the patient as a person and the clinical relationship is more important than the reason for contact or type of health problem?even more so than during ordinary physical consultations. Second, remote consultations favor a demarcated communication style, ?keeping things simple?the one-problem approach,? which can increase work effectiveness. Third, a downside of such effective minimalism is that the uncritical use of remote consultations may undermine the quality of care. Communication becomes too transactional, limiting the chances of addressing more implicit and complex issues, with the risk of missing vital information. Fourth, remote modalities can help engage hesitant and vulnerable patients. Fifth, GPs make communicative trade-offs in the name of continuity to be able to maintain relationships with patients they see as vulnerable or fugitive. Finally, there are advantages and dilemmas stemming from text-based consultations. Although they offer benefits such as multimedia-enabled patient expression and sharing of digital information, some concerns include the risk of information loss through triage errors, managing informal language, and ending chat-like interactions between patients and doctors. Conclusions: The implementation of remote consultations has many effects on clinical interaction and communication. Although these modalities can enhance efficiency, there is a discernible risk of compromised retrieval of essential information and unvoiced problems, potentially resulting in unintended consequences. The preservation of continuity of care emerges as a pivotal strategy to mitigate some of these challenges. UR - https://www.jmir.org/2025/1/e57679 UR - http://dx.doi.org/10.2196/57679 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57679 ER - TY - JOUR AU - Rettinger, Lena AU - Aichinger, Lea AU - Ertelt-Bach, Veronika AU - Huber, Andreas AU - Javorszky, Maria Susanne AU - Maul, Lukas AU - Putz, Peter AU - Sargis, Sevan AU - Werner, Franz AU - Widhalm, Klaus AU - Kuhn, Sebastian PY - 2025/3/26 TI - Best Practice Guide for Reducing Barriers to Video Call?Based Telehealth: Modified Delphi Study Among Health Care Professionals JO - JMIR Hum Factors SP - e64079 VL - 12 KW - telehealth KW - best practices KW - video call KW - Delphi study KW - health communication KW - barriers KW - health care professionals KW - qualitative interviews KW - web-based survey KW - physiotherapists KW - speech therapists KW - language therapists KW - dietitians KW - midwife N2 - Background: Telehealth has grown, especially during the COVID-19 pandemic, improving access for those in remote or underserved areas. However, its implementation faces technological, practical, and interpersonal barriers. Objective: The aim of this study was to identify and consolidate best practices for telehealth delivery, specifically for video call sessions, by synthesizing the insights of health care professionals across various disciplines. Methods: We first identified 15 common telehealth barriers from a preceding scoping review. Subsequently, a modified Delphi method was used, involving 9 health care professionals (physiotherapists, speech and language therapists, dietitians, and midwife) with telehealth experience in qualitative interviews and 2 iterative rounds of web-based surveys to form consensus. Results: This study addressed 15 telehealth barriers and identified 105 best practices. Among these, 20 are technology-related and 85 concern health care practices. Emphasis was placed on setting up telehealth environments, ensuring safety, building relationships and trust, using nonmanual methods, and enhancing observation and assessment skills. Best practice recommendations for dealing with patients or caregiver skepticism or lack of telehealth-specific knowledge were developed. Further, approaches for unstable networks and privacy and IT security issues were identified. Areas with fewer best practices were the lack of technology skills or technology access, unreliability of hardware and software, increased workload, and a lack of caregiver support. Conclusions: This guide of best practices serves as an actionable resource for health care providers to navigate the complexities of telehealth. Despite a small participant sample and the potential for profession-specific biases, the findings provide a foundation for improving telehealth services and inform future research for its application and education. UR - https://humanfactors.jmir.org/2025/1/e64079 UR - http://dx.doi.org/10.2196/64079 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64079 ER - TY - JOUR AU - Bakas, Tamilyn AU - Miller, Elaine AU - Sucharew, Heidi AU - Kreitzer, Natalie AU - Israel, Jahmeel AU - Rota, Matthew AU - Harnett, Brett AU - Dunning, Kari AU - Jones, Holly AU - McCarthy, Michael AU - Brehm, Bonnie AU - Austin, K. Joan AU - Mitchell, H. Pamela PY - 2025/3/25 TI - Examining the Efficacy of the Telehealth Assessment and Skill-Building Kit (TASK III) Intervention for Stroke Caregivers: Protocol for a Randomized Controlled Clinical Trial JO - JMIR Res Protoc SP - e67219 VL - 14 KW - stroke KW - family caregivers KW - depressive symptoms KW - health-related quality of life KW - clinical trial KW - intervention study KW - protocol KW - nursing N2 - Background: Stroke is a leading cause of serious, long-term disability and has a sudden onset. Upon discharge to the home setting, families are thrust into providing care, often without sufficient training from health care providers. Aligned with current patient and caregiver guidelines, the Telehealth Assessment and Skill-Building Kit (TASK III) is a nurse-led intervention designed to empower caregivers to address their own needs and those of the survivor using innovative skill-building strategies. Objective: This study aims to test the short-term (immediately after the intervention at 8 wk) and long-term (12, 24, and 52 wk) efficacy of the TASK III intervention, compared with an information, support, and referral (ISR) group, to improve caregiver life changes (ie, changes in physical health, physical functioning, emotional well-being, and general health) as a result of providing care. Methods: A randomized controlled clinical trial design will be used with baseline data collection from 296 family caregivers by telephone after the stroke survivor is discharged home. Caregivers randomly assigned to the ISR group (n=148, 50%) will receive information from the American Heart Association about stroke family caregiving. Caregivers randomly assigned to the TASK III group (n=148, 50%) will receive a TASK III resource guide and information from the American Heart Association. Both groups will receive 8 weekly calls from a nurse, with a booster call a month later. Outcomes will be assessed by blinded data collectors at 8, 12, 24, and 52 weeks. The primary outcome (at 8 wk) is caregiver life changes measured by the Bakas Caregiving Outcomes Scale. Secondary outcomes are depressive symptoms; other symptoms (eg, stress, fatigue, sleep, pain, and shortness of breath); unhealthy days; diet; exercise; and self-reported health care use. Mediators are task difficulty, threat appraisal, and self-efficacy. Program evaluation outcomes (satisfaction and technology ratings) will also be analyzed. Results: The trial was registered on March 10, 2022. Enrollment and random assignment of the first participant was on November 30, 2022, with an anticipated completion of recruitment by November 30, 2025. Completion of the primary end point data analysis is anticipated by August 31, 2026, with results expected to be reported on ClinicalTrials.gov by April 1, 2027. As of October 9, 2024, a total of 198 (66.9% of the proposed total sample of 296) family caregivers have been enrolled and randomly assigned to the TASK III group (n=98, 49.5%) or the ISR group (n=100, 50.5%). The last update was performed on January 25, 2024. Conclusions: If the TASK III intervention is shown to be efficacious in the proposed randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care, providing a tremendous public health impact. Trial Registration: ClinicalTrials.gov NCT05304078; https://clinicaltrials.gov/study/NCT05304078 International Registered Report Identifier (IRRID): DERR1-10.2196/67219 UR - https://www.researchprotocols.org/2025/1/e67219 UR - http://dx.doi.org/10.2196/67219 UR - http://www.ncbi.nlm.nih.gov/pubmed/39937971 ID - info:doi/10.2196/67219 ER - TY - JOUR AU - Wu, J. Jennifer AU - Graham, Ross AU - Çelebi, Julie AU - Fraser, Kevin AU - Gin, T. Geneen AU - Dang, Laurel AU - Hatamy, Esmatullah AU - Walker, Amanda AU - Barbato, Courtney AU - Lunde, Ottar AU - Coles, Lisa AU - Agnihotri, Parag AU - Morn, Cassandra AU - Tai-Seale, Ming PY - 2025/3/24 TI - Factors Influencing Primary Care Physicians? Intent to Refer Patients With Hypertension to a Digital Remote Blood Pressure Monitoring Program: Mixed Methods Study JO - J Med Internet Res SP - e64933 VL - 27 KW - digital health KW - primary care KW - electronic health records KW - referral KW - hypertension KW - remote monitoring KW - remote blood pressure KW - digital technology KW - mobile phone KW - mixed method KW - quantitative analysis KW - linear regression KW - clinical information N2 - Background: Primary care physicians? (PCP) referral rates to digital health programs are highly variable. This study explores whether knowledge of the digital remote blood pressure monitoring (RBPM) program and information on referral patterns influence PCPs? intention to refer patients. Objective: This study aims to examine the relationship between PCPs? knowledge of the digital RBPM program and information on their own prior referral rates versus their own with their peers? referral rates and their likelihood to refer patients to the digital RBPM program. Methods: This is a mixed methods study integrating quantitative analysis of electronic health record data regarding the frequency of PCPs? referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs? knowledge of the program and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient. They were randomized to either receive their own referral rate or their own plus their peers? referral rate. They were assessed on their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined participant characteristics and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31% (n=70) responded to the survey. From electronic health record data, the mean referral rate of patients per PCP was 11.80% (SD 13.30%). The mean self-reported knowledge of the digital health program was 6.47 (SD 1.81). The mean likelihood of referring an eligible patient (on a scale of 0 to 10, with 0 being not at all, and 10 being definitely) based on a vignette was 8.54 (SD 2.12). The own referral data group?s mean likelihood to refer was 8.91 (SD 1.28), whereas the own plus peer prior referral data group was 8.35 (SD 2.19). Regression analyses suggested the intention to refer the vignette patient was significantly associated with their knowledge (coefficient 0.46, 95% CI 0.20-0.73; P<.001), whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95% CI 0.46-0.78; P<.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95% CI ?0.43 to 0.89; P=.48). Conclusions: Physicians? intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, which was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program. UR - https://www.jmir.org/2025/1/e64933 UR - http://dx.doi.org/10.2196/64933 UR - http://www.ncbi.nlm.nih.gov/pubmed/40126550 ID - info:doi/10.2196/64933 ER - TY - JOUR AU - Murray, Aoife AU - Conroy, Irial AU - Kirrane, Frank AU - Cullen, Leonie AU - Worlikar, Hemendra AU - O'Keeffe, T. Derek PY - 2025/3/21 TI - User Experience of a Bespoke Videoconferencing System for Web-Based Family Visitation for Patients in an Intensive Care Unit: 1-Year Cross-Sectional Survey of Nursing Staff JO - JMIR Hum Factors SP - e54560 VL - 12 KW - telemedicine KW - health KW - telehealth KW - videoconferencing KW - web-based KW - usability KW - intensive care KW - critical care KW - communication KW - COVID-19 KW - SARS-COV-2 KW - intensive care unit KW - ICU KW - cross-sectional survey KW - nursing KW - transmission KW - transmission risk KW - usability questionnaire KW - questionnaire KW - reliability KW - satisfaction KW - usefulness KW - family N2 - Background: During the COVID-19 pandemic, in-person visitation within hospitals was restricted and sometimes eliminated to reduce the risk of transmission of SARS-CoV-2. Many health care professionals created novel strategies that were deployed to maintain a patient-centered approach. Although pandemic-related restrictions have eased, these systems, including videoconferencing or web-based bedside visits, remain relevant for visitors who cannot be present due to other reasons (lack of access to transport, socioeconomic restraints, geographical distance, etc). Objective: The aims of this study were (1) to report the experience of intensive care nursing staff using a bespoke videoconferencing system called ICU FamilyLink; (2) to examine the scenarios in which the nursing staff used the system; and (3) to assess the future use of videoconferencing systems to enhance communication with families. Methods: A modified Telehealth Usability questionnaire was administered to the nursing staff (N=22) of an intensive care unit in a model 4 tertiary hospital in Ireland 1 year after implementing the bespoke videoconferencing system. Results: In total, 22 nurses working in the intensive care department at University Hospital Galway, Ireland, responded to the survey. A total of 23% (n=5) of participants were between the ages of 25 and 34 years, 54% (n=12) were between 35 and 44 years, and 23% (n=5) were between 45 and 54 years. Most (n=15, 68%) of the participants reported never using videoconferencing in the intensive care setting to communicate with family members before March 2020. The modified Telehealth Usability Questionnaire showed overall satisfaction scores for each subcategory of ease of use and learnability, interface quality, interaction quality, reliability, satisfaction and future use, and usefulness. In total, 21 (95%) participants agreed or strongly agreed with the statement, ?I would use the ICU FamilyLink system in future circumstances in which family members cannot be physically present (ie, pandemics, abroad, inability to travel, etc),? and 1 participant responded neutrally. One participant highlighted a common scenario in intensive care settings in which a videoconferencing system can be used ?Even without COVID, web-based communication is important when patients become unexpectedly ill and when families are abroad.? Conclusions: This study provides valuable insights into health care professionals? experience using a videoconferencing system to facilitate web-based visits for families. We conclude that videoconferencing systems when appropriately tailored to the environment with the users in mind can be an acceptable solution to maintain communication with family members who cannot be physically present at the bedside. The bespoke videoconferencing system had an overall positive response from 22 nursing staff who interacted with the system at varying frequency levels. UR - https://humanfactors.jmir.org/2025/1/e54560 UR - http://dx.doi.org/10.2196/54560 ID - info:doi/10.2196/54560 ER - TY - JOUR AU - Ivanova, Julia AU - Cummins, R. Mollie AU - Soni, Hiral AU - Ong, Triton AU - Bunnell, E. Brian AU - López, Esteban AU - Welch, M. Brandon PY - 2025/3/20 TI - Mental Health Providers? Challenges and Solutions in Prescribing Over Telemedicine: Content Analysis of Semistructured Interviews JO - JMIR Hum Factors SP - e65419 VL - 12 KW - telemedicine KW - telehealth KW - prescribe KW - prescription KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutical KW - medication KW - barrier KW - buprenorphine KW - mental health KW - digital health KW - informatics KW - qualitative analysis KW - content analysis KW - provider perspective KW - provider KW - experience KW - attitude KW - opinion KW - perception KW - perspective N2 - Background: In response to the COVID-19 pandemic, the United States extended regulatory flexibilities to make telemedicine more accessible to providers and patients. Some of these flexibilities allowed providers to intake patients over telemedicine and prescribe certain scheduled medications without an in-person visit. Objective: We aim to understand providers? parameters for their comfort in prescribing over telemedicine and report on solutions providers have adopted in response to potential barriers and challenges in prescribing via telemedicine. Methods: As part of a larger mixed methods study between February and April 2024, we conducted 16 semistructured interviews with mental health providers who prescribe via telemedicine within the United States. We used the results of a web-based, cross-sectional survey to develop a codebook and support recruitment. We analyzed a subsection of the 16 interviews using content analysis to capture comfort, barriers, and workarounds in telemedicine prescribing. We reported codes by frequency and by provider. Results: Participants were typically male (11/16, 69%), provided care mostly or completely over telemedicine (11/16, 69%), and were psychiatrists (8/16, 50%) or other physician (3/16, 19%). Providers? primary states (10/16, 62%) of practice included Oregon, Texas, New York, and California. The content analysis yielded a total of 234 codes, with three main codes?comfort (98/234, 41.9%), barriers or challenges (85/234, 36.3%), and workarounds or solutions (27/234, 11.5%)?and two subcodes?uncomfortable prescribing (30/98, 31%) and comfortable prescribing (68/98, 69%) over telemedicine. Participants reported being comfortable prescribing over telemedicine as long as they could meet their main parameters of working within their expertise, having access to needed patient health information, and being compliant with rules and regulations. Participants reported frustrations with e-prescription workflows and miscommunications with pharmacies. Solutions to ease frustrations and alleviate discomforts in prescribing over telemedicine included developing workflows to help patients complete laboratory tests and physical examinations and directly communicating with pharmacies. Conclusions: By applying content analysis to the semistructured provider interviews, we found that physicians are comfortable prescribing via telemedicine when they feel they are practicing within their personal parameters for safety. While many providers experience frustrations such as miscommunication with pharmacies, these barriers appear to not prevent them from telemedicine prescribing. With expected changes in 2024 and 2025 to the US laws and regulations for telemedicine prescribing, we may see changes in provider comfort in prescribing. UR - https://humanfactors.jmir.org/2025/1/e65419 UR - http://dx.doi.org/10.2196/65419 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65419 ER - TY - JOUR AU - Zheng, Yuwen AU - Tian, Meirong AU - Chen, Jingjing AU - Zhang, Lei AU - Gao, Jia AU - Li, Xiang AU - Wen, Jin AU - Qu, Xing PY - 2025/3/20 TI - Public Attitudes Toward Violence Against Doctors: Sentiment Analysis of Chinese Users JO - JMIR Med Inform SP - e63772 VL - 13 KW - doctor-patient conflict KW - sentiment analysis KW - latent Dirichlet allocation KW - LDA KW - social media analysis KW - public health crisis N2 - Background: Violence against doctors attracts the public?s attention both online and in the real world. Understanding how public sentiment evolves during such crises is essential for developing strategies to manage emotions and rebuild trust. Objective: This study aims to quantify the difference in public sentiment based on the public opinion life cycle theory and describe how public sentiment evolved during a high-profile crisis involving violence against doctors in China. Methods: This study used the term frequency-inverse document frequency (TF-IDF) algorithm to extract key terms and create keyword clouds from textual comments. The latent Dirichlet allocation (LDA) topic model was used to analyze the thematic trends and shifts within public sentiment. The integrated Chinese Sentiment Lexicon was used to analyze sentiment trajectories in the collected data. Results: A total of 12,775 valid comments were collected on Sina Weibo about public opinion related to a doctor-patient conflict. Thematic and sentiment analyses showed that the public?s sentiments were highly negative during the outbreak period (disgust: 10,201/30,433, 33.52%; anger: 6792/30,433, 22.32%) then smoothly changed to positive and negative during the spread period (sorrow: 2952/8569, 34.45%; joy: 2782/8569, 32.47%) and tended to be rational and peaceful during the decline period (joy: 4757/14,543, 32.71%; sorrow: 4070/14,543, 27.99%). However, no matter how emotions changed, each period's leading tone contained many negative sentiments. Conclusions: This study simultaneously examined the dynamics of theme change and sentiment evolution in crises involving violence against doctors. It discovered that public sentiment evolved alongside thematic changes, with the dominant negative tone from the initial stage persisting throughout. This finding, distinguished from prior research, underscores the lasting influence of early public sentiment. The results offer valuable insights for medical institutions and authorities, suggesting the need for tailored risk communication strategies responsive to the evolving themes and sentiments at different stages of a crisis. UR - https://medinform.jmir.org/2025/1/e63772 UR - http://dx.doi.org/10.2196/63772 UR - http://www.ncbi.nlm.nih.gov/pubmed/40111382 ID - info:doi/10.2196/63772 ER - TY - JOUR AU - Kong, Menglei AU - Wang, Yu AU - Li, Meixuan AU - Yao, Zhong PY - 2025/3/19 TI - Mechanism Assessment of Physician Discourse Strategies and Patient Consultation Behaviors on Online Health Platforms: Mixed Methods Study JO - J Med Internet Res SP - e54516 VL - 27 KW - online health consultation KW - physician discourse strategies KW - online physician-patient trust KW - shared decision-making KW - patient consultation behavior N2 - Background: Online health platforms are currently experiencing significant growth. Patients can conveniently seek medical consulting services on such platforms. Against the backdrop of the thriving development of digital health care, the patterns of physician-patient communication are undergoing profound changes. It is imperative to focus on physician discourse strategies during online physician-patient interactions, which will improve the efficiency of physician-patient communication and achieve better management of the physician-patient relationship. Objective: This study aims to explore the influencing mechanism between physician discourse strategies and patient consultation behavior on online health platforms. Additionally, we explore the crucial mediating role of online physician-patient trust and the moderating role of shared decision-making in the online physician-patient communication process. Methods: We used a mixed research approach to explore the influencing mechanism. Data on physician basic attributes and physician-patient communication text records were collected from the Chunyu Doctor website using a web spider. The study obtained a total of 8628 interaction texts from January 2022 to July 2023. Physician discourse strategies (capacity-oriented strategy, quality-oriented strategy, and goodwill-oriented strategy), online physician-patient trust, and shared decision-making were captured through text mining and a random forest model. First, we employed text mining to extract the speech acts, modal resources, and special linguistic resources of each record. Then, using a well-trained random forest model, we captured the specific discourse strategy of each interaction text based on the learned features and patterns. The study generated 863 groups of physician samples with 17 data fields. The hypotheses were tested using an ?ordinary least squares? model, and a stability test was conducted by replacing the dependent variable. Results: The capacity-oriented strategy, goodwill-oriented strategy, and quality-oriented strategy had significant effects on patient consultation behavior (?=.151, P=.007; ?=.154, P<.001; and ?=.17, P<.001, respectively). It should be noted that the anticipated strong effect of the capacity-oriented strategy on patient consultation behavior was not observed. Instead, the effects of the quality-oriented strategy and goodwill-oriented strategy were more prominent. Physician notification adequacy from shared decision-making moderated the effect between the goodwill-oriented strategy and patient consultation behavior (?=.172; P<.001). Additionally, patient expression adequacy from shared decision-making moderated the effect between the capacity-oriented strategy and patient consultation behavior (?=.124; P<.001), and between the goodwill-oriented strategy and patient consultation behavior (?=.104; P=.003). Online physician-patient trust played a significant mediating role between physician discourse strategies and patient consultation behavior. Conclusions: The study findings suggest significant implications for stimulating patient consultation behavior on online health platforms by providing guidance on effective discourse strategies for physicians, thus constructing a trustworthy physician image, improving the physician-patient relationship, and increasing platform traffic. UR - https://www.jmir.org/2025/1/e54516 UR - http://dx.doi.org/10.2196/54516 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54516 ER - TY - JOUR AU - Kerr, Gabriele AU - Greenfield, Geva AU - Li, Edmond AU - Beaney, Thomas AU - Hayhoe, J. Benedict W. AU - Car, Josip AU - Clavería, Ana AU - Collins, Claire AU - Gusso, Gustavo AU - Hoffman, D. Robert AU - Jimenez, Geronimo AU - Koskela, H. Tuomas AU - Laranjo, Liliana AU - Lingner, Heidrun AU - Memarian, Ensieh AU - Nessler, Katarzyna AU - Petek, Davorina AU - Tsopra, Rosy AU - Majeed, Azeem AU - Neves, Luisa Ana PY - 2025/3/19 TI - Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study JO - J Med Internet Res SP - e65147 VL - 27 KW - digital health KW - primary care KW - telemedicine KW - virtual consultation KW - healthcare delivery KW - online consultation KW - primary care physician KW - upper-middle income KW - upper-middle income countries KW - high-income countries KW - online survey KW - chi-squared test KW - remote healthcare KW - video consultation KW - chat consultation KW - telephone consultations KW - digital technology KW - virtual care KW - teleconsultation KW - telehealth KW - remote consultation N2 - Background: Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis. Objective: This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability. Methods: Primary care physicians (PCPs) from 20 upper-middle? and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V. Results: A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001). Conclusions: Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations. International Registered Report Identifier (IRRID): RR2-10.2196/30099 UR - https://www.jmir.org/2025/1/e65147 UR - http://dx.doi.org/10.2196/65147 UR - http://www.ncbi.nlm.nih.gov/pubmed/40105882 ID - info:doi/10.2196/65147 ER - TY - JOUR AU - Li, Jiaxuan AU - Yang, Yunchu AU - Mao, Chao AU - Pang, Cheong-Iao Patrick AU - Zhu, Quanjing AU - Xu, Dejian AU - Wang, Yapeng PY - 2025/3/17 TI - Revealing Patient Dissatisfaction With Health Care Resource Allocation in Multiple Dimensions Using Large Language Models and the International Classification of Diseases 11th Revision: Aspect-Based Sentiment Analysis JO - J Med Internet Res SP - e66344 VL - 27 KW - ICD-11 KW - International Classification of Diseases 11th Revision KW - disease classification KW - patient reviews KW - patient satisfaction KW - ChatGPT KW - Sustainable Development Goals KW - chain of thought KW - large language model N2 - Background: Accurately measuring the health care needs of patients with different diseases remains a public health challenge for health care management worldwide. There is a need for new computational methods to be able to assess the health care resources required by patients with different diseases to avoid wasting resources. Objective: This study aimed to assessing dissatisfaction with allocation of health care resources from the perspective of patients with different diseases that can help optimize resource allocation and better achieve several of the Sustainable Development Goals (SDGs), such as SDG 3 (?Good Health and Well-being?). Our goal was to show the effectiveness and practicality of large language models (LLMs) in assessing the distribution of health care resources. Methods: We used aspect-based sentiment analysis (ABSA), which can divide textual data into several aspects for sentiment analysis. In this study, we used Chat Generative Pretrained Transformer (ChatGPT) to perform ABSA of patient reviews based on 3 aspects (patient experience, physician skills and efficiency, and infrastructure and administration)00 in which we embedded chain-of-thought (CoT) prompting and compared the performance of Chinese and English LLMs on a Chinese dataset. Additionally, we used the International Classification of Diseases 11th Revision (ICD-11) application programming interface (API) to classify the sentiment analysis results into different disease categories. Results: We evaluated the performance of the models by comparing predicted sentiments (either positive or negative) with the labels judged by human evaluators in terms of the aforementioned 3 aspects. The results showed that ChatGPT 3.5 is superior in a combination of stability, expense, and runtime considerations compared to ChatGPT-4o and Qwen-7b. The weighted total precision of our method based on the ABSA of patient reviews was 0.907, while the average accuracy of all 3 sampling methods was 0.893. Both values suggested that the model was able to achieve our objective. Using our approach, we identified that dissatisfaction is highest for sex-related diseases and lowest for circulatory diseases and that the need for better infrastructure and administration is much higher for blood-related diseases than for other diseases in China. Conclusions: The results prove that our method with LLMs can use patient reviews and the ICD-11 classification to assess the health care needs of patients with different diseases, which can assist with resource allocation rationally. UR - https://www.jmir.org/2025/1/e66344 UR - http://dx.doi.org/10.2196/66344 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66344 ER - TY - JOUR AU - Olsavszky, Victor AU - Bazari, Mutaz AU - Dai, Ben Taieb AU - Olsavszky, Ana AU - Finkelmeier, Fabian AU - Friedrich-Rust, Mireen AU - Zeuzem, Stefan AU - Herrmann, Eva AU - Leipe, Jan AU - Michael, Alexander Florian AU - Westernhagen, von Hans AU - Ballo, Olivier PY - 2025/3/14 TI - Digital Translation Platform (Translatly) to Overcome Communication Barriers in Clinical Care: Pilot Study JO - JMIR Form Res SP - e63095 VL - 9 KW - language barriers KW - health care communication KW - medical app KW - real-time translation KW - medical translation N2 - Background: Language barriers in health care can lead to misdiagnosis, inappropriate treatment, and increased medical errors. Efforts to mitigate these include using interpreters and translation tools, but these measures often fall short, particularly when cultural nuances are overlooked. Consequently, medical professionals may have to rely on their staff or patients? relatives for interpretation, compromising the quality of care. Objective: This formative pilot study aims to assess the feasibility of Translatly, a digital translation platform, in clinical practice. Specifically, the study focuses on evaluating (1) how health care professionals overcome language barriers and their acceptance of an on-demand video telephony platform, (2) the feasibility of the platform during medical consultations, and (3) identifying potential challenges for future development. Methods: The study included ethnographic interviews with health care professionals and an observational pilot to assess the use of the Translatly platform in clinical practice. Translatly was developed to make real-time translation easy and accessible on both Android and iOS devices. The system?s backend architecture uses Java-based services hosted on DigitalOcean. The app securely exchanges data between mobile devices and servers, with user information and call records stored in a MySQL database. An admin panel helps manage the system, and Firebase integration enables fast push notifications to ensure that health care professionals can connect with translators whenever they need to. The platform was piloted in a German university hospital with 170 volunteer nonprofessional translators, mainly medical students, supporting translation in over 20 languages, including Farsi, Dari, and Arabic. Results: Ethnographic research conducted by interviewing health care professionals in Frankfurt am Main and other German cities revealed that current practices for overcoming language barriers often rely on family members or digital tools such as Google Translate, raising concerns about accuracy and emotional distress. Respondents preferred an on-demand translation service staffed by medically experienced translators, such as medical students, who understand medical terminology and can empathize with patients. The observational pilot study recorded 39 requests for translation services, 16 (41%) of which were successfully completed. The translations covered 6 different languages and were carried out by a team of 10 translators. Most requests came from departments such as infectious diseases (5/16, 31%) and emergency (4/16, 25%). Challenges were identified around translator availability, with 23 (59%) total requests (N=39) going unanswered, which was further evidenced by user feedback. Conclusions: This pilot study demonstrates the feasibility of the Translatly platform in real-world health care settings. It shows the potential to improve communication and patient outcomes by addressing language barriers. Despite its potential, challenges such as translator availability highlight the need for further development. UR - https://formative.jmir.org/2025/1/e63095 UR - http://dx.doi.org/10.2196/63095 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63095 ER - TY - JOUR AU - Sood, Avi Varinn AU - Rishel Brakey, Heidi AU - Myers, Orrin AU - Shore, Xin AU - Sood, Akshay PY - 2025/3/13 TI - Interprofessional Discussion for Knowledge Transfer in a Digital ?Community of Practice? for Managing Pneumoconiosis: Mixed Methods Study JO - JMIR Form Res SP - e67999 VL - 9 KW - digital community of practice KW - knowledge transfer KW - pneumoconiosis KW - telementoring KW - rural health care KW - rural professionals KW - multidisciplinary management KW - interprofessional discussion KW - miner health KW - health equity KW - mixed methods KW - digital health KW - public health KW - digital community KW - self-efficacy KW - quantitative analyses KW - quantitative KW - technology KW - multidisciplinary care KW - patient outcome N2 - Background: Pneumoconiosis prevalence is increasing in the United States, especially among coal miners. Contemporaneously with an increased need for specialized multidisciplinary care for miners, there is a shortage of experts to fulfill this need. Miners? Wellness ECHO (Extension for Community Health Outcomes) is a digital community of practice based on interprofessional discussion for knowledge transfer. The program has been demonstrated to increase participants? self-efficacy for clinical, medicolegal, and ?soft? skills related to miners? health. Objective: We aimed to examine characteristics associated with interprofessional discussions and suggest ways to strengthen knowledge transfer. Methods: This mixed methods study used an exploratory sequential design. We video-recorded and transcribed ECHO sessions over 14 months from July 2018 to September 2019 and analyzed content to examine participant discussions. We focused on participants? statements of expertise followed by other participants? acceptance or eschewal of these statements (utterances). We conducted quantitative analyses to examine the associations of active participation in discussion (primary outcome variable, defined as any utterance). We analyzed the association of the outcome on the following predictors: (1) participant group status, (2) study time frame, (3) participant ECHO experience status, (4) concordance of participant group identity between presenter and participant, (5) video usage, and (6) attendance frequency. We used the generalized estimating equations approach for longitudinal data, logit link function for binary outcomes, and LSMEANS to examine least squares means of fixed effects. Results: We studied 23 sessions with 158 unique participants and 539 total participants, averaging 23.4 (SD 5.6) participants per session. Clinical providers, the largest participant group, constituting 36.7% (n=58) of unique participants, were the most vocal group (mean 21.74, SD 2.11 average utterances per person-session). Benefits counselors were the least vocal group, with an average utterance rate of 0.57 (SD 0.29) per person-session and constituting 8.2% (n=13) of unique participants. Thus, various participant groups exhibited different utterance rates across sessions (P=.003). Experienced participants may have dominated active participation in discussion compared to those with less or intermediate experience, but this difference was not statistically significant (P=.11). When the didactic presenter and participant were from the same participant group, active participation by the silent group participants was greater than when both were from different groups. This association was not seen in vocal group participants (interaction P=.003). Compared to those participating by audio, those participating on video tended to have higher rates of active participation, but this difference was not statistically significant (P=.11). Conclusions: Our findings provide insight into the mechanics of interprofessional discussion in a digital community of practice managing pneumoconiosis. Our results underscore the capacity of the novel ECHO model to leverage technology and workforce diversity to facilitate interprofessional discussions on the multidisciplinary care of miners. Future research will evaluate whether this translates into improved patient outcomes. UR - https://formative.jmir.org/2025/1/e67999 UR - http://dx.doi.org/10.2196/67999 ID - info:doi/10.2196/67999 ER - TY - JOUR AU - Lee, Jongchan AU - Ahn, Soyeon AU - Ohn, Hun Jung AU - Kim, Sun Eun AU - Lim, Yejee AU - Kim, Won Hye AU - Park, Hee-Sun AU - Cho, Ho Jae AU - Kim, Sun-wook AU - Ryu, Jiwon AU - Kim, Jihye AU - Jang, Chul Hak AU - Kim, Nak-Hyun PY - 2025/3/12 TI - Effect of SMS Ward Round Notifications on Inpatient Experience in Acute Medical Settings: Retrospective Cohort Study JO - JMIR Hum Factors SP - e57470 VL - 12 KW - rounds KW - round-time notification KW - text messaging KW - patient experience assessment KW - patient experiences KW - patient-centeredness KW - patient participation N2 - Background: Ward rounds are an essential component of inpatient care. Patient participation in rounds is increasingly encouraged, despite the occasional complicated circumstances, especially in acute care settings. Objective: This study aimed to evaluate the effect of real-time ward round notifications using SMS text messaging on the satisfaction of inpatients in an acute medical ward. Methods: Since January 2021, a service implementing real-time ward round notifications via text messaging (WR-SMS) has been operational at a tertiary-care medical center in Korea. To assess its impact, we conducted a retrospective cohort study of patients admitted to the acute medical unit who participated in a patient experience survey. Patient satisfaction was compared between patients admitted in 2020 (pre?WR-SMS group) and 2021 (post?WR-SMS group). Results: From January 2020 to December 2021, a total of 100 patients were enrolled (53 patients in the pre?WR-SMS group and 47 patients in the post?WR-SMS group). Compared with the pre?WR-SMS group, the post?WR-SMS group showed significantly greater satisfaction about being informed about round schedules (mean 3.43, SD 0.910 vs mean 3.89, SD 0.375; P<.001) and felt more emotionally supported during admission (mean 3.49, SD 0.800 vs mean 3.87, SD 0.397; P<.001). Regarding other questionnaire scores, the post?WR-SMS group showed an overall, although statistically insignificant, improvement compared with the pre?WR-SMS group. Conclusions: Real-time round notifications using a user-friendly SMS may improve inpatient satisfaction effectively. UR - https://humanfactors.jmir.org/2025/1/e57470 UR - http://dx.doi.org/10.2196/57470 ID - info:doi/10.2196/57470 ER - TY - JOUR AU - Ali-Saleh, Ola AU - Massalha, Layalleh AU - Halperin, Ofra PY - 2025/3/12 TI - Evaluation of a Simulation Program for Providing Telenursing Training to Nursing Students: Cohort Study JO - JMIR Med Educ SP - e67804 VL - 11 KW - simulation-based training program KW - telenursing KW - simulation KW - program KW - training KW - nursing student KW - nursing care KW - Israel KW - nurse-patient relationship KW - telehealth nursing KW - remote nursing care KW - undergraduate KW - cohort study KW - knowlege; self efficacy; skills; attitudes N2 - Background: Telenursing has become prevalent in providing care to diverse populations experiencing different health conditions both in Israel and globally. The nurse-patient relationship aims to improve the condition of individuals requiring health services. Objectives: This study aims to evaluate nursing graduates? skills and knowledge regarding remote nursing care prior to and following a simulation-based telenursing training program in an undergraduate nursing degree. Methods: A cohort study assessed 114 third-year nursing students using comprehensive evaluation measures of knowledge, skills, attitudes, self-efficacy, and clinical skills regarding remote nursing care. Assessments were conducted at 2 critical time points: prior to and following a structured simulation-based training intervention. Results: Participant demographics revealed a predominantly female sample (101/114, 88.6%), aged 20?50 years (mean 25.68, SD 4.59 years), with moderate to advanced computer and internet proficiency. Notably, 91.2% (104/114) had no telenursing exposure, yet 75.4% (86/114) expressed training interest. Statistical analyses demonstrated significant improvements across all measured variables, characterized by moderate to high effect sizes. Key findings included substantial increases in telenursing awareness, knowledge, skills, attitudes and self-efficacy; significant reduction in perceived barriers to remote care delivery; and complex interrelation dynamics between variables. A multivariate analysis revealed nuanced correlations: higher awareness and knowledge were consistently associated with more positive attitudes and increased self-efficacy. Positive attitudes correlated with enhanced self-efficacy and reduced perceived barriers. Change score analyses further indicated that increased awareness and knowledge facilitated more positive attitudinal shifts, while heightened awareness and positive attitudes corresponded with decreased implementation barriers. Conclusions: The study underscores the critical importance of integrating targeted telenursing training into nursing education. By providing comprehensive preparation, educational programs can equip students to deliver optimal remote care services. The COVID-19 pandemic has definitively demonstrated that remote nursing will be central to future health care delivery, emphasizing the urgent need to prepare nursing students for this emerging health care paradigm. UR - https://mededu.jmir.org/2025/1/e67804 UR - http://dx.doi.org/10.2196/67804 ID - info:doi/10.2196/67804 ER - TY - JOUR AU - Alturkistani, Abrar AU - Beaney, Thomas AU - Greenfield, Geva AU - Costelloe, E. Ceire PY - 2025/3/11 TI - Prescription Refill Adherence Before and After Patient Portal Registration in Among General Practice Patients in England Using the Clinical Practice Research Datalink: Longitudinal Observational Study JO - JMIR Med Inform SP - e50294 VL - 13 KW - patient portals KW - personal health records KW - general practice KW - delivery of health care KW - medication ordering KW - health care KW - medication adherence KW - clinical practice research KW - patient portal KW - England KW - longitudinal analysis KW - patient health KW - medication KW - cardiovascular disease KW - diabetes KW - chronic kidney disease N2 - Background: Patient portal use has been associated with improved patient health and improved adherence to medications, including statins. However, there is limited research on the association between patient portal registration and outcomes such as statin prescription refill adherence in the context of the National Health Service of England, where patient portals have been widely available since 2015. Objective: We aimed to explore statin prescription refill adherence among general practice patients in England. Methods: This study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee (ID: 21_000411). We used patient-level general practice data from the Clinical Practice Research Datalink in England. The data included patients with cardiovascular disease, diabetes, and chronic kidney disease, who were registered on the patient portal. The primary aim was to investigate whether statin prescription refill adherence, defined as ?80% adherence based on the medication possession ratio, improved after patient portal registration. We used a multilevel logistic regression model to compare aggregate adherence 12 months before and 12 months after patient portal registration. Results: We included 44,141 patients in the study. The analysis revealed a 16% reduction in the odds of prescription refill adherence 12 months after patient portal registration (odds ratio [OR]: 0.84, 95% CI 0.81-0.86) compared to 12 months before registration in the fully adjusted model for patient- and practice-level variables. Conclusions: This study evaluated prescription refill adherence after patient portal registration. Registering to the portal does not fully explain the mechanisms underlying the relationship between patient portal use and health-related outcomes such as medication adherence. Although a small reduction in prescription refill adherence was observed, this reduction disappeared when the follow up time was reduced to 6 months. Given the limitations of the study, reduction in prescription refill adherence cannot be entirely attributable to patient portal registration. However, there may be potential confounding factors influencing this association which should be explored through future research. UR - https://medinform.jmir.org/2025/1/e50294 UR - http://dx.doi.org/10.2196/50294 ID - info:doi/10.2196/50294 ER - TY - JOUR AU - Cummins, R. Mollie AU - Ivanova, Julia AU - Soni, Hiral AU - Robbins, Zoe AU - Bunnell, E. Brian AU - López, Esteban AU - Welch, M. Brandon PY - 2025/3/11 TI - Telemedicine Prescribing by US Mental Health Care Providers: National Cross-Sectional Survey JO - JMIR Form Res SP - e63251 VL - 9 KW - telemedicine KW - telehealth KW - telemental KW - provider KW - professional KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - prescribing KW - prescription KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutic KW - pharmaceutical KW - medication KW - mental health KW - digital health KW - informatics KW - buprenorphine KW - ketamine KW - cross sectional KW - survey KW - questionnaire N2 - Background: In the postpandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. Objective: Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. Methods: We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test. Results: A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of health care providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8% (17/115) to 19.1% (30/115) of health care providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. Conclusions: These health care providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy making in the United States. UR - https://formative.jmir.org/2025/1/e63251 UR - http://dx.doi.org/10.2196/63251 ID - info:doi/10.2196/63251 ER - TY - JOUR AU - Rowland, Bradley AU - Saha, Amit AU - Motamedi, Vida AU - Bundy, Richa AU - Winsor, Scott AU - McNavish, Daniel AU - Lippert, William AU - Khanna, K. Ashish PY - 2025/3/11 TI - Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis JO - J Med Internet Res SP - e66347 VL - 27 KW - clinical KW - continuous KW - monitoring KW - outcomes KW - medical ward KW - wireless KW - wireless monitoring KW - vital sign KW - ward KW - patient outcome KW - hospital ward KW - clinical outcome KW - contemporaneous control KW - contemporaneous KW - teenager KW - young adult KW - adult KW - monitoring device KW - wireless device KW - wearable KW - patient monitoring N2 - Background: Continuous and wireless vital sign (VS) monitoring on hospital wards is superior to intermittent VS monitoring at detecting VS abnormalities; however, the impact on clinical outcomes remains to be confirmed. A recent propensity-matched study of primary surgical patients found decreased odds of intensive care unit (ICU) admission and mortality in patients receiving continuous monitoring. Primary surgical patients are inherently different from their medical counterparts who typically have high morbidity, including frailty. Continuous monitoring research has been limited in primary medical patients. Objective: This study aims to evaluate the clinical outcomes of primary medical patients who received either continuous or, as a contemporaneous control, intermittent vital monitoring as the standard of care using propensity matching. Methods: Propensity-matched analysis of a population-based sample of 7971 patients admitted to the medical wards between January 2018 and December 2019 at a single, tertiary United States medical center. The continuous monitoring device measures oxygen saturation, heart rate, respiratory rate, continuous noninvasive blood pressure, and either 3-lead or 5-lead electrocardiogram. Patients received either 12 hours or more of continuous and wireless VS monitoring (n=1450) or intermittent VS monitoring (n=6521). The primary outcome was the odds of a composite of in-hospital mortality or ICU transfer during hospitalization. Secondary outcomes were the odds of individual components of the primary outcome, as well as heart failure (HF), myocardial infarction (MI), acute kidney injury (AKI), and rapid response team (RRT) activations. Results: Those who received intermittent VS monitoring had greater odds of a composite of in-hospital mortality or ICU admission (odds ratio [OR] 2.79, 95% CI 1.89-4.25; P<.001) compared with those who had continuous and wireless VS monitoring. The odds of HF (OR 1.03, 95% CI 0.83-1.28; P=.77), MI (OR 1.58, 95% CI 0.77-3.47; P=.23), AKI (OR 0.74, 95% CI 0.62-1.02; P=.06), and RRT activation (OR 0.94, 95% CI 0.75-1.19; P=.62) were similar in both groups. Conclusions: In this propensity-matched study, medical ward patients who received standard of care intermittent VS monitoring were at nearly 3 times greater odds of transfer to the ICU or death compared with those who received continuous VS monitoring. Our study was primarily limited by the inability to match patients on admission diagnosis due to limitations in electronic health record data. Other limitations included the number of and reasons for false alarms, which can be challenging with continuous monitoring strategies. Given the limitations of this work, these observations need to be confirmed with prospective interventional trials. UR - https://www.jmir.org/2025/1/e66347 UR - http://dx.doi.org/10.2196/66347 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66347 ER - TY - JOUR AU - Khairat, Saif AU - Ottmar, Paige AU - Chourasia, Prabal AU - Obeid, Jihad PY - 2025/3/5 TI - Effectiveness of Telehealth Versus In-Person Informed Consent: Randomized Study of Comprehension and Decision-Making JO - J Med Internet Res SP - e63473 VL - 27 KW - telehealth KW - informed KW - consent KW - comprehension KW - decision-making KW - cross-sectional study KW - cross-section KW - telemedicine KW - eHealth KW - health care services KW - mHealth KW - effectiveness KW - informed consent KW - statistical analysis KW - feasibility N2 - Background: Obtaining informed consent (IC) is vital for ethically and effectively recruiting participants in research projects. However, traditional in-person IC approaches encounter notable obstacles, such as geographic barriers, transportation expenses, and literacy challenges, which can lead to delays in enrollment and increased costs. Telehealth, especially teleconsent, offers a potential way to overcome these obstacles by facilitating the IC process in a digital setting. Nonetheless, there are concerns about whether teleconsent can achieve levels of understanding and involvement that are equivalent to those of in-person IC meetings. Objective: This study aims to evaluate comprehension and decision-making in participants undergoing teleconsent versus traditional in-person IC. We used validated assessments to determine whether teleconsent is a viable alternative that maintains participants? understanding and decision-making abilities. Methods: A randomized comparative study design was used, recruiting potential participants for a parent study assessing patient experiences with patient portals. Participants were randomly assigned to 2 groups: teleconsent and in-person consent. The teleconsent group used Doxy.me software, allowing real-time interaction between researchers and participants while reviewing and electronically signing the IC documents. Recruitment involved using an institutional web-based platform to identify interested individuals, who were then contacted to assess eligibility and gather demographic information. The Decision-Making Control Instrument (DMCI) survey was used to assess the perceived voluntariness, trust, and decision self-efficacy. The Quality of Informed Consent (QuIC) was used to measure the comprehension level of the consent form. The validated Short Assessment of Health Literacy-English tool was used to measure participants' health literacy levels. Results: A total of 64 participants were enrolled in the study, with 32 in the teleconsent group and 32 in the in-person group. Of 64 participants, 32 (50%) were in the teleconsent group, 54 (84.4%) were females, 44 (68.7%) were aged 18-34 years, 50 (78.1%) were White, and 31 (48.4%) had a bachelor degree. The mean SAHL-E scores were different between the teleconsent and in-person groups (16.72, SD 1.88 vs 17.38, SD 0.95; P=.03). No significant differences were found between the average scores at baseline and follow-up for QuIC part A (P=.29), QuIC part B (P=.25), and DMCI (P=.38) within the teleconsent and in-person groups. Additionally, there were no significant differences in QuIC or DMCI between subgroups based on age, sex, and ethnicity. Conclusions: This study assessed the effectiveness of IC processes through telehealth compared to traditional in-person visits. Findings indicate that telehealth offers similar participant understanding and engagement while overcoming geographic and accessibility barriers. As health care adopts digital solutions, these results highlight telehealth?s potential to improve recruitment and retention in clinical research, suggesting that policy makers should integrate telehealth practices into regulations for better access and health outcomes. UR - https://www.jmir.org/2025/1/e63473 UR - http://dx.doi.org/10.2196/63473 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053795 ID - info:doi/10.2196/63473 ER - TY - JOUR AU - Tan, Jin Rayner Kay AU - Hensel, Devon AU - Ivanova, Olena AU - Bravo, Gomez Raquel AU - Olumide, Adesola AU - Adebayo, Emmanuel AU - Cleeve, Amanda AU - Gesselman, Amanda AU - Shah, Jyoti Sonam AU - Adesoba, Helen AU - Marley, Gifty AU - Tang, Weiming PY - 2025/3/4 TI - Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study JO - J Med Internet Res SP - e60369 VL - 27 KW - COVID-19 KW - telemedicine KW - sexual and reproductive health KW - pandemic KW - web-based survey KW - sexual health KW - reproductive health KW - communication technology KW - medical education KW - contraception KW - abortion KW - health care delivery KW - care KW - chronic condition N2 - Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use. UR - https://www.jmir.org/2025/1/e60369 UR - http://dx.doi.org/10.2196/60369 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053813 ID - info:doi/10.2196/60369 ER - TY - JOUR AU - DesRoches, M. Catherine AU - Wachenheim, Deborah AU - Ameling, Jessica AU - Cibildak, Aysel AU - Cibotti, Nancy AU - Dong, Zhiyong AU - Drane, Alexandra AU - Hurwitz, Isabel AU - Meddings, Jennifer AU - Naimark, Jody AU - O'Donnell, Kimberly AU - Winger, Christine AU - Winnay, Stephens Sarah AU - Young, Jordan AU - Wolff, L. Jennifer PY - 2025/3/4 TI - Identifying, Engaging, and Supporting Care Partners in Clinical Settings: Protocol for a Patient Portal?Based Intervention JO - JMIR Res Protoc SP - e66708 VL - 14 KW - patient portal KW - previsit questionnaire KW - caregivers KW - care partners KW - questionnaires KW - support KW - engagement N2 - Background: In the United States, the landscape of unpaid care delivery is both challenging and complex, with millions of individuals undertaking the vital role of helping families (broadly defined) manage their health care and well-being. This includes 48 million caregivers of adults, 42 million of whom are caregivers of adults aged 50 years or older. These family care partners provide critical and often daily support for tasks such as dressing and bathing, as well as managing medications, medical equipment, appointments, and follow-up care plans. Objective: This study aimed to implement a novel patient portal?based intervention to identify, engage, and support care partners in clinical settings. Methods: The project team collaborated with 3 health care organizations (6 primary care practices in total) to design and implement a patient portal?based intervention. Three days in advance of a visit, patients were invited to log on to their patient portal account and answer a brief questionnaire as part of the routine electronic check-in process asking them to (1) identify themselves as the patient or someone answering for the patient, (2) report major life changes, (3) set the agenda for the upcoming visit, and (4) report on care partner responsibilities. Respondents? answers to this brief questionnaire were available to providers ahead of the visit. Patients with care partner responsibilities, as well as care partners answering the questionnaire on behalf of patients, were provided a link to the ARCHANGELS Caregiver Intensity Index to measure the intensity of their caregiving role and motivate care partners to connect with suggested state and local resources. Results: The intervention was launched in September 2022 at Organization A. Organization B launched in May 2023 in one clinic and June 2023 in the other. In focus groups, staff and clinicians reported that the intervention was easy to implement and did not cause workflow disruption. At 6 months post implementation, across both organizations, a total of 22,152 patients had received questionnaires and 13,825 (62.4%) had submitted completed questionnaires. Full data will be reported at the completion of the intervention period. Conclusions: Early results suggest that the intervention could be an easily scalable and adaptable method of identifying and supporting care partners in clinical settings. International Registered Report Identifier (IRRID): DERR1-10.2196/66708 UR - https://www.researchprotocols.org/2025/1/e66708 UR - http://dx.doi.org/10.2196/66708 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053789 ID - info:doi/10.2196/66708 ER - TY - JOUR AU - Ohlsen, Tessa AU - Hofer, Viola AU - Ingenerf, Josef PY - 2025/2/28 TI - A Validation Tool (VaPCE) for Postcoordinated SNOMED CT Expressions: Development and Usability Study JO - JMIR Med Inform SP - e67984 VL - 13 KW - SNOMED CT KW - PCE KW - postcoordination KW - FHIR KW - validation KW - postcoordinated expression KW - Fast Healthcare Interoperability Resource N2 - Background: The digitalization of health care has increased the demand for efficient data exchange, emphasizing semantic interoperability. SNOMED Clinical Terms (SNOMED CT), a comprehensive terminology with over 360,000 medical concepts, supports this need. However, it cannot cover all medical scenarios, particularly in complex cases. To address this, SNOMED CT allows postcoordination, where users combine precoordinated concepts with new expressions. Despite SNOMED CT?s potential, the creation and validation of postcoordinated expressions (PCEs) remain challenging due to complex syntactic and semantic rules. Objective: This work aims to develop a tool that validates postcoordinated SNOMED CT expressions, focusing on providing users with detailed, automated correction instructions for syntactic and semantic errors. The goal is not just validation, but also offering user-friendly, actionable suggestions for improving PCEs. Methods: A tool was created using the Fast Healthcare Interoperability Resource (FHIR) service $validate-code and the terminology server Ontoserver to check the correctness of PCEs. When errors are detected, the tool processes the SNOMED CT Concept Model in JSON format and applies predefined error categories. For each error type, specific correction suggestions are generated and displayed to users. The key added value of the tool is in generating specific correction suggestions for each identified error, which are displayed to the users. The tool was integrated into a web application, where users can validate individual PCEs or bulk-upload files. The tool was tested with real existing PCEs, which were used as input and validated. In the event of errors, appropriate error messages were generated as output. Results: In the validation of 136 PCEs from 304 FHIR Questionnaires, 18 (13.2%) PCEs were invalid, with the most common errors being invalid attribute values. Additionally, 868 OncoTree codes were evaluated, resulting in 161 (20.9%) PCEs containing inactive concepts, which were successfully replaced with valid alternatives. A user survey reflects a favorable evaluation of the tool?s functionality. Participants found the error categorization and correction suggestions to be precise, offering clear guidance for addressing issues. However, there is potential for enhancement, particularly regarding the level of detail in the error messages. Conclusions: The validation tool significantly improves the accuracy of postcoordinated SNOMED CT expressions by not only identifying errors but also offering detailed correction instructions. This approach supports health care professionals in ensuring that their PCEs are syntactically and semantically valid, enhancing data quality and interoperability across systems. UR - https://medinform.jmir.org/2025/1/e67984 UR - http://dx.doi.org/10.2196/67984 ID - info:doi/10.2196/67984 ER - TY - JOUR AU - Valdes, Daniela AU - Shanker, Ankit AU - Hijazi, Ghofran AU - Mensah, Opoku Daniel AU - Bockarie, Tahir AU - Lazar, Ioana AU - Ibrahim, Aishah Siti AU - Zolfagharinia, Hamid AU - Procter, Rob AU - Spencer, Rachel AU - Dale, Jeremy AU - Paule, Armina AU - Medlin, Jonathon Liam AU - Tharuvara Kallottil, Keerthana PY - 2025/2/28 TI - Global Evidence on the Sustainability of Telemedicine in Outpatient and Primary Care During the First 2 Years of the COVID-19 Pandemic: Scoping Review Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework JO - Interact J Med Res SP - e45367 VL - 14 KW - pandemic KW - primary care KW - outpatients KW - telemedicine KW - ambulatory care KW - global health KW - patient experience KW - NASSS KW - clinician-patient relationship KW - health inequalities KW - gray literature KW - PRISMA N2 - Background: The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about the sustainability of this intervention at the global level. Objective: This research examines the patient experience, health inequalities, and clinician-patient relationship in telemedicine during the COVID-19 pandemic?s first 2 years, aiming to identify sustainability factors. Methods: This study was based on a prepublished protocol using the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included academic and gray literature published between March 2020 and March 2022 according to these criteria: (1) population (any group); (2) concepts (patient experience, clinician-patient relationship, health inequalities); (3) context (telemedicine in primary and outpatient care); (4) excluding studies pertaining to surgery, oncology, and (inpatient) psychiatry. We searched Ovid Medline/PubMed (January 1, 2022), Web of Science (March 19, 2022), Google/Google Scholar (February and March 2022), and others. The risk of bias was not assessed as per guidance. We used an analysis table for the studies and color-coded tabular mapping against a health care technology adoption framework to identify sustainability (using double-blind extraction). Results: Of the 134 studies that met our criteria, 49.3% (66/134) reported no specific population group. Regarding the concepts, 41.8% (56/134) combined 2 of the concepts studied. The context analysis identified that 56.0% (75/134) of the studies referred to, according to the definition in the United Kingdom, an outpatient (ambulatory care) setting, and 34.3% (46/134) referred to primary care. The patient experience analysis reflected positive satisfaction and sustained access during lockdowns. The clinician-patient relationship impacts were nuanced, affecting interaction and encounter quality. When mapping to the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, 81.3% (109/134) of the studies referenced the innovation?s sustainability. Although positive overall, there were some concerns about sustainability based on quality, eHealth literacy, and access to health care for vulnerable migrants and the uninsured. Conclusions: We identified confusion between the concepts of patient experience and patient satisfaction; therefore, future research could focus on established frameworks to qualify the patient experience across the whole pathway and not just the remote encounter. As expected, our research found mainly descriptive analyses, so there is a need for more robust evidence methods identifying impacts of changes in treatment pathways. This study illustrates modern methods to decolonize academic research by using gray literature extracts in other languages. We acknowledge that the use of Google to identify gray literature at the global level and in other languages has implications on reproducibility. We did not consider synchronous text-based communication. Trial Registration: Open Science Framework 4z5ut; https://osf.io/4z5ut/ UR - https://www.i-jmr.org/2025/1/e45367 UR - http://dx.doi.org/10.2196/45367 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053716 ID - info:doi/10.2196/45367 ER - TY - JOUR AU - Wang, Weiyi AU - Chu, Yuntian AU - Cui, Fangfang AU - Shi, Xiaobing AU - Zhang, Xu AU - Sun, Dongxu AU - Shi, Jinming AU - Zhao, Jie PY - 2025/2/26 TI - Correlation Between the Online Visiting Time and Frequency Increase in Telemedicine Services Offered by Health Care Providers Before, During, and After the COVID-19 Pandemic in China: Cross-Sectional Study JO - J Med Internet Res SP - e65092 VL - 27 KW - telemedicine KW - post?COVID-19 KW - provider?s perspective KW - length of online visit KW - COVID-19 KW - pandemic KW - China KW - prevention KW - questionnaire KW - survey KW - healthcare provider N2 - Background: China has changed its COVID-19 prevention and control status since 2023. However, what role telemedicine will play post?COVID-19 is still uncertain. Objective: We aimed to determine the frequency change in health care providers offering telemedicine services before, during, and after COVID-19, as well as the correlation between the frequency change and telemedicine visit time. Methods: The Telemedicine Informationization Professional Committee of China (TIPC) carried out a nationwide questionnaire survey. We adopted data from part of the questionnaires that answered questions regarding the frequency of offering telemedicine services before, during, and after the COVID-19 explosion. Chi-square tests were applied to compare general differences in the between-group telemedicine frequency. Regression models were performed to analyze correlations between the frequency change and the time spent in online versus in-person visits. Results: Questionnaires from 428 providers were included. As reported, 39 (9.11%) providers often and 159 (37.15%) always offered telemedicine services before COVID-19 exploded. The component ratio increased to 12.38% (n=53) of providers often and 45.79% (n=196) always offering telemedicine during COVID-19 explosion and 12.62% (n=54) often and 50% (n=214) always offering telemedicine after pandemic control was relaxed. The increase in frequency shown as a difference between the before and during groups (?2=17.21, P.002) and between the before and after groups (?2=30.17, P<.001) was significant, while it was insignificant between the during and after groups (?2=2.89, P.57). Senior professional titles (odds ratio [OR] 4.38, 95% CI 1.72-11.6) and longer (OR 3.87, 95% CI 1.95-7.89) and shorter (OR 2.04, 95% CI 1.11-3.87) online visits were correlated with the increase in frequency during versus before COVID-19. In addition, senior professional titles (OR 3.47, 95% CI 1.46-8.49), longer (OR 3.14, 95% CI 1.64-6.11) and shorter (OR=2.27, 95% CI 1.31-4.07) online visits, and using third-party telemedicine platforms (OR 0.51, 95% CI 0.29-0.86) were correlated with the increase in frequency after versus before COVID-19. No factor was significantly correlated with the frequency change after versus during COVID-19. In stratified analysis, longer online visits were correlated with both during versus before (OR 3.84, 95% CI 1.73-8.83) and after versus before (OR 3.40, 95% CI 1.61-7.34) groups for providers using hospital-run platforms, while shorter online visits were correlated with both during versus before (OR 8.16, 95% CI 1.39-68.3) and after versus before (OR 5.70, 95% CI 1.22-33.6) groups for providers using third-party platforms. Conclusions: The frequency of telemedicine has increased since the COVID-19 pandemic exploded and is correlated with the time spent in online versus in-person visits. The correlation is different for providers using hospital-run and third party platforms. On a hospital-run platform, providers with longer online visits have a higher frequency of offering telemedicine, while on a third-party platform, providers with shorter online visits are more likely to offer telemedicine. UR - https://www.jmir.org/2025/1/e65092 UR - http://dx.doi.org/10.2196/65092 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65092 ER - TY - JOUR AU - Chen, Yu-Ting AU - Lehman, Michelle AU - Van Denend, Toni AU - Kish, Jacqueline AU - Wu, Yue AU - Preissner, Katharine AU - Plow, Matthew AU - Packer, L. Tanya PY - 2025/2/26 TI - Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review JO - J Med Internet Res SP - e58543 VL - 27 KW - videoconference KW - chronic disease management KW - active participation KW - intervention program KW - self-management KW - scoping review KW - Taxonomy of Every Day Self-Management Strategies KW - TEDSS KW - Behavior Change Technique Taxonomy version 1 KW - BCTTv1 KW - behavior change KW - mobile phone N2 - Background: A dramatic increase in the use of videoconferencing occurred as a response to the COVID-19 pandemic, including delivery of chronic disease management programs. With this increase, clients? openness to and confidence in receiving any type of telehealth care has dramatically improved. However, the rapidity of the response was accomplished with little time to learn from existing knowledge and research. Objective: The purpose of this scoping review was to identify features, barriers, and facilitators of synchronous videoconference interventions that actively engage clients in the management of chronic conditions. Methods: Using scoping review methodology, MEDLINE, CINAHL, and 6 other databases were searched from 2003 onward. The included studies reported on structured, one-on-one, synchronous videoconferencing interventions that actively engaged adults in the management of their chronic conditions at home. Studies reporting assessment or routine care were excluded. Extracted text data were analyzed using thematic analysis and published taxonomies. Results: The 33 included articles reported on 25 distinct programs. Most programs targeted people with neurological conditions (10/25, 40%) or cancer (7/25, 28%). Analysis using the Taxonomy of Every Day Self-Management Strategies and the Behavior Change Technique Taxonomy version 1 identified common program content and behavior change strategies. However, distinct differences were evident based on whether program objectives were to improve physical activity or function (7/25, 28%) or mental health (7/25, 28%). Incorporating healthy behaviors was addressed in all programs designed to improve physical activity or function, whereas only 14% (1/7) of the programs targeting mental health covered content about healthy lifestyles. Managing emotional distress and social interaction were commonly discussed in programs with objectives of improving mental health (6/25, 24% and 4/25, 16%, respectively) but not in programs aiming at physical function (2/25, 8% and 0%, respectively). In total, 13 types of behavior change strategies were identified in the 25 programs. The top 3 types of strategies applied in programs intent on improving physical activity or function were feedback and monitoring, goals and planning, and social support, in contrast to shaping knowledge, regulation, and identity in programs with the goal of improving mental health. The findings suggest that chronic condition interventions continue to neglect evidence that exercise and strong relationships improve both physical and mental health. Videoconference interventions were seen as feasible and acceptable to clients. Challenges were mostly technology related: clients? comfort, technology literacy, access to hardware and the internet, and technical breakdowns and issues. Only 15% (5/33) of the studies explicitly described compliance with health information or privacy protection regulations. Conclusions: Videoconferencing is a feasible and acceptable delivery format to engage clients in managing their conditions at home. Future program development could reduce siloed approaches by adding less used content and behavior change strategies. Addressing client privacy and technology issues should be priorities. UR - https://www.jmir.org/2025/1/e58543 UR - http://dx.doi.org/10.2196/58543 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58543 ER - TY - JOUR AU - Mainer-Pearson, Graham AU - Stewart, Kurtis AU - Williams, Kim AU - Pawlovich, John AU - Graham, Scott AU - Riches, Linda AU - Cressman, Sonya AU - Ho, Kendall PY - 2025/2/19 TI - Estimating Patient and Family Costs and CO2 Emissions for Telehealth and In-Person Health Care Appointments in British Columbia, Canada: Geospatial Mixed Methods Study JO - J Med Internet Res SP - e56766 VL - 27 KW - virtual care KW - economic evaluation KW - patient costs KW - lost productivity KW - informal caregiving KW - out-of-pocket costs KW - environmental costs KW - geospatial KW - patient KW - family KW - CO2 KW - emission costs KW - health care KW - Canada KW - virtual service KW - emergency department KW - hospitalization KW - physician visit KW - consultation KW - sensitivity analysis KW - patient-paid KW - telehealth N2 - Background: Patients inevitably incur some cost for accessing health care, even in universal systems such as Canada. The COVID-19 pandemic dramatically shifted health care delivery from in-person to telehealth services, also shifting the proportion of costs offset by patients and their families by reducing the need to travel to in-person appointments. Objective: This study aimed to develop a method for estimating the costs patients and their families incur and CO2 emissions attributed to travel needed for emergency department (ED) visits, hospitalizations, and physician appointments. Methods: We present a method to evaluate the costs associated with in-person and telehealth care appointments from the perspective of patients, their families, and the environment. We used ED locations, road distances, and duration of appointment to account for costs paid by patients (ie, lost productivity, informal caregiving, and out-of-pocket expenses) attributed to travel to receive medical care. Costs to the environment were evaluated by calculating the amount of CO2 emitted per medical visit. Using our costs calculated per visit, we apply our method to calculate total patient costs for a simulated population over 1 year. Results: Our method estimates that patients in British Columbia pay up to $300 (2023 CAD, CAD $1=US $0.86) on average to attend an in-person ED visit, depending on where they live; $166 may be attributed to lost productivity, $83 to informal caregiving, and $50 to out-of-pocket expenses. These estimates are higher than most observed cost estimates. In addition, avoiding in-person care diverts up to 13 kg of CO2 per medical visit, depending on the distance and frequency of travel to appointments. This translates to up to $0.70 in carbon costs per visit, or cumulatively $44,120 per year in British Columbia, conventionally not included in patient cost estimates. Conclusions: We present a novel method for estimating patient-incurred costs and CO2 emissions from accessing health care and apply it to estimate that every year, patients in British Columbia pay upwards of 30 million dollars to access health care services, primarily for medical travel. Our method adds to the economic evaluation literature by providing a more comprehensive and context-modifiable calculation of patient costs that will allow for more informed decision-making regarding health care services. UR - https://www.jmir.org/2025/1/e56766 UR - http://dx.doi.org/10.2196/56766 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969971 ID - info:doi/10.2196/56766 ER - TY - JOUR AU - Agarwal, Payal AU - Fletcher, George Glenn AU - Ramamoorthi, Karishini AU - Yao, Xiaomei AU - Bhattacharyya, Onil PY - 2025/2/14 TI - Uses of Virtual Care in Primary Care: Scoping Review JO - J Med Internet Res SP - e55007 VL - 27 KW - primary care KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultations KW - medical informatics KW - digital health KW - digital technology KW - digital intervention KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus infections KW - PRISMA N2 - Background: The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care. Objective: This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions. Methods: We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size. Results: A total of 13,667 articles were screened, and 219 (1.6%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5%) were primary studies, and 28 (16.5%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4%), medical assessment and treatment of particular conditions (63/170, 37.1%), rehabilitation (17/170, 10%), and counseling (74/170, 43.5%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes. Conclusions: Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care. UR - https://www.jmir.org/2025/1/e55007 UR - http://dx.doi.org/10.2196/55007 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55007 ER - TY - JOUR AU - Baygi, Fereshteh AU - Bitz Trabjerg, Theis AU - Jensen, Henrik Lars AU - Munch Storsveen, Maria AU - Wehberg, Sonja AU - Sisler, James Jeffrey AU - Søndergaard, Jens AU - Gilså Hansen, Dorte PY - 2025/2/11 TI - Challenges of Cross-Sectoral Video Consultation in Cancer Care on Patients? Perceived Coordination: Randomized Controlled Trial JO - JMIR Cancer SP - e60158 VL - 11 KW - randomized controlled trials KW - video consultations KW - outcome assessment KW - patients? satisfaction KW - patients? care coordination KW - interprofessional relations KW - cancer N2 - Background: Patients with cancer need coordinated care for both treatment and concurrent health conditions. This requires collaboration among specialists when using telemedicine services, emphasizing the importance of care continuity. Objective: This study aimed to explore the effects of cross-sectorial video consultation involving oncologists, general practitioners, and patients with cancer on patients? perceived coordination of care, compared with usual care. Methods: This study describes the primary outcomes from a 7-month follow-up of patients in the Partnership Project, a randomized clinical trial. Patients in the intervention group were randomized to receive a ?partnership consultation,? a shared video consultation with an oncologist, general practitioners, and the patient, in addition to their usual care. Questionnaires were completed for both groups at baseline and 7 months to assess the primary outcome, ?global assessment of inter-sectorial cooperation,? from the Danish questionnaire ?Patients? attitude to the health care service.? The questionnaire also included 2 single items and 5 index scales, examining patients? attitude toward cooperation in the health care system. Change in perceived global coordination from baseline to 7 months was compared between intention-to-treat groups using generalized estimating equations in a linear regression model. Results: A total of 278 participants were randomized with 1:1 allocation, with 80 patients receiving the intervention. Further, 210 patients completed the questionnaire at baseline, while 118 responded at 7-month follow-up. The estimated difference in the primary outcome between usual care (?0.13, 95% CI ?0.38 to 0.12) and intervention (0.11, 95% CI ?0.11 to 0.34) was 0.24 (95% CI ?0.09 to 0.58) and not statistically significant (P=.15). Conclusions: Low rates of intervention completion and high levels of missing data compromised the interpretability of our study. While we observed a high level of global assessment of coordination, the estimated intervention effect was smaller than anticipated, with no significant difference in perceived coordination between control and intervention groups. Future studies should explore strategies like patient incentives to increase response rate and improve the evaluation of this innovative health care model. Trial Registration: ClinicalTrials.gov NCT02716168; https://clinicaltrials.gov/study/NCT02716168 International Registered Report Identifier (IRRID): RR2-10.1186/s12875-019-0978-8 UR - https://cancer.jmir.org/2025/1/e60158 UR - http://dx.doi.org/10.2196/60158 ID - info:doi/10.2196/60158 ER - TY - JOUR AU - Kalla, Mahima AU - O'Brien, Teresa AU - Metcalf, Olivia AU - Hoda, Rashina AU - Chen, Xiao AU - Li, Andy AU - Parker, Catriona AU - Franco, Edward Michael AU - Georgy, Sam AU - Huckvale, Kit AU - Bain, Christopher AU - Poon, Peter PY - 2025/2/11 TI - Understanding Experiences of Telehealth in Palliative Care: Photo Interview Study JO - JMIR Hum Factors SP - e53913 VL - 12 KW - consultation summary KW - digital scribe KW - qualitative research KW - telehealth KW - digital health KW - photo-elicitation KW - palliative care KW - photo interview KW - photographs KW - intertextual analysis N2 - Background: It is widely accepted that the COVID-19 pandemic has accelerated the era of online health care delivery, including within community palliative care. This study was part of a larger project involving a collaboration between universities, health care services, government agencies, and software developers that sought to enhance an existing telehealth (video call) platform with additional features to improve both patient and health care professional (HCP) experience in a palliative care context. Objective: The aim of this study was to understand palliative care patients? and HCPs? experiences of telehealth delivery in a palliative care context in Victoria, Australia. For the purposes of this study, telehealth included consultations by both video and telephone calls. By better understanding users? experiences and perceptions of telehealth, we hoped to determine users? preferences for new telehealth enhancement features. Methods: A total of 6 health care professionals and 6 patients were recruited from a major tertiary hospital network?s palliative care unit in Victoria, Australia. Participants were asked to generate 3?5 photographs depicting their telehealth experiences. These photographs were used as visual aids to prompt discussion during subsequent one-on-one interviews. Intertextual analysis was conducted to identify key themes. Results: A total of 3 overarching themes emerged: comfort (or lack thereof) afforded by telehealth, connection considerations in telehealth, and care quality impacts of telehealth. Patients (n=6) described telehealth as supporting their physical and psychological comfort and maintaining connection with HCPs, yet there were specific situations where it failed to meet their needs or impacted care quality and delayed treatment. HCPs (n=6) recognized the benefit of telehealth for patients but reported several limitations of telehealth, in particular due to lack of physical examination opportunities. Participants indicated that 2 types of connection were imperative for effective telehealth delivery: technical connection (eg, good internet connectivity or clear phone line) and interpersonal connection (ie, good rapport and therapeutic alliance between the HCPs and patients). Often technical connection issues impeded the development of interpersonal connection between the HCPs and patients in telehealth. Conclusions: The findings presented in this study combined with other co-design activities, which are outside the scope of this paper, indicated the potential value of a telehealth enhancement feature that generates patient-facing clinical consultation summaries. Our team has developed a video telehealth enhancement feature (or ?add-on?), which will enable clinicians to distill key actionable advice and self-management guidance discussed during teleconsultations for a take-home summary document for patients. The add-on?s prototype has also been subjected to an initial simulation study, which will be reported in a future publication. UR - https://humanfactors.jmir.org/2025/1/e53913 UR - http://dx.doi.org/10.2196/53913 ID - info:doi/10.2196/53913 ER - TY - JOUR AU - Kearns, Amanda AU - Moorhead, Anne AU - Mulvenna, Maurice AU - Bond, Raymond PY - 2025/2/10 TI - Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review JO - J Med Internet Res SP - e58434 VL - 27 KW - digital communication KW - digital technology KW - digital transformation KW - health professional KW - mental health KW - obesity KW - complex needs KW - artificial intelligence KW - AI KW - PRISMA N2 - Background: Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication. Methods: A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs? use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: ?What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?? Results: In total, 8 studies?featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email?met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P?.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals? complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs. UR - https://www.jmir.org/2025/1/e58434 UR - http://dx.doi.org/10.2196/58434 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58434 ER - TY - JOUR AU - Hossain, Rubana Sheikh AU - Samant, N. Akanksha AU - Balsamo, C. Briana AU - Hawley, E. Chelsea AU - Zanchelli, C. Michael AU - Zhu, Carolyn AU - Venegas, D. Maria AU - Robertson, Marina AU - McCullough, B. Megan AU - Beizer, L. Judith AU - Boockvar, S. Kenneth AU - Siu, L. Albert AU - Moo, R. Lauren AU - Hung, W. William PY - 2025/2/5 TI - Effect of Medication Management at Home via Pharmacist-Led Home Televisits: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e65141 VL - 14 KW - older adults KW - medication management KW - televisit KW - polypharmacy KW - adverse drug reaction N2 - Background: Older adults are more likely to have multiple chronic conditions, be prescribed multiple medications, and be more susceptible to adverse drug reactions (ADRs) to their medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimens. Complex medication regimens are potentially harmful to older adults. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as reviews of medication lists and the implementation of ?brown bag? reconciliation, continue to be challenging, with limited success. Pharmacist-led interventions to improve appropriate medication use in older adults have demonstrated effectiveness in reducing ADRs. Video visits have the potential to provide direct visualization of medications in older adults? homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist-led management of older adults? medication regimens may improve appropriate medication use in older adults. Objective: The objective of this study is to examine the effect of pharmacist-led medication through home televisits compared to usual care on appropriate medication use, medication discrepancies, medication adherence, and ADRs. Methods: We will conduct a 2-site cluster randomized controlled trial (RCT). The intervention will be a pharmacist-led home televisit including medication reconciliation and assessment of actual medication use. The cluster RCT was iteratively adapted after a pilot test. The primary outcome of medication appropriateness of the intervention will be measured using the STOPP (Screening Tool of Older Persons? Prescriptions) criteria for potentially inappropriate medications (PIMs) at 6 months. Medication lists obtained will be compared against electronic medical records (EMRs) by a clinician to establish discrepancies in medications. The clinician will review medications using the validated Medication Appropriateness Index (MAI). Results: This project has been peer-reviewed and selected for support by the Veterans Affairs (VA) Health Services Research Service. The pilot phase of the study was completed December 2021 with 20 veterans and was primarily informed by the Steinman model of the prescribing process adapted to include system- and provider-level factors. The last date of enrollment was August 6, 2021. We anticipate the completion of the ongoing trial in spring 2025. The first results are expected to be submitted for publication in 2025. Conclusions: The cluster RCT will provide evidence on medication management through televisits. If found effective in improving the use of medications, the intervention has the potential to impact older adults with multiple chronic conditions and polypharmacy. Trial Registration: ClinicalTrials.gov NCT04340570; https://clinicaltrials.gov/study/NCT04340570 International Registered Report Identifier (IRRID): PRR1-10.2196/65141 UR - https://www.researchprotocols.org/2025/1/e65141 UR - http://dx.doi.org/10.2196/65141 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65141 ER - TY - JOUR AU - de Ligt, M. Kelly AU - Hommes, Saar AU - Vromans, D. Ruben AU - Boomstra, Eva AU - van de Poll, V. Lonneke AU - Krahmer, J. Emiel PY - 2025/2/5 TI - Improving the Implementation of Patient-Reported Outcome Measure in Clinical Practice: Tackling Current Challenges With Innovative Digital Communication Technologies JO - J Med Internet Res SP - e60777 VL - 27 KW - patient reported outcome measures KW - quality of life KW - health communication KW - delivery of health care KW - digital sciences KW - clinical practice: patient reported outcomes KW - patient reported outcome KW - digital communication KW - communication KW - health management KW - digital technologies UR - https://www.jmir.org/2025/1/e60777 UR - http://dx.doi.org/10.2196/60777 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60777 ER - TY - JOUR AU - Wu, Tzu-Chi AU - Ho, Chien-Ta PY - 2025/2/3 TI - Reconstructing Risk Dimensions in Telemedicine: Investigating Technology Adoption and Barriers During the COVID-19 Pandemic in Taiwan JO - J Med Internet Res SP - e53306 VL - 27 KW - telemedicine KW - perceived risk KW - technology acceptance model KW - risk KW - performance risk N2 - Background: The COVID-19 pandemic has shifted health care toward virtual and online models, impacting both users and providers. Numerous user concerns and perceived risks related to telemedicine are continually evolving and adjusting in response to the pandemic. In many countries, there has been a substantial increase in the use of virtual health care visits, which offers a unique opportunity for researchers to explore these user concerns. Objective: This study aimed to first reconstruct the risk dimensions associated with telemedicine, then identify the risk factors affecting users? adoption, and finally propose effective solutions to mitigate these concerns. By integrating the newly constructed perceived risk with the technology acceptance model (TAM), we scrutinized various dimensions of perceived risk and their influence on users? perceptions of ease of use, perceived usefulness, and use intention (UI). Methods: Our target population consists of adults aged ?18 years who have used or may use telemedicine services, recruited through an anonymous, voluntary, open, web-based survey. We collected responses and used part of them to reconstruct risk dimensions using exploratory factor analysis. Subsequently, we analyzed the intricate relationship between perceived risk, the TAM, and the acceptance of telemedicine using structural equation modeling with another part of the responses. Results: A total of 1600 valid responses were collected. Eight distinct risk dimensions were reconstructed, revealing a substantial negative impact of performance risk on UI. The psychological and social risk was the strongest barrier to the ease of using telemedicine. Time risk, provider risk, and privacy risk were not statistically significant to the TAM. The resulting model elucidates a remarkable 66% variance in UI for telemedicine services. Conclusions: This study substantially advances the field of telemedicine research by reconstructing and redefining 8 risk dimensions and confirming the statistical significance of 5 perceived risks on the adoption of telemedicine services. These insights are poised to facilitate the promotion and enhancement of telemedicine services in the health care sector. UR - https://www.jmir.org/2025/1/e53306 UR - http://dx.doi.org/10.2196/53306 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53306 ER - TY - JOUR AU - Sugawara, Yuka AU - Hirakawa, Yosuke AU - Iwagami, Masao AU - Inokuchi, Ryota AU - Wakimizu, Rie AU - Nangaku, Masaomi PY - 2025/1/31 TI - Metrics for Evaluating Telemedicine in Randomized Controlled Trials: Scoping Review JO - J Med Internet Res SP - e67929 VL - 27 KW - patient experience KW - patient-reported outcome KW - quality of life KW - quality-adjusted life year KW - telehealth KW - eHealth KW - mobile phone KW - metrics KW - telemedicine KW - systematic review KW - scoping review KW - review KW - telecommunications KW - database KW - health care KW - patient-centeredness KW - patient satisfaction KW - patient outcome KW - clinical parameter KW - cost-effectiveness KW - evaluation metrics KW - mHealth KW - mobile health N2 - Background: Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined. Objective: This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials. Methods: MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized. Results: Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51%), including cost assessment and quality-adjusted life year. Notably, only 25 (32%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10%; system usability: 3/79, 4%; and environmental impact: 2/79, 3%). Conclusions: A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies. Trial Registration: Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7 UR - https://www.jmir.org/2025/1/e67929 UR - http://dx.doi.org/10.2196/67929 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67929 ER - TY - JOUR AU - Taneja, Shipra AU - Kalia, Kamini AU - Tang, Terence AU - Wodchis, P. Walter AU - Vanderhout, Shelley PY - 2025/1/31 TI - Examining Health Care Provider Experiences With Patient Portal Implementation: Mixed Methods Study JO - J Med Internet Res SP - e65967 VL - 27 KW - patient portal KW - mixed methods KW - implementation KW - healthcare provider KW - health system KW - patient care KW - online questionnaire KW - Canada KW - descriptive statistics KW - thematic analysis N2 - Background: Health systems are increasingly offering patient portals as tools for patients to access their health information with the goal of improving engagement in care. However, understanding health care providers? perspectives on patient portal implementation is crucial. Objective: This study aimed to understand health care providers? experiences of implementing the MyChart patient portal, perspectives about its impact on patient care, clinical practice, and workload, and opportunities for improvement. Methods: Using an explanatory sequential mixed methods approach, we conducted a web-based questionnaire and semistructured individual interviews with health care providers at a large Canadian community hospital, 6 months after MyChart was first offered to patients. We explored perspectives about the impact of MyChart on clinical practice, workload, and patient care. Data were analyzed using descriptive statistics and thematic analysis. Results: In total, 261 health care providers completed the web-based questionnaire, and 15 also participated in interviews. Participants agreed that patients should have access to their health information through MyChart and identified its benefits such as patients gaining a greater understanding of their own health, which could improve patient safety (160/255, 62%). While many health care providers agreed that MyChart supported better patient care (108/258, 42%), there was limited understanding of features available to patients and expectations for integrating MyChart into clinical routines. Concerns were raised about the potential negative impacts of MyChart on patient-provider relationships because sensitive notes or results could be inappropriately interpreted (109/251, 43%), and a potential increase in workload if additional portal features were introduced. Suggested opportunities for improvement included support for both patients and health care providers to learn about MyChart and establishing guidelines for health care providers on how to communicate information available in MyChart to patients. Conclusions: While health care providers acknowledged that MyChart improved patients? access to health information, its implementation introduced some friction and concerns. To reduce the risk of these challenges, health systems can benefit from engaging health care providers early to identify effective patient portal implementation strategies. UR - https://www.jmir.org/2025/1/e65967 UR - http://dx.doi.org/10.2196/65967 UR - http://www.ncbi.nlm.nih.gov/pubmed/39888658 ID - info:doi/10.2196/65967 ER - TY - JOUR AU - Soltani, Nazli AU - Dietz, Thilo AU - Ochterbeck, Doris AU - Dierkes, Jens AU - Restel, Katja AU - Christianson, Lara AU - De Santis, Karolina Karina AU - Zeeb, Hajo PY - 2025/1/28 TI - Digital Information Exchange Between the Public and Researchers in Health Studies: Scoping Review JO - J Med Internet Res SP - e63373 VL - 27 KW - health information KW - information exchange KW - communication KW - knowledge translation KW - dissemination KW - digital technology KW - research participant KW - scoping review N2 - Background: Information exchange regarding the scope and content of health studies is becoming increasingly important. Digital methods, including study websites, can facilitate such an exchange. Objective: This scoping review aimed to describe how digital information exchange occurs between the public and researchers in health studies. Methods: This scoping review was prospectively registered and adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Eligibility was defined using the population (public and researchers), concept (digital information exchange), and context (health studies) framework. Bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science), bibliographies of the included studies, and Google Scholar were searched up to February 2024. Studies published in peer-reviewed journals were screened for inclusion based on the title, abstract, and full text. Data items charted from studies included bibliographic and PCC (Population, Concept, and Context) characteristics. Data were processed into categories that inductively emerged from the data and were synthesized into main themes using descriptive statistics. Results: Overall, 4072 records were screened, and 18 studies published between 2010 and 2021 were included. All studies evaluated or assessed the preferences for digital information exchange. The target populations included the public (mainly adults with any or specific diseases), researchers, or both. The digital information exchange methods included websites, emails, forums, platforms, social media, and portals. Interactivity (ie, if digital information exchange is or should be active or passive) was addressed in half of the studies. Exchange content included health information or data with the aim to inform, recruit, link, or gather innovative research ideas from participants in health studies. We identified 7 facilitators and 9 barriers to digital information exchange. The main facilitators were the consideration of any stakeholder perspectives and needs to clarify expectations and responsibilities, the use of modern or low-cost communication technologies and public-oriented language, and continuous communication of the health study process. The main barriers were that information exchange was not planned or not feasible due to inadequate resources, highly complex technical language was used, and ethical concerns (eg, breach of anonymity if study participants are brought together) were raised. Evidence gaps indicate that new studies should assess the methods and the receiver (ie, public) preferences and needs that are required to deliver and facilitate interactive digital information exchange. Conclusions: Few studies addressing digital information exchange in health studies could be identified in this review. There was little focus on interactivity in such an exchange. Digital information exchange was associated with more barriers than facilitators, suggesting that more effort is required to improve such an exchange between the public and researchers. Future studies should investigate interactive digital methods and the receiver preferences and needs required for such an exchange. UR - https://www.jmir.org/2025/1/e63373 UR - http://dx.doi.org/10.2196/63373 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63373 ER - TY - JOUR AU - Schürmann, Fiona AU - Westmattelmann, Daniel AU - Schewe, Gerhard PY - 2025/1/27 TI - Factors Influencing Telemedicine Adoption Among Health Care Professionals: Qualitative Interview Study JO - JMIR Form Res SP - e54777 VL - 9 KW - trust referents KW - multidimensional risk KW - benefits KW - transparency KW - technology adoption KW - telemedicine KW - extended valence framework N2 - Background: Telemedicine is transforming health care by enabling remote diagnosis, consultation, and treatment. Despite rapid adoption during the COVID-19 pandemic, telemedicine uptake among health care professionals (HCPs) remains inconsistent due to perceived risks and lack of tailored policies. Existing studies focus on patient perspectives or general adoption factors, neglecting the complex interplay of contextual variables and trust constructs influencing HCPs? telemedicine adoption. This gap highlights the need for a framework integrating risks, benefits, and trust in telemedicine adoption, while addressing health care?s unique dynamics. Objective: This study aimed to adapt and extend the extended valence framework (EVF) to telemedicine, deconstructing factors driving adoption from an HCP perspective. Specifically, it investigated the nuanced roles of perceived risks, benefits, and trust referents (eg, technology, treatment, technology provider, and patient) in shaping behavioral intentions, while integrating contextual factors. Methods: We used a qualitative research design involving semistructured interviews with 14 HCPs experienced in offering video consultations. The interview data were analyzed with deductive and inductive coding based on the EVF. Two coders conducted the coding process independently, achieving an intercoder reliability of 86.14%. The qualitative content analysis aimed to uncover the nuanced perspectives of HCPs, identifying key risk and benefit dimensions and trust referents relevant to telemedicine adoption. Results: The study reveals the complex considerations HCPs have when adopting telemedicine. Perceived risks were multidimensional, including performance risks such as treatment limitations (mentioned by 7/14, 50% of the participants) and reliance on technical proficiency of patients (5/14, 36%), privacy risks related to data security (10/14, 71%), and time and financial risks associated with training (7/14, 50%) and equipment costs (4/14, 29%). Perceived benefits encompassed convenience through reduced travel time (5/14, 36%), improved care quality due to higher accessibility (8/14, 57%), and operational efficiency (7/14, 50%). Trust referents played a pivotal role; trust in technology was linked to functionality (6/14, 43%) and reliability (5/14, 36%), while trust in treatment depended on effective collaboration (9/14, 64%). Transparency emerged as a critical antecedent of trust across different referents, comprising disclosure, clarity, and accuracy. In addition, the study highlighted the importance of context-specific variables such as symptom characteristics (10/14, 71%) and prior professional experience with telemedicine (11/14, 79%). Conclusions: This study expands the EVF for telemedicine, providing a framework integrating multidimensional risks, benefits, trust, and contextual factors. It advances theory by decomposing trust referents and transparency into actionable subdimensions and emphasizing context-specific variables. Practically, the findings guide stakeholders: policy makers should prioritize transparent regulations and data security, health care organizations should provide training and support for HCPs, and technology developers must design telemedicine solutions aligning with trust and usability needs. This understanding equips health care to address barriers, optimize adoption, and leverage telemedicine?s potential for sustainable clinical integration. UR - https://formative.jmir.org/2025/1/e54777 UR - http://dx.doi.org/10.2196/54777 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54777 ER - TY - JOUR AU - Alharbi, A. Abdullah AU - Aljerian, A. Nawfal AU - Binhotan, S. Meshary AU - Alghamdi, A. Hani AU - Alsultan, K. Ali AU - Arafat, S. Mohammed AU - Aldhabib, Abdulrahman AU - Alaska, A. Yasser AU - Alwahbi, B. Eid AU - Muaddi, A. Mohammed AU - Alqassim, Y. Ahmad AU - Horner, D. Ronnie PY - 2025/1/24 TI - Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data JO - JMIR Public Health Surveill SP - e64257 VL - 11 KW - digital health KW - mental health KW - health policy KW - epidemiology KW - Saudi Arabia KW - SMARC KW - health care transformation KW - e-referral KW - Saudi Medical Appointments and Referrals Centre N2 - Background: Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia?s novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020?2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18?44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. ?Unavailable subspecialty? was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems. UR - https://publichealth.jmir.org/2025/1/e64257 UR - http://dx.doi.org/10.2196/64257 ID - info:doi/10.2196/64257 ER - TY - JOUR AU - Mazzella-Ebstein, Marie Ann AU - Daly, Robert AU - Huang, Jennie AU - Bernal, Camila AU - Wilhelm, Clare AU - Panageas, S. Katherine AU - Holland, Jessie AU - Salvaggio, Rori AU - Ackerman, Jill AU - Cracchiolo, Jennifer AU - Kuperman, Gilad AU - Mao, Jun AU - Begue, Aaron AU - Barton-Burke, Margaret PY - 2025/1/24 TI - Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach JO - JMIR Hum Factors SP - e60585 VL - 12 KW - cancer KW - oncology KW - clinician end users KW - remote patient monitoring KW - digital health KW - implementation science KW - patient monitoring KW - patient access KW - care KW - communication KW - usability KW - functionality KW - survey KW - interview KW - efficiency KW - workflow KW - user KW - clinician support N2 - Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians? workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program?s utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. UR - https://humanfactors.jmir.org/2025/1/e60585 UR - http://dx.doi.org/10.2196/60585 ID - info:doi/10.2196/60585 ER - TY - JOUR AU - Shin, Yoomi AU - Park, Ju Eun AU - Lee, Anna PY - 2025/1/17 TI - Early Intervention for Children With Developmental Disabilities and Their Families via Telehealth: Systematic Review JO - J Med Internet Res SP - e66442 VL - 27 KW - developmental disabilities KW - developmental delay KW - early intervention KW - telehealth KW - digital intervention KW - autistic spectrum disorder KW - cerebral palsy KW - family-centered care KW - multidisciplinary care KW - systematic review N2 - Background: Early intervention during the first 3 years of life is crucial for children with developmental disabilities to optimize developmental outcomes. However, access to such services is often limited by geographical distance and resource constraints. Telehealth can be part of a solution for overcoming these barriers, enabling the delivery of early intervention services. However, a comprehensive understanding of the efficacy and implementation of telehealth in early interventions remains elusive, particularly for children aged 0-3 years. Objective: This systematic review aims to synthesize existing research on the effectiveness and implementation of telehealth interventions in infants and toddlers (aged 0?3 years) who are at risk of or diagnosed with developmental disabilities. The primary objective of the study is to evaluate the ways that telehealth compares to conventional in-person interventions in improving developmental outcomes for children and supporting family well-being. Methods: A systematic search was conducted of 4 electronic databases (PubMed, Embase, CINAHL, and Web of Science), focusing on studies published between 2010 and 2024. The inclusion criteria were studies involving telehealth interventions for children aged 0-3 years who were at high risk or had developmental disabilities, which involved active interactions between the providers and the families. Study quality was assessed using the mixed methods appraisal tool, and a narrative synthesis was used to analyze the data. Results: Eighteen studies met the inclusion criteria: 12 single-case designs, 4 randomized controlled trials, and 2 nonequivalent control group designs. All studies involved caregiver-child dyads, with child ages ranging from 5 to 37 months and having or at risk of autistic spectrum disorder (n=10, 56%), cerebral palsy (n=4, 22%), and other conditions (n=4, 22%). Synchronous videoconferencing was the primary modality for caregiver training and coaching (n=17, 94%) while 1 intervention used an Internet of Things system. Outcomes were identified in child communication (n=9, 50%), physical (n=6, 33%), social or emotional (n=6, 33%), and adaptive behavior (n=4, 22%), as well as caregiver implementation (n=12, 66%). Telehealth demonstrated comparable or superior effectiveness to traditional in-person methods in 2 studies. However, the focus on specific conditions and limited research on cognitive development were notable gaps. Conclusions: Telehealth can be a viable alternative to traditional in-person early interventions for young children who have developmental disabilities and their families. It enhances accessibility and interactions between families and providers at a distance while promoting family-centered care. Challenges exist, including those of technological literacy, and the lack of research on cognitive outcomes must be addressed. Future work should explore more comprehensive interventions, including multidisciplinary approaches and expanded family outcomes, to solidify the role that telehealth plays in early intervention. Trial Registration: PROSPERO CRD42024551286; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=551286 UR - https://www.jmir.org/2025/1/e66442 UR - http://dx.doi.org/10.2196/66442 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66442 ER - TY - JOUR AU - Ramos-García, Vanesa AU - Rivero-Santana, Amado AU - Peñate-Castro, Wenceslao AU - Álvarez-Pérez, Yolanda AU - Duarte-Díaz, Andrea AU - Torres-Castaño, Alezandra AU - Trujillo-Martín, Mar María del AU - González-González, Isabel Ana AU - Serrano-Aguilar, Pedro AU - Perestelo-Pérez, Lilisbeth PY - 2025/1/16 TI - A Brief Web-Based Person-Centered Care Group Training Program for the Management of Generalized Anxiety Disorder: Feasibility Randomized Controlled Trial in Spain JO - JMIR Med Educ SP - e50060 VL - 11 KW - person-centered care KW - primary care KW - shared decision-making KW - anxiety disorder KW - training program KW - SDM N2 - Background: Shared decision-making (SDM) is a crucial aspect of patient-centered care. While several SDM training programs for health care professionals have been developed, evaluation of their effectiveness is scarce, especially in mental health disorders such as generalized anxiety disorder. Objective: This study aims to assess the feasibility and impact of a brief training program on the attitudes toward SDM among primary care professionals who attend to patients with generalized anxiety disorder. Methods: A feasibility randomized controlled trial was conducted. Health care professionals recruited in primary care centers were randomized to an intervention group (training program) or a control group (waiting list). The intervention consisted of 2 web-based sessions applied by 2 psychologists (VR and YA), based on the integrated elements of the patient-centered care model and including group dynamics and video viewing. The outcome variable was the Leeds Attitudes Towards Concordance scale, second version (LATCon II), assessed at baseline and after the second session (3 months). After the randomized controlled trial phase, the control group also received the intervention and was assessed again. Results: Among 28 randomized participants, 5 withdrew before the baseline assessment. The intervention significantly increased their scores compared with the control group in the total scale (b=0.57; P=.018) and 2 subscales: communication or empathy (b=0.74; P=.036) and shared control (ie, patient participation in decisions: b=0.68; P=.040). The control group also showed significant pre-post changes after receiving the intervention. Conclusions: For a future effectiveness trial, it is necessary to improve the recruitment and retention strategies. The program produced a significant improvement in participants? attitude toward the SDM model, but due to this study?s limitations, mainly the small sample size, more research is warranted. UR - https://mededu.jmir.org/2025/1/e50060 UR - http://dx.doi.org/10.2196/50060 ID - info:doi/10.2196/50060 ER - TY - JOUR AU - Chen, Nai-Jung AU - Chang, Ching-Hao AU - Huang, Chiu-Mieh AU - Lin, Fen-He AU - Lu, Li-Ting AU - Liu, Kuan-Yi AU - Lai, Chih-Lin AU - Lin, Chin-Yao AU - Hou, Yi-Chou AU - Guo, Jong-Long PY - 2025/1/9 TI - Assessing the Effectiveness of Interactive Robot-Assisted Virtual Health Coaching for Health Literacy and Disease Knowledge of Patients with Chronic Kidney Disease: Quasiexperimental Study JO - J Med Internet Res SP - e68072 VL - 27 KW - chronic kidney disease KW - disease knowledge KW - eHealth KW - health coaching KW - health education KW - health literacy KW - interactive robot N2 - Background: Chronic kidney disease (CKD) imposes a significant global health and economic burden, impacting millions globally. Despite its high prevalence, public awareness and understanding of CKD remain limited, leading to delayed diagnosis and suboptimal management. Traditional patient education methods, such as 1-on-1 verbal instruction or printed brochures, are often insufficient, especially considering the shortage of nursing staff. Technology-assisted education presents a promising and standardized solution, emphasizing the need for innovative and scalable approaches to improve CKD-specific knowledge and health literacy. Objective: This study aimed to develop and evaluate the effectiveness of an innovative 12-unit virtual health coaching program delivered through interactive robots that is intended to enhance disease knowledge and health literacy among patients with CKD. Methods: A quasiexperimental design was used, and 60 participants were evenly assigned to experimental and comparison groups. However, due to attrition, 14 participants in the experimental group and 16 participants in the comparison group completed the study. The intervention involved a 12-unit program, with each unit lasting approximately 20 minutes to 30 minutes and delivered across 3 to 4 learning sessions, and participants completed 3 to 4 units per session. The program addressed key aspects of CKD-specific health literacy including functional, communicative, and critical literacy and CKD-specific knowledge including basic knowledge, prevention, lifestyle, dietary intake, and medication. Data were collected through validated pre and postintervention questionnaires. All 30 participants completed the program and subsequent evaluations, with outcome measures assessing changes in CKD-specific knowledge and health literacy. Results: Postintervention analysis using generalized estimating equations, adjusted for age, revealed that the experimental group (n=14) had significantly greater improvements in health literacy (coefficient=2.51, Wald ?²1=5.89; P=.02) and disease knowledge (coefficient=1.66, Wald ?²1=11.75; P=.001) than the comparison group (n=16). Postintervention t tests revealed significant improvements in CKD-specific health literacy and disease knowledge (P<.001) between the experimental and comparison groups. Additional analyses identified significant group × time interactions, indicating improvements in communicative literacy (P=.01) and critical literacy (P=.02), while no significant changes were observed in functional literacy. Regarding disease knowledge, the experimental group demonstrated a significant improvement in medication (P<.001), whereas changes in basic knowledge, prevention, lifestyle, and dietary intake were not significant. Conclusions: This study demonstrated that interactive robot-assisted eHealth coaching effectively enhanced CKD-specific disease knowledge and health literacy. Despite the challenges posed by the COVID-19 pandemic, which constrained sample sizes, the findings indicate that this program is a promising patient education tool in clinical nephrology. Future research should involve larger sample sizes to enhance generalizability and examine additional factors influencing effectiveness. UR - https://www.jmir.org/2025/1/e68072 UR - http://dx.doi.org/10.2196/68072 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68072 ER - TY - JOUR AU - Kristiansen, Eli AU - Atherton, Helen AU - Austad, Bjarne AU - Bergmo, Strand Trine AU - Norberg, Lønnebakke Børge AU - Salisbury, Chris AU - Zanaboni, Paolo PY - 2025/1/8 TI - Patients? Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study JO - J Med Internet Res SP - e55158 VL - 27 KW - e-consultation KW - remote consultation KW - telehealth KW - primary care KW - general practitioner KW - patient experience KW - cross-sectional KW - digital health KW - survey N2 - Background: e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. Objective: This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? Methods: A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users? expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. Results: Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38%). Overall, 68.7% (8802/13,011) of respondents expected an answer within 24 hours, and 17.7% (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5% (5917/13,011) of respondents would have booked a GP appointment, and 44.9% (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95% CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95% CI 1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95% CI 3.46-10.66) and with a new health problem (OR 2.71, 95% CI 2.09-3.51) were more likely to choose this option. In addition, 4.7% (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95% CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95% CI 1.27-3.80) or a new health issue (OR 1.74, 95% CI 1.43-2.12) had higher odds for not seeking help. Conclusions: e-Consultations were often the patients? first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency. UR - https://www.jmir.org/2025/1/e55158 UR - http://dx.doi.org/10.2196/55158 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55158 ER - TY - JOUR AU - Su, Jianwei AU - Ye, Cuiling AU - Zhang, Qian AU - Liang, Yi AU - Wu, Jianwei AU - Liang, Guixi AU - Cheng, Yalan AU - Yang, Xiaojuan PY - 2025/1/1 TI - Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial JO - JMIR Res Protoc SP - e60420 VL - 14 KW - thoracic surgery KW - rehabilitation medicine KW - patient-reported outcome measures KW - patient participation KW - telemedicine KW - eHealth KW - mobile phone N2 - Background: Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management through electronic patient-reported outcomes (ePROs) offers a potential solution to improve adherence by enabling more effective monitoring and intervention. Objective: This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery for lung cancer. Methods: In this single-center, prospective, randomized controlled trial, 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomly assigned 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and postdischarge days 3, 7, 14, 21, and 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, and fatigue) scored ?4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is the rehabilitation exercise adherence rate. Secondary outcomes include postdischarge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction. Results: The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data have been collected and thoroughly reviewed. Conclusions: This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence after video-assisted thoracic surgery for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings. Trial Registration: ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946 International Registered Report Identifier (IRRID): DERR1-10.2196/60420 UR - https://www.researchprotocols.org/2025/1/e60420 UR - http://dx.doi.org/10.2196/60420 UR - http://www.ncbi.nlm.nih.gov/pubmed/39610048 ID - info:doi/10.2196/60420 ER - TY - JOUR AU - Hansen, Steffen AU - Jensen, Secher Tue AU - Schmidt, Mette Anne AU - Strøm, Janni AU - Vistisen, Peter AU - Høybye, Terp Mette PY - 2024/12/30 TI - The Effectiveness of Video Animations as a Tool to Improve Health Information Recall for Patients: Systematic Review JO - J Med Internet Res SP - e58306 VL - 26 KW - public health KW - health information KW - patient information KW - animation video KW - digital health KW - visualization KW - memory KW - recall KW - education KW - synthesis KW - review methods KW - review methodology KW - systematic KW - PRISMA N2 - Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (?18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials?3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and Türkiye, respectively?met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display_record.php?RecordID=380016 UR - https://www.jmir.org/2024/1/e58306 UR - http://dx.doi.org/10.2196/58306 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58306 ER - TY - JOUR AU - Sang, Ling AU - Zheng, Bixin AU - Zeng, Xianzheng AU - Liu, Huizhen AU - Jiang, Qing AU - Liu, Maotong AU - Zhu, Chenyu AU - Wang, Maoying AU - Yi, Zengwei AU - Song, Keyu AU - Song, Li PY - 2024/12/30 TI - Effectiveness of Outpatient Chronic Pain Management for Middle-Aged Patients by Internet Hospitals: Retrospective Cohort Study JO - JMIR Med Inform SP - e54975 VL - 12 KW - chronic pain management KW - internet hospital KW - physical hospital KW - quality of life KW - outpatient care KW - telemedicine KW - digital health N2 - Background: Chronic pain is widespread and carries a heavy disease burden, and there is a lack of effective outpatient pain management. As an emerging internet medical platform in China, internet hospitals have been successfully applied for the management of chronic diseases. There are also a certain number of patients with chronic pain that use internet hospitals for pain management. However, no studies have investigated the effectiveness of pain management via internet hospitals. Objective: The aim of this retrospective cohort study was to explore the effectiveness of chronic pain management by internet hospitals and their advantages and disadvantages compared to traditional physical hospital visits. Methods: This was a retrospective cohort study. Demographic information such as the patient?s sex, age, and number of visits was obtained from the IT center. During the first and last patient visits, information on outcome variables such as the Brief Pain Inventory (BPI), medical satisfaction, medical costs, and adverse drug events was obtained through a telephone follow-up. All patients with chronic pain who had 3 or more visits (internet or offline) between September 2021, and February 2023, were included. The patients were divided into an internet hospital group and a physical hospital group, according to whether they had web-based or in-person consultations, respectively. To control for confounding variables, propensity score matching was used to match the two groups. Matching variables included age, sex, diagnosis, and number of clinic visits. Results: A total of 122 people in the internet hospital group and 739 people in the physical hospital group met the inclusion criteria. After propensity score matching, 77 patients in each of the two groups were included in the analysis. There was not a significant difference in the quality of life (QOL; QOL assessment was part of the BPI scale) between the internet hospital group and the physical hospital group (P=.80), but the QOL of both groups of patients improved after pain management (internet hospital group: P<.001; physical hospital group: P=.001). There were no significant differences in the pain relief rate (P=.25) or the incidence of adverse events (P=.60) between the two groups. The total cost (P<.001) and treatment-related cost (P<.001) of the physical hospital group were higher than those of the internet hospital group. In addition, the degree of satisfaction in the internet hospital group was greater than that in the physical hospital group (P=.01). Conclusions: Internet hospitals are an effective way of managing chronic pain. They can improve patients? QOL and satisfaction, reduce treatment costs, and can be used as part of a multimodal strategy for chronic pain self-management. UR - https://medinform.jmir.org/2024/1/e54975 UR - http://dx.doi.org/10.2196/54975 ID - info:doi/10.2196/54975 ER - TY - JOUR AU - Backman, Chantal AU - Papp, Rosie AU - Tonjock Kolle, Aurelie AU - Papp, Steve AU - Visintini, Sarah AU - Schaefer Ferreira de Mello, Lúcia Ana AU - de Melo Lanzoni, Marcellino Gabriela AU - Harley, Anne PY - 2024/12/30 TI - Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review JO - J Med Internet Res SP - e55753 VL - 26 KW - platform based KW - patient-clinician KW - digital health intervention KW - care transition KW - mobile phone N2 - Background: Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients. Objective: The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs. Methods: A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods. Results: We screened 8322 articles, of which 97 (1.17%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61%), a web-based platform (28/97, 29%), or a combination of both (10/97, 10%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23%) and stroke (11/97, 11%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13%) and time constraints to use the DHIs (10/97, 10%), and the top 2 enablers were the ability to use the DHIs (17/97, 18%) and their ease of use (11/97, 11%). The main conflicting theme was access (enabler; 28/97, 29%) or limited access (barrier; 15/97, 15%) to technology or the internet. Conclusions: Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes. UR - https://www.jmir.org/2024/1/e55753 UR - http://dx.doi.org/10.2196/55753 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55753 ER - TY - JOUR AU - Lin, Cheng-Fu AU - Chang, Pei?Jung AU - Chang, Hui-Min AU - Chen, Ching-Tsung AU - Hsu, Pi-Shan AU - Wu, Chieh-Liang AU - Lin, Shih-Yi PY - 2024/12/26 TI - Evaluation of a Telemonitoring System Using Electronic National Early Warning Scores for Patients Receiving Medical Home Care: Pilot Implementation Study JO - JMIR Med Inform SP - e63425 VL - 12 KW - aging in place KW - early warning score KW - home hospitalization KW - remote monitoring KW - telemonitoring N2 - Background: Telehealth programs and wearable sensors that enable patients to monitor their vital signs have expanded due to the COVID-19 pandemic. The electronic National Early Warning Score (e-NEWS) system helps identify and respond to acute illness. Objective: This study aimed to implement and evaluate a comprehensive telehealth system to monitor vital signs using e-NEWS for patients receiving integrated home-based medical care (iHBMC). The goal was to improve the early detection of patient deterioration and enhance care delivery in home settings. The system was deployed to optimize remote monitoring in iHBMC and reduce emergency visits and hospitalizations. Methods: The study was conducted at a medical center and its affiliated home health agency in central Taiwan from November 1, 2022, to October 31, 2023. Patients eligible for iHBMC were enrolled, and sensor data from devices such as blood pressure monitors, thermometers, and pulse oximeters were transmitted to a cloud-based server for e-NEWS calculations at least twice per day over a 2-week period. Patients with e-NEWSs up to 4 received nursing or physician recommendations and interventions based on abnormal physiological data, with reassessment occurring after 2 hours. Implementation (Results): A total of 28 participants were enrolled, with a median age of 84.5 (IQR 79.3?90.8) years, and 32% (n=9) were male. All participants had caregivers, with only 5 out of 28 (18%) able to make decisions independently. The system was implemented across one medical center and its affiliated home health agency. Of the 28 participants, 27 completed the study, while 1 exited early due to low blood pressure and shortness of breath. The median e-NEWS value was 4 (IQR 3?6), with 397 abnormal readings recorded. Of the remaining 27 participants, 8 participants had earlier home visits due to abnormal readings, 6 required hypertension medication adjustments, and 9 received advice on oxygen supplementation. Overall, 24 out of 28 (86%) participants reported being satisfied with the system. Conclusions: This study demonstrated the feasibility of implementing a telehealth system integrated with e-NEWS in iHBMC settings, potentially aiding in the early detection of clinical deterioration. Although caregivers receive training and resources for their tasks, the system may increase their workload, which could lead to higher stress levels. The small sample size, short monitoring duration, and regional focus in central Taiwan may further limit the applicability of the findings to areas with differing countries, regions, and health care infrastructures. Further research is required to confirm its impact. UR - https://medinform.jmir.org/2024/1/e63425 UR - http://dx.doi.org/10.2196/63425 ID - info:doi/10.2196/63425 ER - TY - JOUR AU - Khatun, Fatema AU - Das, Chandra Novel AU - Hoque, Rakibul Md AU - Saqeeb, Nazmus Kazi AU - Rahman, Monjur AU - Park, Ryul Kyung AU - Rasheed, Sabrina AU - Reidpath, D. Daniel PY - 2024/12/23 TI - Users? Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study JO - JMIR Hum Factors SP - e46566 VL - 11 KW - telemedicine KW - COVID-19 KW - LMIC KW - low- and middle-income countries KW - Bangladesh KW - service quality KW - user satisfaction KW - structural equation modeling KW - digital health N2 - Background: COVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. Objective: The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. Methods: A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service?Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Results: Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18?39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (?=.946), service interaction (?=.974), and outcome (?=.955) contributed to service quality. Service quality was positively associated with user satisfaction (?=.327; P<.001) and intention to use teleconsultation services (?=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (?=.311; P<.001). Conclusions: The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery. UR - https://humanfactors.jmir.org/2024/1/e46566 UR - http://dx.doi.org/10.2196/46566 ID - info:doi/10.2196/46566 ER - TY - JOUR AU - Hartnagel, Lisa-Marie AU - Emden, Daniel AU - Foo, C. Jerome AU - Streit, Fabian AU - Witt, H. Stephanie AU - Frank, Josef AU - Limberger, F. Matthias AU - Schmitz, E. Sara AU - Gilles, Maria AU - Rietschel, Marcella AU - Hahn, Tim AU - Ebner-Priemer, W. Ulrich AU - Sirignano, Lea PY - 2024/12/23 TI - Momentary Depression Severity Prediction in Patients With Acute Depression Who Undergo Sleep Deprivation Therapy: Speech-Based Machine Learning Approach JO - JMIR Ment Health SP - e64578 VL - 11 KW - ambulatory assessment KW - depression KW - speech features KW - openSMILE KW - machine learning KW - sleep deprivation therapy KW - remote monitoring KW - depressive disorder KW - mobile phone KW - digital health KW - mobile health KW - mHealth KW - mental health N2 - Background: Mobile devices for remote monitoring are inevitable tools to support treatment and patient care, especially in recurrent diseases such as major depressive disorder. The aim of this study was to learn if machine learning (ML) models based on longitudinal speech data are helpful in predicting momentary depression severity. Data analyses were based on a dataset including 30 inpatients during an acute depressive episode receiving sleep deprivation therapy in stationary care, an intervention inducing a rapid change in depressive symptoms in a relatively short period of time. Using an ambulatory assessment approach, we captured speech samples and assessed concomitant depression severity via self-report questionnaire over the course of 3 weeks (before, during, and after therapy). We extracted 89 speech features from the speech samples using the Extended Geneva Minimalistic Acoustic Parameter Set from the Open-Source Speech and Music Interpretation by Large-Space Extraction (audEERING) toolkit and the additional parameter speech rate. Objective: We aimed to understand if a multiparameter ML approach would significantly improve the prediction compared to previous statistical analyses, and, in addition, which mechanism for splitting training and test data was most successful, especially focusing on the idea of personalized prediction. Methods: To do so, we trained and evaluated a set of >500 ML pipelines including random forest, linear regression, support vector regression, and Extreme Gradient Boosting regression models and tested them on 5 different train-test split scenarios: a group 5-fold nested cross-validation at the subject level, a leave-one-subject-out approach, a chronological split, an odd-even split, and a random split. Results: In the 5-fold cross-validation, the leave-one-subject-out, and the chronological split approaches, none of the models were statistically different from random chance. The other two approaches produced significant results for at least one of the models tested, with similar performance. In total, the superior model was an Extreme Gradient Boosting in the odd-even split approach (R²=0.339, mean absolute error=0.38; both P<.001), indicating that 33.9% of the variance in depression severity could be predicted by the speech features. Conclusions: Overall, our analyses highlight that ML fails to predict depression scores of unseen patients, but prediction performance increased strongly compared to our previous analyses with multilevel models. We conclude that future personalized ML models might improve prediction performance even more, leading to better patient management and care. UR - https://mental.jmir.org/2024/1/e64578 UR - http://dx.doi.org/10.2196/64578 ID - info:doi/10.2196/64578 ER - TY - JOUR AU - Rådestad, Monica AU - Kanfjäll, Torkel AU - Lindström, Veronica PY - 2024/12/19 TI - Real-Time Triage, Position, and Documentation (TriPoD) During Medical Response to Major Incidents: Protocol for an Action Research Study JO - JMIR Res Protoc SP - e57819 VL - 13 KW - action research KW - decision support technique KW - information technology KW - medical response KW - major incident KW - management N2 - Background: There is a need to address the implementation of technological innovation into emergency medical services to facilitate and improve information exchange between prehospital emergency care providers, command centers, and hospitals during major incidents to enable better allocation of resources and minimize loss of life. At present, there is a lack of technology supporting real-time information sharing in managing major incidents to optimize the use of resources available. Objective: The aim of this protocol is to develop, design, and evaluate information technology innovations for use in medical response to major incidents. Methods: This study has a qualitative action research design. This research approach is suitable for developing and changing practice in health care settings since it is cyclical in nature and involves development, evaluation, redevelopment, and replanning. The qualitative data collection will include workshops, structured meetings, semistructured interviews, questionnaires, observations, and focus group interviews. This study assesses the use of a digital solution for real-time information sharing by involving 3 groups of indented users: prehospital emergency care personnel, hospital personnel, and designated duty officers with experience and specific knowledge in managing major incidents. This study will explore end users? experiences and needs, and a digital solution for prehospital and hospital settings will be developed in collaboration with technology producers. Results: The trial implementation and evaluation phase for this study is from April 2024 to May 2026. Interviews and questionnaires with end users were conducted during the planning phase. We have performed observations in connection with 2 major exercises in April 2024 and November 2024. The outcome of this analysis will form the basis for the design and development of a new information technology system. We aim to complete the observations in training sessions and exercises (phase 3) by September 2025, followed by modification of the technology solutions tested (phase 4) before dissemination in a scientific journal. Conclusions: This protocol includes several methods for data collection that will form the basis for the design and development process of a digital solution for real-time information sharing to support efficient management in major incidents based on the experiences and requirements of end users. The findings from this study will contribute to the limited research on users? perspectives and the development of digital solutions for real-time information during major incidents. International Registered Report Identifier (IRRID): PRR1-10.2196/57819 UR - https://www.researchprotocols.org/2024/1/e57819 UR - http://dx.doi.org/10.2196/57819 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57819 ER - TY - JOUR AU - Pathak, R. Priya AU - Stockwell, S. Melissa AU - Lane, M. Mariellen AU - Robbins-Milne, Laura AU - Friedman, Suzanne AU - Pethe, Kalpana AU - Krause, C. Margaret AU - Soren, Karen AU - Matiz, Adriana Luz AU - Solomon, B. Lauren AU - Burke, E. Maria AU - Bracho-Sanchez, Edith PY - 2024/12/17 TI - Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study JO - JMIR Pediatr Parent SP - e57702 VL - 7 KW - telemedicine KW - telehealth KW - pediatric primary care KW - COVID-19 pandemic KW - disparities KW - primary care KW - pediatrics KW - portals KW - access KW - accessibility KW - accessible KW - use KW - demographics KW - low income KW - Latino KW - Hispanic KW - Spanish KW - mobile phone N2 - Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. Methods: A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. Results: There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4% (n=8959) of the population. Nearly all patients (n=10,830, 87.5%) had an activated portal, and 33.8% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95% CI 0.51-0.76; 5-11 years: aOR 0.28, 95% CI 0.23-0.32; 12-14 years: aOR 0.29, 95% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95% CI 0.74-0.89 and aOR 0.71, 95% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1%), dermatology (n=1287, 19.5%), gastrointestinal (n=771, 11.7%), well and follow-up care (n=459, 7%), and other specialty-related care (n=415, 6.3%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. Conclusions: The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations. UR - https://pediatrics.jmir.org/2024/1/e57702 UR - http://dx.doi.org/10.2196/57702 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57702 ER - TY - JOUR AU - Badwal, Singh Randeep AU - Cavo, Paul AU - Panesar, Mandip PY - 2024/12/17 TI - Insights and Trends in Open Note Access: Retrospective Observational Study JO - J Med Internet Res SP - e55982 VL - 26 KW - open note trends KW - open notes KW - open note access KW - open note use, open note sex KW - open note specialty KW - clinical note views KW - patient portal KW - patients KW - trends KW - hospitals KW - engagement KW - retrospective observational study KW - outpatient KW - assessment KW - older patients KW - adults KW - pandemic KW - COVID-19 N2 - Background: As of 2021, at least 4 out of every 5 hospitals offered patients access to clinical notes via a web-based patient portal, a number that is expected to grow because of the 21st Century Cures Act. There is limited data on how open note use may have evolved over time or which types of clinical interactions were viewed most in the outpatient setting. Objective: This study aims to analyze trends in outpatient open note access over time; characterize usage in terms of age, sex, and clinical interaction type; and assess the method of access to help uncover areas of improvement in patient engagement and identify further areas of research. Methods: A retrospective observational study was conducted at Erie County Medical Center from November 1, 2021, to December 31, 2022, to coincide with the time that open notes went live. Outpatient note access and account logs were downloaded from the portal and combined into a single dataset consisting of 18,384 note accesses by 4615 users, with column headings of the patient index, sex, age, note title that was accessed, clinical interaction type, time stamp of note creation, time stamp of access, and method of access (web vs mobile). A separate table was created with sex data for all 35,273 portal accounts. Microsoft Excel and Microsoft Power Query were used to combine and analyze the data. Results: During the study period, 4615 portal users viewed 12,150 documents for a total of 18,384 times, averaging 2.6 notes per patient viewed 4 times. Only 13.1% (4615/35,273) of all portal inpatient and outpatient registrants viewed their outpatient notes. There was a female predominance in those who viewed notes (2926/4615, 63.4%; P<.001), while 56.8% (20,047/35,273) of all portal registrants were female. Users in their 30s and 50s accessed more notes than other age groups. The ratio of mobile-to-web access of notes tended to decrease as a function of increasing age, which was not observed in those aged ?90 years. Notes regarding COVID-19 assessments were the most accessed among all clinical interactions (4725/12,150, 38.9%). Overall, the number of users accessing notes reached a maximum of 1968 before declining to 1027 by the end of the study period. Conclusions: Open note access was largely dominated by COVID-19 assessments, and the number of users viewing their notes has declined over time as the pandemic subsided. Furthermore, female patients and those aged in their 30s as well as 50s viewed more notes than other groups. Finally, the percentage of notes viewed via a mobile device tended to decrease as a function of increasing age, showing that web-based access of open notes is an important modality for older patients. UR - https://www.jmir.org/2024/1/e55982 UR - http://dx.doi.org/10.2196/55982 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55982 ER - TY - JOUR AU - Huang, Yi-Yan AU - Wang, Rong AU - Huang, Wei-Peng AU - Wu, Tian AU - Wang, Shi-Yun AU - R. Redding, Sharon AU - Ouyang, Yan-Qiong PY - 2024/12/17 TI - Effects of a Smartphone-Based Breastfeeding Coparenting Intervention Program on Breastfeeding-Related Outcomes in Couples During First Pregnancy: Randomized Controlled Trial JO - J Med Internet Res SP - e51566 VL - 26 KW - breastfeeding KW - co-parenting KW - randomized controlled KW - child KW - efficacy KW - depressive symptoms N2 - Background: A low breastfeeding rate causes an increased health care burden and negative health outcomes for individuals and society. Coparenting is an essential tactic for encouraging breastfeeding when raising a child. The efficacy of the coparenting interventions in enhancing breastfeeding-related outcomes is controversial. Objective: This study aimed to examine the effects of coparenting interventions on exclusive breastfeeding rates, exclusive breastfeeding duration, breastfeeding knowledge, parenting sense of competence, coparenting relationships, depressive symptoms in new couples at 1 and 6 months post partum, and the BMI of infants 42 days post partum. Methods: This was a randomized, single-blinded controlled clinical trial. Eligible couples in late pregnancy in a hospital in central China were randomly assigned to 2 groups. While couples in the control group received general care, couples in the intervention group had access to parenting classes, a fathers? support group, and individual counseling. Data were collected at baseline (T0), 1 month post partum (T1), and 6 months post partum (T2). Data on exclusive breastfeeding rate and exclusive breastfeeding duration were analyzed using the chi-square, Fisher exact, or Mann-Whitney U tests; coparenting relationships and the infant?s BMI were analyzed using an independent samples t test; and breastfeeding knowledge, parenting sense of competence, and depressive symptoms were analyzed using a generalized estimation equation. Results: A total of 96 couples were recruited, and 79 couples completed the study. The intervention group exhibited significantly higher exclusive breastfeeding rates at T1 (90% vs 65%, P=.02) and T2 (43.6% vs 22.5%, P=.02), compared with the control group. Exclusive breastfeeding duration was extended in the intervention group than in the control group at T1 (30, range 30-30 days vs 30, range 26.5-30 days; P=.01) and T2 (108, range 60-180 days vs 89, range 28-149.3 days; P<.05). The intervention group exhibited greater improvements in maternal breastfeeding knowledge (?=.07, 95% CI 0.006-0.13; P=.03) and maternal parenting sense of competence (?=5.49, 95% CI 2.09-8.87; P<.01) at T1, enhanced coparenting relationships at T1 (P<.001) and T2 (P=.02), paternal breastfeeding knowledge at T2 (?=.25, 95% CI 0.15-0.35, P<.001), paternal parenting sense of competence at T1 (?=5.35, 95% CI 2.23-8.47, P<.01), and reduced paternal depressive symptoms at T2 (?=.25, 95% CI 0.15-0.35, P<.001), and there was a rise in infants? BMI at 42 days post partum (?=.33, 95% CI 0.01-0.64, P=.04). Conclusions: An evidence-based breastfeeding coparenting intervention is effective in improving exclusive breastfeeding rate, prolonging exclusive breastfeeding duration within the initial 6 months post partum, enhancing parental breastfeeding knowledge, levels of parenting sense of competence and coparenting relationship, infant?s BMI, and reducing paternal depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069648; https://tinyurl.com/2p8st2p8 UR - https://www.jmir.org/2024/1/e51566 UR - http://dx.doi.org/10.2196/51566 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51566 ER - TY - JOUR AU - Helminski, Danielle AU - Sussman, B. Jeremy AU - Pfeiffer, N. Paul AU - Kokaly, N. Alex AU - Ranusch, Allison AU - Renji, Deep Anjana AU - Damschroder, J. Laura AU - Landis-Lewis, Zach AU - Kurlander, E. Jacob PY - 2024/12/10 TI - Development, Implementation, and Evaluation Methods for Dashboards in Health Care: Scoping Review JO - JMIR Med Inform SP - e59828 VL - 12 KW - dashboard KW - medical informatics KW - quality improvement KW - electronic health record KW - scoping review KW - monitoring KW - health care system KW - patient care KW - clinical research KW - emergency department KW - inpatient KW - clinical management N2 - Background: Dashboards have become ubiquitous in health care settings, but to achieve their goals, they must be developed, implemented, and evaluated using methods that help ensure they meet the needs of end users and are suited to the barriers and facilitators of the local context. Objective: This scoping review aimed to explore published literature on health care dashboards to characterize the methods used to identify factors affecting uptake, strategies used to increase dashboard uptake, and evaluation methods, as well as dashboard characteristics and context. Methods: MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from inception through July 2020. Studies were included if they described the development or evaluation of a health care dashboard with publication from 2018?2020. Clinical setting, purpose (categorized as clinical, administrative, or both), end user, design characteristics, methods used to identify factors affecting uptake, strategies to increase uptake, and evaluation methods were extracted. Results: From 116 publications, we extracted data for 118 dashboards. Inpatient (45/118, 38.1%) and outpatient (42/118, 35.6%) settings were most common. Most dashboards had ?2 stated purposes (84/118, 71.2%); of these, 54 of 118 (45.8%) were administrative, 43 of 118 (36.4%) were clinical, and 20 of 118 (16.9%) had both purposes. Most dashboards included frontline clinical staff as end users (97/118, 82.2%). To identify factors affecting dashboard uptake, half involved end users in the design process (59/118, 50%); fewer described formative usability testing (26/118, 22%) or use of any theory or framework to guide development, implementation, or evaluation (24/118, 20.3%). The most common strategies used to increase uptake included education (60/118, 50.8%); audit and feedback (59/118, 50%); and advisory boards (54/118, 45.8%). Evaluations of dashboards (84/118, 71.2%) were mostly quantitative (60/118, 50.8%), with fewer using only qualitative methods (6/118, 5.1%) or a combination of quantitative and qualitative methods (18/118, 15.2%). Conclusions: Most dashboards forego steps during development to ensure they suit the needs of end users and the clinical context; qualitative evaluation?which can provide insight into ways to improve dashboard effectiveness?is uncommon. Education and audit and feedback are frequently used to increase uptake. These findings illustrate the need for promulgation of best practices in dashboard development and will be useful to dashboard planners. International Registered Report Identifier (IRRID): RR2-10.2196/34894 UR - https://medinform.jmir.org/2024/1/e59828 UR - http://dx.doi.org/10.2196/59828 ID - info:doi/10.2196/59828 ER - TY - JOUR AU - Huang, Xuan AU - Wang, Ying AU - Yang, Xixian AU - Jiang, Ruo AU - Liu, Yicheng AU - Wang, Hui PY - 2024/12/4 TI - Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study JO - JMIR Form Res SP - e45763 VL - 8 KW - mobile health technology KW - smartphones KW - mobile phone KW - internet hospital KW - China N2 - Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China?s Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. UR - https://formative.jmir.org/2024/1/e45763 UR - http://dx.doi.org/10.2196/45763 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45763 ER - TY - JOUR AU - Spethmann, Sebastian AU - Hindricks, Gerhard AU - Koehler, Kerstin AU - Stoerk, Stefan AU - Angermann, E. Christiane AU - Böhm, Michael AU - Assmus, Birgit AU - Winkler, Sebastian AU - Möckel, Martin AU - Mittermaier, Mirja AU - Lelgemann, Monika AU - Reuter, Daniel AU - Bosch, Ralph AU - Albrecht, Alexander AU - von Haehling, Stephan AU - Helms, M. Thomas AU - Sack, Stefan AU - Bekfani, Tarek AU - Gröschel, Wolfgang Jan AU - Koehler, Magdalena AU - Melzer, Christoph AU - Wintrich, Jan AU - Zippel-Schultz, Bettina AU - Ertl, Georg AU - Vogelmeier, Claus AU - Dagres, Nikolaos AU - Zernikow, Jasmin AU - Koehler, Friedrich PY - 2024/12/4 TI - Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany JO - J Med Internet Res SP - e63391 VL - 26 KW - telemedicine KW - e-counseling KW - heart decompensation KW - Europe KW - patient care management N2 - Background: Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020. Objective: This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine?s integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine. Methods: We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring. Results: Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care. Conclusions: The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF. UR - https://www.jmir.org/2024/1/e63391 UR - http://dx.doi.org/10.2196/63391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63391 ER - TY - JOUR AU - Ma, Yuanchao AU - Lessard, David AU - Vicente, Serge AU - Engler, Kim AU - Rodriguez Cruz, Adriana AU - Laymouna, Moustafa AU - AU - Hijal, Tarek AU - Del Balso, Lina AU - Thériault, Guillaume AU - Paisible, Nathalie AU - Kronfli, Nadine AU - Pomey, Marie-Pascale AU - Peiris, Hansi AU - Barkati, Sapha AU - Brouillette, Marie-Josée AU - Klein, Marina AU - Cox, Joseph AU - de Pokomandy, Alexandra AU - Asselah, Jamil AU - Bartlett, J. Susan AU - Lebouché, Bertrand PY - 2024/12/4 TI - Implementing a Patient Portal for the Remote Follow-Up of Self-Isolating Patients With COVID-19 Infection Through Patient and Stakeholder Engagement (the Opal-COVID Study): Mixed Methods Pilot Study JO - J Particip Med SP - e48194 VL - 16 KW - SARS-CoV-2 KW - coronavirus KW - infectious disease KW - implementation science KW - Canada KW - patient portal KW - telehealth KW - telemedicine KW - app KW - health information technology KW - remote monitoring KW - mobile phone N2 - Background: The COVID-19 pandemic was an unprecedent challenge to public health systems, with 95% of cases in Quebec sent home for self-isolation. To ensure continuous care, we implemented an intervention supported by a patient portal (Opal) to remotely monitor at-home patients with COVID-19 via daily self-reports of symptoms, vital signs, and mental health that were reviewed by health care professionals. Objective: We describe the intervention?s implementation, focusing on the (1) process; (2) outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden; and (3) barriers and facilitators encountered by stakeholders. Methods: The implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In the mixed methods study at the McGill University Health Centre in Montreal, Quebec, participants completed questionnaires on implementation outcomes on days 1, 7, and 14. All scores were examined against predefined success thresholds. Linear mixed models and generalized estimating equations were used to assess changes in scores over time and whether they differed by sex, age, and race. Semistructured interviews were conducted with expert patients, health care professionals, and coordinators for the qualitative analysis and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research. Results: In total, 51 participants were enrolled between December 2020 and March 2021; 49 (96%) were included in the quantitative analysis. Observed recruitment and retention rates (51/52, 98% and 49/51, 96%) met the 75% feasibility success threshold. Over 80% of the participants found it ?quite easy/very easy? to complete the daily self-report, with a completion rate (fidelity) of >75% and a nonsignificant decreasing trend over time (from 100%, 49/49 to 82%, 40/49; P=.21). Mean acceptability and usability scores at all time points exceeded the threshold of 4 out of 5. Acceptability scores increased significantly between at least 2 time points (days 1, 7, and 14: mean 4.06, SD 0.57; mean 4.26, SD 0.59; and mean 4.25, SD 0.57; P=.04). Participants aged >50 years reported significantly lower mean ease of use (usability) scores than younger participants (days 1, 7, and 14: mean 4.29, SD 0.91 vs mean 4.67, SD 0.45; mean 4.13, SD 0.89 vs mean 4.77, SD 0.35; and mean 4.24, SD 0.71 vs mean 4.72, SD 0.71; P=.004). In total, 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders? recommendations, the adjustability of the intervention, and the team?s emphasis on safety. However, Opal?s thorough privacy protection measures and limited acute follow-up capacities were identified as barriers, along with implementation delays due to data security?related institutional barriers. Conclusions: The intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have potential for the remote follow-up of acute health conditions. International Registered Report Identifier (IRRID): RR2-10.2196/35760 UR - https://jopm.jmir.org/2024/1/e48194 UR - http://dx.doi.org/10.2196/48194 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48194 ER - TY - JOUR AU - Jolliff, Anna AU - Holden, J. Richard AU - Valdez, Rupa AU - Coller, J. Ryan AU - Patel, Himalaya AU - Zuraw, Matthew AU - Linden, Anna AU - Ganci, Aaron AU - Elliott, Christian AU - Werner, E. Nicole PY - 2024/12/3 TI - Investigating the Best Practices for Engagement in Remote Participatory Design: Mixed Methods Analysis of 4 Remote Studies With Family Caregivers JO - J Med Internet Res SP - e60353 VL - 26 KW - user-centered design KW - family caregivers KW - mobile health KW - digital health KW - web-based intervention KW - stakeholder engagement KW - patient engagement KW - community-based participatory action research KW - community participation KW - qualitative evaluation N2 - Background: Digital health interventions are a promising method for delivering timely support to underresourced family caregivers. The uptake of digital health interventions among caregivers may be improved by engaging caregivers in participatory design (PD). In recent years, there has been a shift toward conducting PD remotely, which may enable participation by previously hard-to-reach groups. However, little is known regarding how best to facilitate engagement in remote PD among family caregivers. Objective: This study aims to (1) understand the context, quality, and outcomes of family caregivers? engagement experiences in remote PD and (2) learn which aspects of the observed PD approach facilitated engagement or need to be improved. Methods: We analyzed qualitative and quantitative data from evaluation and reflection surveys and interviews completed by research and community partners (family caregivers) across 4 remote PD studies. Studies focused on building digital health interventions for family caregivers. For each study, community partners met with research partners for 4 to 5 design sessions across 6 months. After each session, partners completed an evaluation survey. In 1 of the 4 studies, research and community partners completed a reflection survey and interview. Descriptive statistics were used to summarize quantitative evaluation and reflection survey data, while reflexive thematic analysis was used to understand qualitative data. Results: In 62.9% (83/132) of evaluations across projects 1-3, participants described the session as ?very effective.? In 74% (28/38) of evaluations for project 4, participants described feeling ?extremely satisfied? with the session. Qualitative data relating to the engagement context identified that the identities of partners, the technological context of remote PD, and partners? understanding of the project and their role all influenced engagement. Within the domain of engagement quality, relationship-building and co-learning; satisfaction with prework, design activities, time allotted, and the final prototype; and inclusivity and the distribution of influence contributed to partners? experience of engagement. Outcomes of engagement included partners feeling an ongoing interest in the project after its conclusion, gratitude for participation, and a sense of meaning and self-esteem. Conclusions: These results indicate high satisfaction with remote PD processes and few losses specific to remote PD. The results also demonstrate specific ways in which processes can be changed to improve partner engagement and outcomes. Community partners should be involved from study inception in defining the problem to be solved, the approach used, and their roles within the project. Throughout the design process, online tools may be used to check partners? satisfaction with design processes and perceptions of inclusivity and power-sharing. Emphasis should be placed on increasing the psychosocial benefits of engagement (eg, sense of community and purpose) and increasing opportunities to participate in disseminating findings and in future studies. UR - https://www.jmir.org/2024/1/e60353 UR - http://dx.doi.org/10.2196/60353 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60353 ER - TY - JOUR AU - McCann, Lisa AU - Lewis, Liane AU - Oduntan, Olubukola AU - Harris, Jenny AU - Darley, Andrew AU - Berg, V. Geir AU - Lubowitzki, Simone AU - Cheevers, Katy AU - Miller, Morven AU - Armes, Jo AU - Ream, Emma AU - Fox, Patricia AU - Furlong, Patricia Eileen AU - Gaiger, Alexander AU - Kotronoulas, Grigorios AU - Patiraki, Elisabeth AU - Katsaragakis, Stylianos AU - McCrone, Paul AU - Miaskowski, Christine AU - Cardone, Antonella AU - Orr, Dawn AU - Flowerday, Adrian AU - Skene, Simon AU - Moore, Margaret AU - De Souza, Nicosha AU - Donnan, Peter AU - Maguire, Roma PY - 2024/12/3 TI - Patients? and Clinicians? Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study JO - J Med Internet Res SP - e53834 VL - 26 KW - cancer KW - clinician experiences KW - digital interventions KW - patient experiences KW - remote monitoring KW - qualitative methods N2 - Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention?Advanced Symptom Management System (ASyMS)?after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients? and clinicians? experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients? experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients? and clinicians? experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients? and clinicians? experiences using ASyMS. One central orienting theme?ASyMS as a facilitator of change?was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is ?normal? and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients? and clinicians? experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients? and clinicians? perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 UR - https://www.jmir.org/2024/1/e53834 UR - http://dx.doi.org/10.2196/53834 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53834 ER - TY - JOUR AU - Rivas Velarde, Minerva AU - Izquierdo Martinez, Catalina Laura AU - Dalal, Jyoti AU - Martinez-R, Angela AU - Cruz Reyes, Lesley Danna AU - Cuculick, Jess AU - Vallejo-Silva, Alexie AU - Irreño-Sotomonte, Jonathan AU - Groce, Nora PY - 2024/12/2 TI - Video Remote Sign Language Interpreting in Health Communication for Deaf People: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64590 VL - 13 KW - assistive technology KW - video remote interpretation KW - deaf KW - disability KW - communication KW - healthcare N2 - Background: The current standard of interpretation provision is not efficacious or not acceptable to Deaf patients who communicate using sign language. In-person or video relay interpretation (VRI) sign language interpretation is largely unavailable. There are no clear data on the availability of VRI or in-person interpretation. Given the limited number of available sign language interpreters and the cost, VRI may be more available than in-person. Existing evidence tends to focus on assessing personal preferences of Deaf users regarding interpretation and interpreters? preferences. Although respecting preferences is essential, there is a vacuum of knowledge on how the format of access to interpretation impacts the quality of communication between Deaf persons and health personnel. Objective: This study aims to look at the effectiveness of the VRI system in improving communication outcomes between Deaf patients and doctors versus the available standard of care of the usual communication tools, including informal interpretation, lip- or note-reading, and using their mobile phones to contact a formal or informal interpreter, for Deaf patients aged 18 years and older in Bogota, Colombia. Methods: This is a randomized controlled trial with a total sample size of 216 participants, divided into 2 groups: an intervention group, which receives a medical appointment using VRI, and a control group, which receives a medical appointment using standard communication. Both the Deaf participants and the health care professionals will be blinded to the allocation, as they will not know whether the appointment will involve VRI or standard communication until they arrive at the office. The primary outcome measure will be an assessment of communication using a Doctor-Patient Communication Scale. This scale was translated into Colombian Sign Language following a rigorous cultural adaptation and translation procedure. Furthermore, the database contains key clinical variables and recommendations provided by the doctor during a general medicine appointment. We will compute associations. Results: Recruitment opened on August 24, 2023. As of July 2024, 180 participants had been enrolled. The intervention and data collection were finalized in October 2024. The findings of this study are expected to be submitted for publication in early 2025. Conclusions: This study will provide rigorous evidence regarding information and communications technology intervention in health care, addressing empirical challenges in using inclusive research designs in public health. In addition, effective VRI models that address the challenges faced by Deaf people will be tested, implemented, and maintained in low- and middle-income countries. A disability-inclusive evaluative tool for quality communication mediated by VRI in health care is also tested. Ultimately, this will lead to evidence-based recommendations for implementing the Convention on the Rights of Persons with Disabilities (CRPD) in mobile health contexts. Trial Registration: ClinicalTrials.gov NCT05966623; https://clinicaltrials.gov/study/NCT05966623 International Registered Report Identifier (IRRID): DERR1-10.2196/64590 UR - https://www.researchprotocols.org/2024/1/e64590 UR - http://dx.doi.org/10.2196/64590 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64590 ER - TY - JOUR AU - Narayan, Shawna AU - Gooderham, Ellie AU - Spencer, Sarah AU - McCracken, K. Rita AU - Hedden, Lindsay PY - 2024/12/2 TI - Virtual Primary Care for People With Opioid Use Disorder: Scoping Review of Current Strategies, Benefits, and Challenges JO - J Med Internet Res SP - e54015 VL - 26 KW - telehealth KW - virtual care KW - primary care KW - opioid use disorder KW - opioid agonist therapy KW - COVID-19 KW - mobile phone N2 - Background: There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. Objective: This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies. Methods: We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research. Results: Our search identified 1474 studies. We removed 36.36% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3% (28/938) of the studies for extraction. Only 14% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39%) or impede (7/28, 25%) the provision of care virtually. In addition, clinicians? perceptions of patient stability (5/28, 18%) and the heightened risks associated with virtual care (10/28, 36%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43%). Conclusions: The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities. UR - https://www.jmir.org/2024/1/e54015 UR - http://dx.doi.org/10.2196/54015 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54015 ER - TY - JOUR AU - Su, Jingyuan AU - Shen, Ning Kathy AU - Guo, Xitong PY - 2024/11/29 TI - Impact of Reverse Empowerment and Proactive Motivations on Physicians? Online Knowledge Sharing in Digital Platforms: Survey Study JO - J Med Internet Res SP - e59904 VL - 26 KW - physician behavior KW - online knowledge sharing KW - proactivity KW - patient empowerment KW - digital platforms KW - health communication N2 - Background: Digital platforms offer a venue for patients and physicians to exchange health information and provide health care services outside traditional organizational contexts. Previous studies have seldom focused on the factors that drive the proactivity of physicians? online behavior. Additionally, there is limited research exploring the influence of patients on physicians? online behavior, particularly from the perspective of patients possessing power. Objective: This study aims to investigate the effect of patient-empowering behaviors on physicians? online knowledge sharing and uncover the potential mechanisms of proactivity. Based on the proactive motivational model and empowerment theory, we propose the existence of a reverse empowerment process, where empowerment flows from patients to physicians. We suggest that patient-empowering behaviors may drive physicians? online knowledge sharing as a form of proactivity. Specifically, 3 proactive motivational states?knowledge-sharing self-efficacy, sharing meaning, and positive professional affect?mediate this relationship. Additionally, platform extrinsic rewards, as a contextual factor, have a moderating effect. Methods: To validate our proposed research model, we conducted a survey in China using the WJX platform, targeting physicians engaged in online knowledge sharing. The measurement instrument utilizes validated items adapted from prior research, using a 5-point Likert scale. We collected 257 valid responses, ensuring that participation was both anonymous and voluntary. Data analysis was performed in 2 stages. The first stage assessed the measurement model for reliability and validity, using the Harman 1-factor test and confirmatory factor analysis. The second stage used partial least squares-structural equation modeling to examine the direct, moderation, and mediation effects among the constructs, with bootstrapping used for significance testing. This comprehensive approach ensures a robust analysis of the proposed hypotheses and contributes to the overall validity of our research model. Results: Perceived patient-empowering behaviors significantly and positively influence physicians? online knowledge sharing (?=0.27, P<.001). Knowledge-sharing self-efficacy (effect=0.06, P=.04), sharing meaning (effect=0.12, P<.001), and positive professional affect (effect=0.10, P=.003) each partially mediate the effect of patient-empowering behaviors on physicians? online knowledge sharing. The overall proactive motivational states play a complete mediation role, meaning the entire indirect effect of the model is significant (effect=0.29, P<.001), while the direct effect in the model is nonsignificant (effect=0.07, P=.26). Additionally, platform extrinsic rewards significantly and negatively moderate the effect of sharing meaning on physicians? online knowledge sharing (?=?0.13, P=.001). Conclusions: This study is the first to recognize and examine proactivity as an alternative mediating mechanism for physicians? online knowledge sharing, highlighting the active role of patients in empowering physicians. It makes a significant contribution to the existing literature on empowerment, eHealth, and proactive behavior. Additionally, the findings offer valuable guidance for designing and managing digital platforms to ensure service sustainability. UR - https://www.jmir.org/2024/1/e59904 UR - http://dx.doi.org/10.2196/59904 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59904 ER - TY - JOUR AU - Smith, C. Lisa AU - Johnson, George AU - Jadhav, Snehal AU - Kabayundo, Josiane AU - Ahuja, Muskan AU - Wang, Hongmei AU - Ratnapradipa, L. Kendra PY - 2024/11/28 TI - Ever Use of Telehealth in Nebraska by March 2021: Cross-Sectional Analysis JO - J Med Internet Res SP - e53320 VL - 26 KW - COVID-19 KW - digital divide KW - health care access KW - telehealth KW - cross-sectional study KW - Nevada KW - United States KW - adult KW - medical care KW - geographical area KW - disparity KW - accessibility KW - utilization KW - survey KW - chi-square test KW - regression model KW - socioeconomic KW - demographic KW - health condition KW - digital health N2 - Background: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients? access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated. Objective: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas. Methods: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions. Results: The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor?s degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P?.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth. Conclusions: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted. UR - https://www.jmir.org/2024/1/e53320 UR - http://dx.doi.org/10.2196/53320 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53320 ER - TY - JOUR AU - Tisdale, Lauren Rebecca AU - Purmal, Colin AU - Kalwani, Neil AU - Sandhu, Alexander AU - Heidenreich, Paul AU - Zulman, Donna AU - Hussain, Tanvir PY - 2024/11/28 TI - Opportunities to Address Specialty Care Deserts and the Digital Divide through the Veterans Health Administration?s Telehealth Hub-and-Spoke Cardiology Clinic: Retrospective Cohort Study JO - J Med Internet Res SP - e53932 VL - 26 KW - telehealth KW - specialty care KW - cardiovascular disease KW - telemedicine KW - cardiology KW - veterans KW - low income KW - digital divide KW - access KW - Veterans Health Administration KW - VA KW - VHA KW - rural KW - clinical resource hub KW - CRH N2 - Background: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs. Objective: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA?s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user. Results: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37% (n=292 vs n=213) in users and 64% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3% (67/804) were female and 41.4% (333/804) were aged ?75 years, compared with 4.3% (840/19,583) and 49% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5%; nonusers: 4936/19,583, 25.2%), highly disabled (users: 387/804, 48.1%; nonusers: 9246/19,583, 47.2%), and low-income (users: 165/804, 20.5%; nonusers: 3941/19,583, 20.1%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95% CI 1.29-2.24) and lower for older veterans (aged ?75 years; 0.33, 95% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95% CI 1.00-1.42; P=.046). Conclusions: The VA?s Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings. UR - https://www.jmir.org/2024/1/e53932 UR - http://dx.doi.org/10.2196/53932 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53932 ER - TY - JOUR AU - Yan, Z. Allie AU - Staab, M. Erin AU - Nuñez, Daisy AU - Zhu, Mengqi AU - Wan, Wen AU - Schaefer, T. Cynthia AU - Campbell, Amanda AU - Quinn, T. Michael AU - Baig, A. Arshiya PY - 2024/11/28 TI - Impact of a Text Messaging Intervention as an In-Between Support to Diabetes Group Visits in Federally Qualified Health Centers: Cluster Randomized Controlled Study JO - JMIR Diabetes SP - e55473 VL - 9 KW - diabetes KW - diabetes mellitus KW - type 2 diabetes KW - mHealth KW - mobile health KW - digital health KW - digital technology KW - digital intervention KW - text messaging intervention KW - text message KW - text messaging KW - texting KW - federally qualified health center KW - FQHC KW - mobile phone N2 - Background: In the United States, 1 in 11 people receive primary care from a federally qualified health center (FQHC). Text messaging interventions (TMIs) are accessible ways to deliver health information, engage patients, and improve health outcomes in the health center setting. Objective: We aimed to evaluate the impact of a TMI implemented with a group visit (GV) intervention among patients with type 2 diabetes mellitus (T2DM) at FQHCs on patient-reported outcomes and clinical outcomes based on patient TMI engagement. Methods: A TMI was implemented for 11 health centers participating in a cluster randomized study of diabetes GVs in Midwestern FQHCs targeting adults with T2DM. FQHC patients participated in 6 monthly GVs either in person or online and a concurrent 25-week TMI. Outcome measures included clinical markers such as glycated hemoglobin A1c and patient-reported diabetes distress, diabetes self-care, diabetes self-efficacy, diabetes care knowledge, diabetes quality of life, diabetes social support, and TMI use and satisfaction. TMI response rate was calculated as responses to an SMS text message requesting a response divided by total messages requesting a response sent. Patients were grouped as high responders if their response rate was greater than or equal to the median response rate and low responders if their response rate was below the median. We conducted linear mixed models to compare high and low responders and within a group, adjusting for age, gender, GV attendance, and depression/anxiety at baseline. Results: In total, 101 of 124 GV patients (81.5%) enrolled in the TMI. The average age of the population in the TMI was 53 years. Of the 101 respondents, 61 (60%) were racial or ethnic minorities, while 42 of 82 respondents (51%) had a high school diploma/General Education Development or less, and 56 of 80 respondents (71%) reported an annual income less than US $30,000. In addition, 70 of 81 respondents (86%) owned a smartphone and 74 of 80 respondents (93%) had an unlimited texting plan. The median response rate was 41% and the mean response rate was 41.6%. Adjusted models showed significantly improved diabetes knowledge (P<.001), foot care (P<.001), and exercise (P=.002) in high responders (n=34) compared to low responders (n=23) at 6 months. No group difference was found in glycated hemoglobin A1c. Within high responders, diabetes distress (P=.001), social support (P<.001), quality of life (P<.001), diabetes knowledge (P<.001), foot care (P<.001), and diet (P=.003) improved from baseline to 6 months. Low responders only improved in diabetes quality of life (P=.003) from baseline to 6 months. Conclusions: In a FQHC safety net population participating in a combined TMI and GV intervention, our study showed improved diabetes distress, social support, knowledge, self-care, self-efficacy, and quality of life among patients highly engaged in the SMS text messaging program. Trial Registration: ClinicalTrials.gov NCT03487692; https://clinicaltrials.gov/study/NCT03487692 UR - https://diabetes.jmir.org/2024/1/e55473 UR - http://dx.doi.org/10.2196/55473 ID - info:doi/10.2196/55473 ER - TY - JOUR AU - Chiou, Piao-Yi AU - Tsao, Wei-Wen AU - Li, Chia-Lin AU - Yu, Jheng-Min AU - Su, Wen-Han AU - Liu, Zhi-Hua AU - He, Cheng-Ru AU - Chang, Yu-Chun AU - Tsai, Yi-Hsuan PY - 2024/11/28 TI - Recruitment for Voluntary Video and Mobile HIV Testing on Social Media Platforms During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e54420 VL - 26 KW - COVID-19 KW - HIV testing KW - mobile health KW - risk-taking behavior KW - social media KW - video KW - mobile phone N2 - Background: The COVID-19 pandemic prompted social distancing policies and caused misinformation that hindered in-person HIV screening for high-risk groups. Social media platforms provide additional options for voluntary counseling and testing (VCT) for HIV, overcoming these limitations. However, there is a lack of data on HIV testing recruitment through social media platforms and its outcomes during the pandemic. Objective: This study aimed to measure the rate of face-to-face mobile and video VCT conducted after recruitment through social media platforms and friend referrals during the pandemic and compare the geographic distribution, risk feature targeting, testing outcome, and cost between the 2 models. Methods: Data were collected from March 3 to December 31, 2021, during the COVID-19 outbreak in Taiwan. Participants engaging in unprotected sex were recruited. After one-on-one message discussions through the platforms, the well-trained research assistants provided mobile or video VCT based on the participants? availability. Primary outcomes were completion rate, testing results, and CD4 count. Secondary outcomes included demographic and HIV risk-taking and protective features from a questionnaire. Selection bias was controlled by adjusting for the testing site (Taipei vs non-Taipei) using univariable multinomial logistic regression. Results: This study gathered 5142 responses on the social media platforms, recruiting 1187 participants. Video VCT had a completion rate of 31.8% (207/651), higher than mobile VCT?s 21.8% (980/4491). Both rates were higher than those before the COVID-19 pandemic. Recruitment through friend referrals, instant messaging apps (eg, Line [LY Corporation]), and geosocial dating apps (eg, Hornet [Queer Networks Inc], Grindr [Grindr LLC], and Gsland [Tien-Hao Tsai]) resulted in higher acceptance and completion rates than social networks (eg, Facebook [Meta], X [formerly Twitter], and Instagram [Meta]). Mobile VCT had higher recruitment among urban residents and screening density, while video VCT reached a broader geographic area. The mobile group was more likely to have had more than 10 sexual partners (odds ratio [OR] 1.92, 95% CI 1.05-3.50; P=.03), history of sex work (OR 4.19, 95% CI 1.68-10.43; P=.002), and sexually transmitted diseases (OR 2.23, 95% CI 1.18-4.23; P=.01) within the past 3 months. The video group was more likely to meet sexual partners through social media. The HIV-positive rate in the mobile group was 0.7% (7/973) with an average CD4 count of 460/?L, while in the video group, it was 1% (2/205) with an average CD4 count of 347/?L, indicating a later diagnosis. Both positivity rates were higher than those before the COVID-19 pandemic, with no significant difference between the groups. The video group cost US $54.68 per participant, slightly higher than the US $50.36 for the mobile group. Conclusions: Recruiting through social media platforms that facilitate one-on-one message discussions can effectively target high-risk groups for mobile and video VCT. This approach should be integrated into the current screening model to enhance HIV case finding. UR - https://www.jmir.org/2024/1/e54420 UR - http://dx.doi.org/10.2196/54420 UR - http://www.ncbi.nlm.nih.gov/pubmed/39607762 ID - info:doi/10.2196/54420 ER - TY - JOUR AU - Nabelsi, Veronique AU - Leclerc, Chantal Marie AU - Plouffe, Véronique PY - 2024/11/27 TI - Nurses? and Nursing Assistants? Experiences With Teleconsultation in Small Rural Long-Term Care Facilities: Semistructured Interview Pilot Study JO - JMIR Aging SP - e65111 VL - 7 KW - teleconsultation KW - long-term care facilities KW - nursing KW - nursing practices KW - workflow optimization KW - residents KW - rural KW - telehealth KW - Quebec N2 - Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers (?Centres d?hébergement et de soins de longue durée?; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec?s Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project. Objective: This study aims to explore nurses? and nursing assistants? experience of integrating teleconsultation during night shifts in rural CHSLDs with ?50 residents. Methods: The 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. Results: Participants? experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals? roles and in supporting effective adaptation to teleconsultation. Conclusions: This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents. UR - https://aging.jmir.org/2024/1/e65111 UR - http://dx.doi.org/10.2196/65111 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65111 ER - TY - JOUR AU - McGowan, J. Laura AU - Graham, Fiona AU - Lecouturier, Jan AU - Goffe, Louis AU - Echevarria, Carlos AU - Kelly, P. Michael AU - Sniehotta, F. Falko PY - 2024/11/27 TI - The Views and Experiences of Integrated Care System Commissioners About the Adoption and Implementation of Virtual Wards in England: Qualitative Exploration Study JO - J Med Internet Res SP - e56494 VL - 26 KW - virtual wards KW - remote monitoring KW - whole systems KW - qualitative KW - implementation science KW - integrated care system KW - England KW - digital technology KW - acute care KW - clinical practice KW - semistructured interviews KW - thematic analysis KW - patient-centered care KW - hospital-centric language KW - eHealth KW - health services N2 - Background: Virtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees involved in the planning of, agreeing to, and monitoring of services within NHS England and have an important role in the adoption and implementation of VWs in clinical practice. Objective: This study aims to develop an understanding of the acceptability and feasibility of adopting and implementing VWs in England from integrated care system commissioners? perspectives, including the identification of barriers and facilitators to implementation. Methods: Qualitative semistructured interviews were conducted with 20 commissioners employed by NHS England (NHSE) in various geographic regions of England. Thematic analysis was conducted, structured using the framework approach, and informed by the Consolidated Framework for Implementation Research. The COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines were followed. Results: Four overarching themes were identified reflecting the acceptability and feasibility of key adoption and implementation processes: (1) assessing the need for VWs, (2) coordinating a system approach, (3) agreeing to Program Outcomes: NHSE Versus Organizational Goals, and (4) planning and adapting services. Commissioners expressed the need for system-level change in care provision within the NHS, with VWs perceived as a promising model that could reform patient-centered care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also uncertainty over the extent to which VWs should be technology-enabled, and the specific ways technology may enhance condition-specific pathways. Differing interpretations of the NHSE instructions between different health care sectors and a lack of clarity in definitions, as well as use of hospital-centric language within national guidance, were considered hindrances to convening a system approach. Furthermore, narrow parameters of success measures in terms of goals and outcomes of VWs, unrealistic timescales for planning and delivery, lack of interoperability of technology and time-consuming procurement procedures, liability concerns, and patient suitability for technology-enabled home-based care were identified as barriers to implementation. Motivated and passionate clinical leads were considered key to successful implementation. Conclusions: VWs have the potential to reform patient-centered care in England and were considered a promising approach by commissioners in this study. However, there should be greater clarity over definitions and specifications for technology enablement and evidence provided about how technology can enhance patient care. The use of less hospital-centric language, a greater focus on patient-centered measures of success, and more time allowance to ensure the development of technology-enabled VW services that meet the needs of patients and staff could enhance adoption and implementation. UR - https://www.jmir.org/2024/1/e56494 UR - http://dx.doi.org/10.2196/56494 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56494 ER - TY - JOUR AU - McCaffrey, Graham AU - Wilson, Erin AU - Zimmer, V. Lela AU - Singh, Anurag AU - Jonatansdottir, Steinunn AU - Zimmer, Peter AU - Snadden, David AU - Graham, D. Ian AU - MacLeod, Martha PY - 2024/11/26 TI - Effects of Virtual Care on Patient and Provider Experience of the Clinical Encounter: Qualitative Hermeneutic Study JO - J Med Internet Res SP - e52552 VL - 26 KW - virtual medicine KW - telehealth KW - professional-patient relations KW - hermeneutics KW - kidney KW - health care facility KW - British Columbia KW - Canada KW - qualitative research KW - eHealth KW - health informatics KW - physician KW - COVID-19 KW - pandemic KW - patient experience N2 - Background: Virtual health care has transformed health care delivery, with its use dramatically increasing since the COVID-19 pandemic. While it has been quickly adopted for its convenience and efficiency, there has been a relative lack of in-depth exploration of its human impact, specifically how both patients and providers experience clinical encounters. Objective: This analysis aims to identify and explore themes of change in how patients and providers in a geographically dispersed renal service described their experiences with virtual care, including those changes that occurred during the COVID-19 pandemic. Methods: Hermeneutics is an interpretive research methodology that treats human experience as inherently interpretive, generating meaning through interactions with others in specific, historically conditioned, social contexts. A total of 17 patients and 10 providers from various disciplines were interviewed by phone as part of a study on health care implementation in the context of a kidney care service in northern British Columbia, Canada. The interview data were analyzed using a hermeneutic approach, which emphasizes careful attention to reported experiences in relation to the relationships and contexts of care. Results: During analysis, the interdisciplinary team identified themes related to changes in the clinical encounter and how virtual care influenced perceptions of care among both providers and patients. We organized these themes into 2 categories: the structure and content of the encounter. The structure category included the convenience for patients, who no longer had to travel long distances for appointments, as well as changes in care networks. For example, communication between specialist services and local primary care providers became more crucial for ensuring continuity of care. The content category included issues related to trust-building and assessment. Providers expressed concerns about the difficulty in assessing and understanding their patients? physical and social well-being beyond laboratory results. Conclusions: Patients in the study appreciated the convenience of not needing to travel for appointments, while still having the option for in-person contact with local providers or specialists if their condition changed. Providers were more concerned about the loss of visual cues and sensory data for assessments, as well as the reduced opportunity to build relationships through conversation with patients. Providers also described changes in the locus of control and boundaries, as patients could join phone encounters from anywhere, bypassing traditional privacy and confidentiality boundaries. The study offers a nuanced view of the effects of virtual care on clinical encounters in one setting, seen through the experiences of both patients and providers. UR - https://www.jmir.org/2024/1/e52552 UR - http://dx.doi.org/10.2196/52552 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52552 ER - TY - JOUR AU - Craig, William AU - Ohlmann, Suzanne PY - 2024/11/26 TI - The Benefits of Using Active Remote Patient Management for Enhanced Heart Failure Outcomes in Rural Cardiology Practice: Single-Site Retrospective Cohort Study JO - J Med Internet Res SP - e49710 VL - 26 KW - rural KW - remote patient monitoring KW - heart failure KW - heart failure hospitalizations KW - office visits KW - rural health inequalities KW - telehealth N2 - Background: Rural populations have a disproportionate burden of heart failure (HF) morbidity and mortality, associated with socioeconomic and racial inequities. Multiple randomized controlled trials of remote patient monitoring (RPM) using both direct patient contact and device-based monitoring have been conducted to assess improvement in HF outcomes, with mixed results. Objective: We aimed to assess whether a novel digital health care platform designed to proactively assess and manage patients with HF improved patient outcomes by preventing HF re-exacerbations, thus reducing emergency room visits and HF hospitalizations. Methods: This was a single-site, retrospective cohort study using electronic medical record (EMR) data gathered from 2 years prior to RPM initiation and 2 years afterward. In January 2017, this single center began enrolling New York Heart Association (NYHA) class II and class III patients with HF prone to HF exacerbation into an RPM program using the Cordella HF system. By July 2022, 93 total patients had been enrolled in RPM. Of these patients, 87% lived in rural areas. This retrospective review included 40 of the 93 patients enrolled in RPM. These 40 were selected because they had 2 years of established EMR data prior to initiation of RPM and 2 years of post-RPM data; each consented to this Sterling IRB?approved study. Results: We included 40 patients with at least 4 years of follow-up, including 2 years prior to RPM initiation and 2 years after RPM initiation. In the 2 years after RPM initiation, check-up calls increased 519%, medication change calls increased 519%, and total calls increased by 519%. Emergency room visits for HF fell 93%, heart failure hospitalizations fell 83%, and all other cardiovascular hospitalizations fell 50%. Additionally, the total number of office visits declined by 15% after RPM, and unscheduled or urgent office visits declined by 73%. Conclusions: Daily monitoring of trends in vital sign data between engaged patients and a collaborative team of clinicians, incorporated into daily clinical workflow, enhanced patient interactions and allowed timely response or intervention when HF decompensation occurred, resulting in a reduction of outpatient and inpatient clinical use over more than 2 years of follow-up. UR - https://www.jmir.org/2024/1/e49710 UR - http://dx.doi.org/10.2196/49710 UR - http://www.ncbi.nlm.nih.gov/pubmed/39589775 ID - info:doi/10.2196/49710 ER - TY - JOUR AU - Tao, Youyou AU - Vo, Ace AU - Wu, Dezhi AU - Lin, Junyuan AU - Seal, Kala AU - Mishra, Abhay AU - Brahma, Arindam PY - 2024/11/25 TI - Impact of Telehealth on Health Disparities Associated With Travel Time to Hospital for Patients With Recurrent Admissions: 4-Year Panel Data Analysis JO - J Med Internet Res SP - e63661 VL - 26 KW - telehealth KW - health disparities KW - travel time KW - length of stay KW - recurrent admissions KW - health care access KW - virtualization potential KW - virtual care N2 - Background: Geographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time?the time required for patients to travel from their residences to health facilities?remain understudied compared with others. Objective: This study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital. Methods: We sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients? travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups. Results: Our summary statistics show that, on average, 22.08% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients? drive time to the hospital increases. Specifically, the coefficient for drive time is ?0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases. Conclusions: Our findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth?s role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth. UR - https://www.jmir.org/2024/1/e63661 UR - http://dx.doi.org/10.2196/63661 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63661 ER - TY - JOUR AU - Lockhart, Elizabeth AU - Gootee, Jordan AU - Copeland, Leah AU - Turner, DeAnne PY - 2024/11/22 TI - Willingness to Be Contacted via a Patient Portal for Health Screening, Research Recruitment, and at-Home Self-Test Kits for Health Monitoring: Pilot Quantitative Survey JO - JMIR Form Res SP - e59837 VL - 8 KW - patient portals KW - patient engagement KW - personal health records KW - risk assessments KW - health information KW - information access KW - open notes KW - user perceptions N2 - Background: Patient portals are being increasingly used by health systems in the United States. Although some patients use portals for clinical use, patient perspectives on using portals for research-related activities, to complete health screenings, and to request at-home self-test kits are unclear. Objective: We aimed to understand patient perspectives on using electronic health portals for research; health-related screenings; and patient-initiated, home-based self-testing. Methods: Patients (N=105) from the Patient Engaged Research Center at a large, urban, midwestern health system completed a 23-item web-based survey on patient portal (MyChart) use and willingness to use the patient portal for research, risk assessments, and self-test kits. Frequencies and percentages were generated. Results: Almost all participants (102/105, 97.1%) had accessed MyChart at least once, with most (44/102, 43.1%) indicating they logged in at least once per month. Participants indicated logging into MyChart to check laboratory results or other health data (89/105, 84.8%), because they received a message to log in (85/105, 81%), and to message their health care professional (83/105, 79%). Fewer participants logged in to see what medications they had been prescribed (16/105, 15.2%) and to learn more about their health conditions (29/105, 27.6%). Most participants indicated logging into MyChart on a computer via a website (70/105, 66.7%) or on a smartphone via an app (54/105, 51.4%). When asked about how likely they would be to participate in different types of research if contacted via MyChart, most (90/105, 85.7%) said they would be likely to answer a survey, fill out a health assessment (87/105, 82.9%), or watch a video (86/105, 81.9%). Finally, participants would be willing to answer risk assessment questions on MyChart regarding sleep (74/101, 73.3%), stress (65/105, 61.9%), diabetes (60/105, 57.1%), anxiety (59/105, 56.2%), and depression (54/105, 51.4%) and would be interested in receiving an at-home self-test kit for COVID-19 (66/105, 62.9%), cholesterol (63/105, 60%), colon cancer (62/105, 59%), and allergies (56/105, 53.3%). There were no significant demographic differences for any results (all P values were >.05). Conclusions: Patient portals may be used for research recruitment; sending research-related information; and engaging patients to answer risk assessments, read about health information, and complete other clinical tasks. The lack of significant findings based on race and gender suggests that patient portals may be acceptable tools for recruiting research participants and conducting research. Allowing patients to request self-test kits and complete risk assessments in portals may help patients to take agency over their health care. Future research should examine if patient portal recruitment may help address persistent biases in clinical trial recruitment to increase enrollment of women and racial minority groups. UR - https://formative.jmir.org/2024/1/e59837 UR - http://dx.doi.org/10.2196/59837 ID - info:doi/10.2196/59837 ER - TY - JOUR AU - Bavngaard, Vinther Martin AU - Lund, Anne AU - Thordardottir, Björg AU - Rasmussen, Børve Erik PY - 2024/11/22 TI - The Uses and Experiences of Synchronous Communication Technology for Home-Dwelling Older Adults in a Home Care Services Context: Qualitative Systematic Review JO - J Med Internet Res SP - e59285 VL - 26 KW - systematic review KW - qualitative KW - thematic synthesis KW - communication technology KW - relatives KW - home care services KW - aging in place KW - home-dwelling KW - older adult KW - aging KW - gerontology KW - European KW - effectiveness KW - information KW - technology KW - health care provider KW - cross-disciplinary KW - telehealth KW - telemonitoring N2 - Background: European health care systems regard information and communication technology as a necessity in supporting future health care provision by community home care services to home-dwelling older adults. Communication technology enabling synchronous communication between 2 or more human actors at a distance constitutes a significant component of this ambition, but few reviews have synthesized research relating to this particular type of technology. As evaluations of information and communication technology in health care services favor measurements of effectiveness over the experiences and dynamics of putting these technologies into use, the nuances involved in technology implementation processes are often omitted. Objective: This review aims to systematically identify and synthesize qualitative findings on the uses and experiences of synchronous communication technology for home-dwelling older adults in a home care services context. Methods: The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist for reporting. We conducted a cross-disciplinary search in 5 databases for papers published between 2011 and 2023 that yielded 4210 citations. A total of 13 studies were included after 4 screening phases and a subsequent appraisal of methodological quality guided by the Critical Appraisal Skills Programme tool. From these, prespecified data were extracted and incorporated in a 3-stage thematic synthesis producing 4 analytical themes. Results: The first theme presented the multiple trajectories that older users? technology acceptance could take, namely straightforward, gradual, partial, and resistance laden, notwithstanding outright rejection. It also emphasized both instrumental and emotional efforts by the older adults? relatives in facilitating acceptance. Moving beyond acceptance, the second theme foregrounded the different types of work involved in attempts to integrate the technology by older users, their relatives, and health care providers. Theme 3 highlighted how the older users? physical and cognitive conditions formed a contextual backdrop challenging this integration work, together with challenges related to spatial context. Finally, consequences derived from taking the technology into use could be of a both enabling and complicating nature as integration reconfigured the way users related to themselves and each other. Conclusions: The acceptance and integration of synchronous communication technology for older adults involves multiple user groups in work tending to the technology, to the users themselves, and to each other through intergroup negotiations. This review?s original contribution consists of its attention to the dynamics across different user groups in deriving consequences from using the technology in question, in addition to its assertion that such consequences may be both intentional and unintentional. We argue that our findings may be used to provide nuance to policies addressing?and practices taking place in?contexts that involve similar user technology constellations to the ones explored in this paper. Trial Registration: PROSPERO CRD42023414243; https://tinyurl.com/wrha6j3f UR - https://www.jmir.org/2024/1/e59285 UR - http://dx.doi.org/10.2196/59285 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59285 ER - TY - JOUR AU - Schmollinger, Martin AU - Gerstner, Jessica AU - Stricker, Eric AU - Muench, Alexander AU - Breckwoldt, Benjamin AU - Sigle, Manuel AU - Rosenberger, Peter AU - Wunderlich, Robert PY - 2024/11/21 TI - Evaluation of an App-Based Mobile Triage System for Mass Casualty Incidents: Within-Subjects Experimental Study JO - J Med Internet Res SP - e65728 VL - 26 KW - disaster medicine KW - mass casualty incidents KW - digitalization KW - triage KW - Germany KW - mobile triage app N2 - Background: Digitalization in disaster medicine holds significant potential to accelerate rescue operations and ultimately save lives. Mass casualty incidents demand rapid and accurate information management to coordinate effective responses. Currently, first responders manually record triage results on patient cards, and brief information is communicated to the command post via radio communication. Although this process is widely used in practice, it involves several time-consuming and error-prone tasks. To address these issues, we designed, implemented, and evaluated an app-based mobile triage system. This system allows users to document responder details, triage categories, injury patterns, GPS locations, and other important information, which can then be transmitted automatically to the incident commanders. Objective: This study aims to design and evaluate an app-based mobile system as a triage and coordination tool for emergency and disaster medicine, comparing its effectiveness with the conventional paper-based system. Methods: A total of 38 emergency medicine personnel participated in a within-subject experimental study, completing 2 triage sessions with 30 patient cards each: one session using the app-based mobile system and the other using the paper-based tool. The accuracy of the triages and the time taken for each session were measured. Additionally, we implemented the User Experience Questionnaire along with other items to assess participants? subjective ratings of the 2 triage tools. Results: Our 2 (triage tool) × 2 (tool order) mixed multivariate analysis of variance revealed a significant main effect for the triage tool (P<.001). Post hoc analyses indicated that participants were significantly faster (P<.001) and more accurate (P=.005) in assigning patients to the correct triage category when using the app-based mobile system compared with the paper-based tool. Additionally, analyses showed significantly better subjective ratings for the app-based mobile system compared with the paper-based tool, in terms of both school grading (P<.001) and across all 6 scales of the User Experience Questionnaire (all P<.001). Of the 38 participants, 36 (95%) preferred the app-based mobile system. There was no significant main effect for tool order (P=.24) or session order (P=.06) in our model. Conclusions: Our findings demonstrate that the app-based mobile system not only matches the performance of the conventional paper-based tool but may even surpass it in terms of efficiency and usability. This advancement could further enhance the potential of digitalization to optimize processes in disaster medicine, ultimately leading to the possibility of saving more lives. UR - https://www.jmir.org/2024/1/e65728 UR - http://dx.doi.org/10.2196/65728 UR - http://www.ncbi.nlm.nih.gov/pubmed/39474975 ID - info:doi/10.2196/65728 ER - TY - JOUR AU - Kang, Ye Ji AU - Jung, Weon AU - Kim, Ji Hyun AU - An, Hyun Ji AU - Yoon, Hee AU - Kim, Taerim AU - Chang, Hansol AU - Hwang, Yeon Sung AU - Park, Eun Jong AU - Lee, Tak Gun AU - Cha, Chul Won AU - Heo, Sejin AU - Lee, Uk Se PY - 2024/11/20 TI - Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data JO - JMIR Public Health Surveill SP - e59138 VL - 10 KW - telemedicine KW - public health KW - medication adherence KW - COVID-19 KW - chronic diseases N2 - Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. UR - https://publichealth.jmir.org/2024/1/e59138 UR - http://dx.doi.org/10.2196/59138 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59138 ER - TY - JOUR AU - C Areias, Anabela AU - G Moulder, Robert AU - Molinos, Maria AU - Janela, Dora AU - Bento, Virgílio AU - Moreira, Carolina AU - Yanamadala, Vijay AU - P Cohen, Steven AU - Dias Correia, Fernando AU - Costa, Fabíola PY - 2024/11/19 TI - Predicting Pain Response to a Remote Musculoskeletal Care Program for Low Back Pain Management: Development of a Prediction Tool JO - JMIR Med Inform SP - e64806 VL - 12 KW - telerehabilitation KW - predictive modeling KW - personalized medicine KW - rehabilitation KW - clinical decision support KW - machine learning KW - artificial intelligence N2 - Background: Low back pain (LBP) presents with diverse manifestations, necessitating personalized treatment approaches that recognize various phenotypes within the same diagnosis, which could be achieved through precision medicine. Although prediction strategies have been explored, including those employing artificial intelligence (AI), they still lack scalability and real-time capabilities. Digital care programs (DCPs) facilitate seamless data collection through the Internet of Things and cloud storage, creating an ideal environment for developing and implementing an AI predictive tool to assist clinicians in dynamically optimizing treatment. Objective: This study aims to develop an AI tool that continuously assists physical therapists in predicting an individual?s potential for achieving clinically significant pain relief by the end of the program. A secondary aim was to identify predictors of pain nonresponse to guide treatment adjustments. Methods: Data collected actively (eg, demographic and clinical information) and passively in real-time (eg, range of motion, exercise performance, and socioeconomic data from public data sources) from 6125 patients enrolled in a remote digital musculoskeletal intervention program were stored in the cloud. Two machine learning techniques, recurrent neural networks (RNNs) and light gradient boosting machine (LightGBM), continuously analyzed session updates up to session 7 to predict the likelihood of achieving significant pain relief at the program end. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC), precision-recall curves, specificity, and sensitivity. Model explainability was assessed using SHapley Additive exPlanations values. Results: At each session, the model provided a prediction about the potential of being a pain responder, with performance improving over time (P<.001). By session 7, the RNN achieved an ROC-AUC of 0.70 (95% CI 0.65-0.71), and the LightGBM achieved an ROC-AUC of 0.71 (95% CI 0.67-0.72). Both models demonstrated high specificity in scenarios prioritizing high precision. The key predictive features were pain-associated domains, exercise performance, motivation, and compliance, informing continuous treatment adjustments to maximize response rates. Conclusions: This study underscores the potential of an AI predictive tool within a DCP to enhance the management of LBP, supporting physical therapists in redirecting care pathways early and throughout the treatment course. This approach is particularly important for addressing the heterogeneous phenotypes observed in LBP. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 and NCT05417685; https://clinicaltrials.gov/ct2/show/NCT05417685 UR - https://medinform.jmir.org/2024/1/e64806 UR - http://dx.doi.org/10.2196/64806 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64806 ER - TY - JOUR AU - Wang, Yipei AU - Zhang, Pei AU - Xing, Yan AU - Shi, Huifeng AU - Cui, Yunpu AU - Wei, Yuan AU - Zhang, Ke AU - Wu, Xinxia AU - Ji, Hong AU - Xu, Xuedong AU - Dong, Yanhui AU - Jin, Changxiao PY - 2024/11/19 TI - Telemedicine Integrated Care Versus In-Person Care Mode for Patients With Short Stature: Comprehensive Comparison of a Retrospective Cohort Study JO - J Med Internet Res SP - e57814 VL - 26 KW - telemedicine KW - telemedicine integrated care mode KW - short stature KW - clinical outcomes KW - health-seeking behaviors KW - cost analysis KW - in-person care KW - mobile health KW - mHealth KW - telehealth KW - eHealth KW - video virtual visit KW - access to care KW - children KW - pediatrics KW - China KW - accessibility KW - temporal KW - spatial constraints KW - chronic disease N2 - Background: Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent. Objective: This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China. Methods: Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase. Results: In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group (?zTIC=0.74) was more substantial than that for the IPC group (?zIPC=0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group?s visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits. Conclusions: We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results. UR - https://www.jmir.org/2024/1/e57814 UR - http://dx.doi.org/10.2196/57814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57814 ER - TY - JOUR AU - Aguas, Mariam AU - Del Hoyo, Javier AU - Vicente, Raquel AU - Barreiro-de Acosta, Manuel AU - Melcarne, Luigi AU - Hernandez-Camba, Alejandro AU - Madero, Lucía AU - Arroyo, Teresa María AU - Sicilia, Beatriz AU - Chaparro, María AU - Martin-Arranz, Dolores María AU - Pajares, Ramón AU - Mesonero, Francisco AU - Mañosa, Miriam AU - Martinez, Pilar AU - Chacón, Silvia AU - Tosca, Joan AU - Marín, Sandra AU - Sanroman, Luciano AU - Calvo, Marta AU - Monfort, David AU - Saiz, Empar AU - Zabana, Yamile AU - Guerra, Ivan AU - Varela, Pilar AU - Baydal, Virginia AU - Faubel, Raquel AU - Corsino, Pilar AU - Porto-Silva, Sol AU - Brunet, Eduard AU - González, Melodi AU - Gutiérrez, Ana AU - Nos, Pilar PY - 2024/11/18 TI - Telemonitoring of Active Inflammatory Bowel Disease Using the App TECCU: Short-Term Results of a Multicenter Trial of GETECCU JO - J Med Internet Res SP - e60966 VL - 26 KW - clinical trial KW - telemonitoring KW - inflammatory bowel disease KW - Crohn disease KW - ulcerative colitis KW - quality of life KW - socioeconomical and psychological end points KW - health outcomes KW - remission time N2 - Background: Telemonitoring for inflammatory bowel disease (IBD) has not consistently demonstrated superiority over standard care; however, noninferiority may be an acceptable outcome if remote care proves to be more efficient. Objective: This study aims to compare the remission time and quality of life of patients with active IBD managed through standard care versus the TECCU (Telemonitoring of Crohn Disease and Ulcerative Colitis) app. Methods: A 2-arm, randomized, multicenter trial with a noninferiority design was conducted across 24 hospitals in Spain. The study included adult patients with IBD who were starting immunosuppressive or biological therapy. Participants were randomized into 2 groups: the telemonitoring group (G_TECCU) and the standard care group (G_Control). The follow-up schedule for the telemonitoring group (G_TECCU) was based on contacts via the TECCU app, while the control group (G_Control) adhered to standard clinical practice, which included in-person visits and telephone calls. In both groups, treatment adjustments were made based on the progression of disease activity and medication adherence, assessed using specific indices and biological markers at each check-up. The primary outcome was the duration of remission after 12 weeks, while secondary outcomes included quality of life, medication adherence, adverse events, and patient satisfaction. Results: Of the 169 patients enrolled, 158 were randomized and 150 were analyzed per protocol: telemonitoring (n=71) and control (n=79). After 12 weeks, the time in clinical remission was not inferior in the telemonitoring group (mean 4.20, SD 3.73 weeks) compared with the control group (mean 4.32, SD 3.28 weeks), with a mean difference between arms of ?0.12 weeks (95% CI ?1.25 to 1.01; noninferiority P=.02). The mean reduction in C-reactive protein values was ?15.40 mg/L (SD 90.15 mg/L; P=.19) in the G_TECCU group and ?13.16 mg/L (SD 54.61 mg/L; P=.05) in the G_Control group, with no significant differences between the 2 arms (P=.73). Similarly, the mean improvement in fecal calprotectin levels was 832.3 mg/L (SD 1825.0 mg/L; P=.003) in the G_TECCU group and 1073.5 mg/L (SD 3105.7 mg/L; P=.03) in the G_Control group; however, the differences were not statistically significant (P=.96). Quality of life improved in both groups, with a mean increase in the 9-item Inflammatory Bowel Disease Questionnaire score of 13.44 points (SD 19.1 points; P<.001) in the G_TECCU group and 18.23 points (SD 22.9 points; P=.001) in the G_Control group. Additionally, the proportion of patients who adhered to their medication significantly increased from 35% (25/71) to 68% (48/71) in the G_TECCU group (P=.001) and from 46% (36/79) to 73% (58/79) in the G_Control group (P=.001). The satisfaction rate remained stable at around 90%, although noninferiority was not demonstrated for the secondary outcomes. Conclusions: Telemonitoring patients with active IBD is not inferior to standard care for achieving and maintaining short-term remission. The TECCU app may serve as a viable alternative follow-up tool, pending confirmation of improved health outcomes and cost-effectiveness over the long-term. Trial Registration: ClinicalTrials.gov NCT06031038; https://clinicaltrials.gov/ct2/show/NCT06031038 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9639 UR - https://www.jmir.org/2024/1/e60966 UR - http://dx.doi.org/10.2196/60966 UR - http://www.ncbi.nlm.nih.gov/pubmed/39189160 ID - info:doi/10.2196/60966 ER - TY - JOUR AU - Song, Faying AU - Gong, Xue AU - Yang, Yuting AU - Guo, Rui PY - 2024/11/14 TI - Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study JO - J Med Internet Res SP - e55400 VL - 26 KW - telemedicine KW - direct-to-consumer telemedicine KW - standardized patient KW - China KW - public KW - private KW - platform KW - objective evaluation KW - quality of care KW - effectiveness KW - safety KW - timeliness KW - regression model KW - management N2 - Background: Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods. Objective: Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China?s public and private sectors. Methods: We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables. Results: Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted ? 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted ? 3.34, P<.001); and spend more time with SPs (adjusted ? 839.70, P<.001), with more responses (adjusted ? 1.33, P=.001) and more words (adjusted ? 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted ? 505.87, P=.001) and each response (adjusted ? 168.33, P=.04) and paid more for the average visit (adjusted ? 40.03, P<.001). Conclusions: There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine. UR - https://www.jmir.org/2024/1/e55400 UR - http://dx.doi.org/10.2196/55400 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55400 ER - TY - JOUR AU - Almashmoum, Maryam AU - Cunningham, James AU - Ainsworth, John PY - 2024/11/13 TI - Evaluating Factors Affecting Knowledge Sharing Among Health Care Professionals in the Medical Imaging Departments of 2 Cancer Centers: Concurrent Mixed Methods Study JO - JMIR Hum Factors SP - e53780 VL - 11 KW - knowledge management KW - knowledge sharing KW - medical imaging departments KW - cancer centers KW - The Christie KW - Kuwait Cancer Control Center KW - concurrent mixed methods KW - factors KW - challenges KW - definition KW - mechanisms KW - practices N2 - Background: Knowledge sharing is a crucial part of any knowledge management implementation. It refers to sharing skills and experience among team members in an organization. In a health care setting, sharing knowledge, whether tacit or explicit, is important and can lead to better health care services. In medical imaging departments, knowledge sharing can be of particular importance. There are several factors that affect knowledge-sharing practices in medical imaging departments: individual, departmental, and technological. Evaluating the importance of these factors and understanding their use can help with improving knowledge-sharing practices in medical imaging departments. Objective: We aimed to assess the level of motivation, identify current knowledge-sharing tools, and evaluate factors affecting knowledge sharing in the medical imaging departments of 2 cancer centers, The Christie, United Kingdom, and the Kuwait Cancer Control Center (KCCC). Methods: A concurrent mixed methods study was conducted through nonprobability sampling techniques between February 1, 2023, and July 30, 2023. Semistructured interviews were used to validate the results of the quantitative analysis. Data were collected using an electronic questionnaire that was distributed among health care professionals in both cancer centers using Qualtrics. Semistructured interviews were conducted online using Microsoft Teams. The quantitative data were analyzed using the Qualtrics MX software to report the results for each question, whereas the qualitative data were analyzed using a thematic approach with codes classified through NVivo. Results: In total, 56 respondents from the KCCC and 29 from The Christie participated, with a 100% response rate (56/56, 100% and 29/29, 100%, respectively) based on the Qualtrics survey tool. A total of 59% (17/29) of health care professionals from The Christie shared their knowledge using emails and face-to-face communication as their main tools on a daily basis, and 57% (32/56) of health care professionals from the KCCC used face-to-face communication for knowledge sharing. The mean Likert-scale score of all the components that assessed the factors that affected knowledge-sharing behaviors fell between ?somewhat agree? and ?strongly agree? in both centers, excepting extrinsic motivation, which was rated as ?neither agree nor disagree.? This was similar to the results related to incentives. It was shown that 52% (15/29) of health care professionals at The Christie had no incentives to encourage knowledge-sharing practices. Therefore, establishing clear policies to manage incentives is important to increase knowledge-sharing practices. Conclusions: This study offered an evaluation of factors that affect knowledge sharing in 2 cancer centers. Most health care professionals were aware of the importance of knowledge-sharing practices in enhancing health care services. Several challenges were identified, such as time constraints, a lack of staff, and the language barrier, which limit knowledge-sharing practices. Therefore, establishing a clear policy for knowledge sharing is vital to practicing knowledge-sharing behaviors and facing any challenges that limit this practice. UR - https://humanfactors.jmir.org/2024/1/e53780 UR - http://dx.doi.org/10.2196/53780 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53780 ER - TY - JOUR AU - Gulzar, Saleema AU - Rahim, Shirin AU - Dossa, Khadija AU - Saeed, Sana AU - Agha, Insiyah AU - Khoja, Shariq AU - Karmaliani, Rozina PY - 2024/11/12 TI - Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study JO - JMIR Form Res SP - e48664 VL - 8 KW - teleconsultation KW - digital health KW - school health KW - child health KW - information technology KW - eConsultation KW - telehealth N2 - Background: In Pakistan?s remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS?s cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. UR - https://formative.jmir.org/2024/1/e48664 UR - http://dx.doi.org/10.2196/48664 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48664 ER - TY - JOUR AU - Liu, Yayuan AU - Jin, Haofeng AU - Yu, Zhuoyuan AU - Tong, Yu PY - 2024/11/11 TI - Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study JO - J Med Internet Res SP - e57609 VL - 26 KW - internet hospital KW - online consultation KW - telehealth KW - outpatient visits KW - outpatient expenses KW - urban-rural healthcare disparity N2 - Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients? offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients? adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients? adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and the associated expenses by 15.5% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients? residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients? adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients? urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. UR - https://www.jmir.org/2024/1/e57609 UR - http://dx.doi.org/10.2196/57609 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57609 ER - TY - JOUR AU - Cho, Jaeso AU - Han, Yeon Ji AU - Cho, Anna AU - Yoo, Sooyoung AU - Lee, Ho-Young AU - Kim, Hunmin PY - 2024/11/8 TI - Enhancing Clinical History Taking Through the Implementation of a Streamlined Electronic Questionnaire System at a Pediatric Headache Clinic: Development and Evaluation Study JO - JMIR Med Inform SP - e54415 VL - 12 KW - electronic questionnaire system KW - electronic questionnaire KW - history taking KW - medical history KW - headache KW - migraine KW - neuralgia KW - pediatric KW - paediatric KW - infant KW - neonatal KW - toddler KW - child KW - youth KW - adolescent N2 - Background: Accurate history taking is essential for diagnosis, treatment, and patient care, yet miscommunications and time constraints often lead to incomplete information. Consequently, there has been a pressing need to establish a system whereby the questionnaire is duly completed before the medical appointment, entered into the electronic health record (EHR), and stored in a structured format within a database. Objective: This study aimed to develop and evaluate a streamlined electronic questionnaire system, BEST-Survey (Bundang Hospital Electronic System for Total Care-Survey), integrated with the EHR, to enhance history taking and data management for patients with pediatric headaches. Methods: An electronic questionnaire system was developed at Seoul National University Bundang Hospital, allowing patients to complete previsit questionnaires on a tablet PC. The information is automatically integrated into the EHR and stored in a structured database for further analysis. A retrospective analysis compared clinical information acquired from patients aged <18 years visiting the pediatric neurology outpatient clinic for headaches, before and after implementing the BEST-Survey system. The study included 365 patients before and 452 patients after system implementation. Answer rates and positive rates of key headache characteristics were compared between the 2 groups to evaluate the system?s clinical utility. Results: Implementation of the BEST-Survey system significantly increased the mean data acquisition rate from 54.6% to 99.3% (P<.001). Essential clinical features such as onset, location, duration, severity, nature, and frequency were obtained in over 98.7% (>446/452) of patients after implementation, compared to from 53.7% (196/365) to 85.2% (311/365) before. The electronic system facilitated comprehensive data collection, enabling detailed analysis of headache characteristics in the patient population. Most patients (280/452, 61.9%) reported headache onset less than 1 year prior, with the temporal region being the most common pain location (261/703, 37.1%). Over half (232/452, 51.3%) experienced headaches lasting less than 2 hours, with nausea and vomiting as the most commonly associated symptoms (231/1036, 22.3%). Conclusions: The BEST-Survey system markedly improved the completeness and accuracy of essential history items for patients with pediatric headaches. The system also streamlined data extraction and analysis for clinical and research purposes. While the electronic questionnaire cannot replace physician-led history taking, it serves as a valuable adjunctive tool to enhance patient care. UR - https://medinform.jmir.org/2024/1/e54415 UR - http://dx.doi.org/10.2196/54415 ID - info:doi/10.2196/54415 ER - TY - JOUR AU - Zhang, Guang-Wei AU - Li, Bin AU - Gu, Zheng-Min AU - Yang, Wei-Feng AU - Wang, Yi-Ran AU - Li, Hui-Jun AU - Zheng, Han-Bing AU - Yue, Ying-Xu AU - Wang, Kui-Zhong AU - Gong, Mengchun AU - Gong, Da-Xin PY - 2024/11/8 TI - In-Depth Examination of the Functionality and Performance of the Internet Hospital Information Platform: Development and Usability Study JO - J Med Internet Res SP - e54018 VL - 26 KW - internet hospital KW - smart hospital KW - mobile applications KW - operational data KW - information system KW - online service KW - patient service KW - management tool KW - electronic prescriptions KW - medical education KW - integration N2 - Background: Internet hospitals (IHs) have rapidly developed as a promising strategy to address supply-demand imbalances in China?s medical industry, with their capabilities directly dependent on information platform functionality. Furthermore, a novel theory of ?Trinity? smart hospital has provided advanced guidelines on IH constructions. Objective: This study aimed to explore the construction experience, construction models, and development prospects based on operational data from IHs. Methods: Based on existing information systems and internet service functionalities, our hospital has built a ?Smart Hospital Internet Information Platform (SHIIP)? for IH operations, actively to expand online services, digitalize traditional health care, and explore health care services modes throughout the entire process and lifecycle. This article encompasses the platform architecture design, technological applications, patient service content and processes, health care professional support features, administrative management tools, and associated operational data. Results: Our platform has presented a set of data, including 82,279,669 visits, 420,120 online medical consultations, 124,422 electronic prescriptions, 92,285 medication deliveries, 6,965,566 prediagnosis triages, 4,995,824 offline outpatient appointments, 2025 medical education articles with a total of 15,148,310 views, and so on. These data demonstrate the significant role of IH as an indispensable component of our physical hospital services, with deep integration between online and offline health care systems. Conclusions: The upward trends in various data metrics indicate that our IH has gained significant recognition and usage among both the public and healthcare workers, and may have promising development prospects. Additionally, the platform construction approach, which prioritizes comprehensive service digitization and the 'Trinity' of the public, healthcare workers, and managers, serves as an effective means of promoting the development of Internet Hospitals. Such insights may prove invaluable in guiding the development of IH and facilitating the continued evolution of the Internet healthcare sector. UR - https://www.jmir.org/2024/1/e54018 UR - http://dx.doi.org/10.2196/54018 UR - http://www.ncbi.nlm.nih.gov/pubmed/39168813 ID - info:doi/10.2196/54018 ER - TY - JOUR AU - Smith, N. Shawna AU - Lanham, M. Michael S. AU - Seagull, Jacob F. AU - Fabbri, Morris AU - Dorsch, P. Michael AU - Jennings, Kathleen AU - Barnes, Geoffrey PY - 2024/11/8 TI - System-Wide, Electronic Health Record?Based Medication Alerts for Appropriate Prescribing of Direct Oral Anticoagulants: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e64674 VL - 8 KW - direct oral anticoagulants KW - electronic health record KW - medication safety KW - prescribing errors KW - pilot randomized controlled trial KW - alert system optimization KW - clinical decision support KW - EHR KW - randomized controlled trial KW - RCT KW - oral anticoagulants N2 - Background: While direct oral anticoagulants (DOACs) have improved oral anticoagulation management, inappropriate prescribing remains prevalent and leads to adverse drug events. Antithrombotic stewardship programs seek to enhance DOAC prescribing but require scalable and sustainable strategies. Objective: We present a pilot, prescriber-level randomized controlled trial to assess the effectiveness of electronic health record (EHR)?based medication alerts in a large health system. Methods: The pilot assessed prescriber responses to alerts for initial DOAC prescription errors (apixaban and rivaroxaban). A user-centered, multistage design process informed alert development, emphasizing clear indication, appropriate dosing based on renal function, and drug-drug interactions. Alerts appeared whenever a DOAC was being prescribed in a way that did not follow package label instructions. Clinician responses measured acceptability, accuracy, feasibility, and utilization of the alerts. Results: The study ran from August 1, 2022, through April 30, 2023. Only 1 prescriber requested trial exclusion, demonstrating acceptability. The error rate for false alerts due to incomplete data was 6.6% (16/243). Two scenarios with alert design and/or execution errors occurred but were quickly identified and resolved, underlining the importance of a responsive quality assurance process in EHR-based interventions. Trial feasibility issues related to alert-data capture were identified and resolved. Trial feasibility was also assessed with balanced randomization of prescribers and the inclusion of various alerts across both medications. Assessing utilization, 34.2% (83/243) of the encounters (with 134 prescribers) led to a prescription change. Conclusions: The pilot implementation study demonstrated the acceptability, accuracy, feasibility, and estimates of the utilization of EHR-based medication alerts for DOAC prescriptions and successfully established just-in-time randomization of prescribing clinicians. This pilot study sets the stage for large-scale, randomized implementation evaluations of EHR-based alerts to improve medication safety. Trial Registration: ClinicalTrials.gov NCT05351749; https://clinicaltrials.gov/study/NCT05351749 UR - https://formative.jmir.org/2024/1/e64674 UR - http://dx.doi.org/10.2196/64674 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64674 ER - TY - JOUR AU - Bruera, Sebastian AU - Staggers, Andrews Kristen AU - Suarez-Almazor, Eugenia Maria AU - Agarwal, Krishna Sandeep PY - 2024/11/1 TI - Telemedicine for Patients With Systemic Lupus Erythematosus in a Publicly Funded Hospital System: Retrospective Study JO - Interact J Med Res SP - e49065 VL - 13 KW - lupus KW - systemic lupus erythematosus KW - telemedicine KW - COVID-19 KW - access to care KW - autoimmune disease KW - no-show KW - socioeconomic status KW - adherence KW - laboratory test KW - management N2 - Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that requires frequent clinic and laboratory visits. However, patients with SLE, particularly those who are underresourced, have unacceptably high rates of no-shows. Objective: This study aims to determine no-show rates associated with telemedicine visits during the COVID-19 pandemic in comparison to no-show rates associated with contemporaneous and historic in-person visits. Methods: We performed a retrospective cohort study in a publicly funded county hospital system in Houston, Texas. We identified a cohort of established patients with SLE by the International Classification of Diseases codes that were independently confirmed as SLE by a review of medical records. We identified patients who were seen from March to December in 2018, 2019, and 2020 (to reflect the height of the COVID-19 pandemic and account for seasonal changes in disease activity). Our primary outcome was the percentage of no-shows for rheumatology clinic appointments. Our secondary outcome was laboratory use adherence, which was defined as lupus-specific blood and urine studies conducted within 30 days of the scheduled appointment. Covariates included age, sex, race, ethnicity, and SLE-related prescription drugs. Results: We included 156 patients with SLE in our analysis. Most were female (n=141, 90.4%), were Hispanic (n=75, 49.3%), and had a median age of 43 (range 19-80) years. In 2020, the no-show rate for telemedicine was 5.5% (10/182) compared to a no-show rate of 16.2% (31/191) for in-person visits (P=.002). After multivariable adjustment for covariates, the odds of no-show were lower for telemedicine visits (odds ratio 0.39, 95% CI 0.20-0.77). There were no differences in adherence to laboratory testing. Conclusions: Telemedicine visits had decreased odds of no-shows without difference in laboratory testing adherence after adjustment for covariates. More research is needed to determine the clinical impact of telemedicine on patients with SLE. UR - https://www.i-jmr.org/2024/1/e49065 UR - http://dx.doi.org/10.2196/49065 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078399 ID - info:doi/10.2196/49065 ER - TY - JOUR AU - Sakhuja, Mayank AU - Yelton, Brooks AU - Kavarana, Simone AU - Schaurer, Lauren AU - Rumthao, Rachel Jancham AU - Noblet, Samuel AU - Arent, A. Michelle AU - Macauda, M. Mark AU - Donelle, Lorie AU - Friedman, B. Daniela PY - 2024/10/31 TI - How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars JO - J Med Internet Res SP - e57040 VL - 26 KW - health literacy KW - digital health literacy KW - eHealth literacy KW - social determinants of health KW - SDoH KW - research scholarship KW - health care KW - public health research KW - digital health tools KW - community health N2 - Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars? conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators? research. Results: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. UR - https://www.jmir.org/2024/1/e57040 UR - http://dx.doi.org/10.2196/57040 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57040 ER - TY - JOUR AU - Yang, Lingrui AU - Pang, Jiali AU - Zuo, Song AU - Xu, Jian AU - Jin, Wei AU - Zuo, Feng AU - Xue, Kui AU - Xiao, Zhongzhou AU - Peng, Xinwei AU - Xu, Jie AU - Zhang, Xiaofan AU - Chen, Ruiyao AU - Luo, Shuqing AU - Zhang, Shaoting AU - Sun, Xin PY - 2024/10/30 TI - Evolution of the ?Internet Plus Health Care? Mode Enabled by Artificial Intelligence: Development and Application of an Outpatient Triage System JO - J Med Internet Res SP - e51711 VL - 26 KW - artificial intelligence KW - triage system KW - all department recommendation KW - subspecialty department recommendation KW - ?internet plus healthcare? KW - ?internet plus health care? N2 - Background: Although new technologies have increased the efficiency and convenience of medical care, patients still struggle to identify specialized outpatient departments in Chinese tertiary hospitals due to a lack of medical knowledge. Objective: The objective of our study was to develop a precise and subdividable outpatient triage system to improve the experiences and convenience of patient care. Methods: We collected 395,790 electronic medical records (EMRs) and 500 medical dialogue groups. The EMRs were divided into 3 data sets to design and train the triage model (n=387,876, 98%) and test (n=3957, 1%) and validate (n=3957, 1%) it. The triage system was altered based on the current BERT (Bidirectional Encoder Representations from Transformers) framework and evaluated by recommendation accuracies in Xinhua Hospital using the cancellation rates in 2021 and 2022, from October 29 to December 5. Finally, a prospective observational study containing 306 samples was conducted to compare the system?s performance with that of triage nurses, which was evaluated by calculating precision, accuracy, recall of the top 3 recommended departments (recall@3), and time consumption. Results: With 3957 (1%) records each, the testing and validation data sets achieved an accuracy of 0.8945 and 0.8941, respectively. Implemented in Xinhua Hospital, our triage system could accurately recommend 79 subspecialty departments and reduce the number of registration cancellations from 16,037 (3.83%) of the total 418,714 to 15,338 (3.53%) of the total 434200 (P<.05). In comparison to the triage system, the performance of the triage nurses was more accurate (0.9803 vs 0.9153) and precise (0.9213 vs 0.9049) since the system could identify subspecialty departments, whereas triage nurses or even general physicians can only recommend main departments. In addition, our triage system significantly outperformed triage nurses in recall@3 (0.6230 vs 0.5266; P<.001) and time consumption (10.11 vs 14.33 seconds; P<.001). Conclusions: The triage system demonstrates high accuracy in outpatient triage of all departments and excels in subspecialty department recommendations, which could decrease the cancellation rate and time consumption. It also improves the efficiency and convenience of clinical care to fulfill better the usage of medical resources, expand hospital effectiveness, and improve patient satisfaction in Chinese tertiary hospitals. UR - https://www.jmir.org/2024/1/e51711 UR - http://dx.doi.org/10.2196/51711 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51711 ER - TY - JOUR AU - Robertson, Noah AU - Syed, J. Maryam AU - Song, Bowen AU - Kaur, Arshdeep AU - Patel, G. Janaki AU - Marawar, Rohit AU - Basha, Maysaa AU - Zutshi, Deepti PY - 2024/10/30 TI - Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey JO - JMIR Form Res SP - e53491 VL - 8 KW - telemedicine KW - telehealth KW - neurology KW - eHealth KW - teleneurology KW - patient experience KW - patient satisfaction N2 - Background: Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Objective: Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Methods: Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Results: Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4%), followed by multiple sclerosis (n=33, 28.2%) and neuroimmunology (n=7, 6%). Overall, 74.4% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52% (26/50) of Black patients reporting that an office visit is better, compared to 25% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52%), followed by residents or fellows (n=15, 38%) and nurse practitioners or physician assistants (n=4, 10%). Of the specialties represented, 15 (38%) of the providers were in neurology. Conclusions: Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3%) and were able to connect with few to no technological difficulties (84/117, 71.8%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care. UR - https://formative.jmir.org/2024/1/e53491 UR - http://dx.doi.org/10.2196/53491 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53491 ER - TY - JOUR AU - Tisdale, Lauren Rebecca AU - Ferguson, M. Jacqueline AU - Van Campen, James AU - Greene, Liberty AU - Wray, M. Charlie AU - Zulman, M. Donna PY - 2024/10/25 TI - Patient-, Provider-, and Facility-Level Contributors to the Use of Cardiology Telehealth Care in the Veterans Health Administration: Retrospective Cohort Study JO - J Med Internet Res SP - e53298 VL - 26 KW - telehealth KW - mixed models KW - veteran KW - patient KW - virtual cardiology KW - cardiology care KW - cohort study N2 - Background: Telehealth (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in cardiology telehealth use. Objective: The aim of this study is to estimate the relative extent to which patient-, clinician-, and facility-level factors affect cardiology telehealth use in VHA. Methods: This was a retrospective, nation-wide cohort study of veterans? use of VHA cardiology telehealth care during the first 2 years of the COVID-19 pandemic (March 11, 2020, to March 10, 2022). We constructed multilevel, multivariable, logistic regression models of patient-level cardiology telehealth use (telephone or video-based care). Models included random effects for the patient, the patient?s main cardiology provider, and the patient?s primary facility (ie, VHA medical center) for specialty care and fixed effects for patient sociodemographic and clinical characteristics. Results: Our analytic cohort comprised 223,809 veterans with 989,271 encounters among 2235 unique clinicians. The veterans? average age was 70.2 years, and 3.4% (n=7616) were women. Of the 989,271 encounters, 4.2% (n=41,480) were video based and 34.3% (n=338,834) were phone based. Adjusted odds of telehealth use were slightly higher for women versus men (adjusted odds ratio [AOR] 1.08, 95% CI 1.05-1.10), individuals identifying as Hispanic or Latino versus not Hispanic or Latino (AOR 1.46, 95% CI 1.43-1.49), and those with medium and long drive times versus short drive time (AOR 1.11, 95% CI 1.10-1.12 and AOR 1.09, 95% CI 1.07-1.10, respectively). Further, 40.5% of the variation in a veteran?s likelihood of using cardiology telehealth care was found at the patient level, 30.8% at the clinician level, and 7% at the facility level. Conclusions: The largest share of the attributable variability in VHA cardiology telehealth use in this cohort was explained by the patient, followed closely by the clinician. Little variability was attributed to the primary facility through which the veteran received their cardiology care. These results suggest that policy solutions intended to improve equity of cardiology telehealth care use in VHA may be most impactful when directed at patients and clinicians. UR - https://www.jmir.org/2024/1/e53298 UR - http://dx.doi.org/10.2196/53298 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53298 ER - TY - JOUR AU - van Maurik, S. I. AU - Doodeman, J. H. AU - Veeger-Nuijens, W. B. AU - Möhringer, M. R. P. AU - Sudiono, R. D. AU - Jongbloed, W. AU - van Soelen, E. PY - 2024/10/24 TI - Targeted Development and Validation of Clinical Prediction Models in Secondary Care Settings: Opportunities and Challenges for Electronic Health Record Data JO - JMIR Med Inform SP - e57035 VL - 12 KW - clinical prediction model KW - electronic health record KW - targeted validation KW - EHR KW - EMR KW - prediction models KW - validation KW - CPM KW - secondary care KW - machine learning KW - artificial intelligence KW - AI UR - https://medinform.jmir.org/2024/1/e57035 UR - http://dx.doi.org/10.2196/57035 ID - info:doi/10.2196/57035 ER - TY - JOUR AU - Fiordelli, Maddalena PY - 2024/10/23 TI - Transitioning Perspectives in Digital Health Through Phenomenology Integration JO - J Med Internet Res SP - e62691 VL - 26 KW - eHealth KW - digital health KW - phenomenology KW - phenomenological KW - participatory KW - health communication KW - health information KW - active listening KW - lived experience UR - https://www.jmir.org/2024/1/e62691 UR - http://dx.doi.org/10.2196/62691 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62691 ER - TY - JOUR AU - Garvin, Lynn AU - Richardson, Eric AU - Heyworth, Leonie AU - McInnes, Keith D. PY - 2024/10/23 TI - Exploring Contactless Vital Signs Collection in Video Telehealth Visits Among Veterans Affairs Providers and Patients: Pilot Usability Study JO - JMIR Form Res SP - e60491 VL - 8 KW - veteran KW - provider KW - video-based care KW - vital statistics KW - telemonitoring KW - usability KW - mobile health app KW - telemedicine KW - health care access KW - vital sign KW - video KW - telehealth KW - patient KW - Veterans Affairs KW - telehealth platform KW - photoplethysmography KW - camera KW - web-based survey KW - electronic medical record KW - home-based biometric devices KW - mHealth N2 - Background: To expand veterans? access to health care, the Veterans Affairs (VA) Office of Connected Care explored a novel software feature called ?Vitals? on its VA Video Connect telehealth platform. Vitals uses contactless, video-based, remote photoplethysmography (rPPG) through the infrared camera on veterans? smartphones (and other devices) to automatically scan their faces to provide real-time vital statistics on screen to both the provider and patient. Objective: This study aimed to assess VA clinical provider and veteran patient attitudes regarding the usability of Vitals. Methods: We conducted a mixed methods evaluation of Vitals among VA providers and patients, collecting data in July and August 2023 at the VA Boston Healthcare System and VA San Diego Healthcare System. We conducted analyses in October 2023. In-person usability testing sessions consisted of a think-aloud procedure while using the software, a semistructured interview, and a 26-item web-based survey. Results: Usability test sessions with 20 VA providers and 13 patients demonstrated that both groups found Vitals ?useful? and ?easy to use,? and they rated its usability highly (86 and 82 points, respectively, on a 100-point scale). Regarding acceptability or willingness/intent to use, providers and patients generally expressed confidence and trust in Vitals readings, with high ratings of 90 and 85 points, respectively. Providers and patients rated Vitals highly for its feasibility and appropriateness for context (90 and 90 points, respectively). Finally, providers noted that Vitals? flexibility makes it appropriate and advantageous for implementation in a wide range of clinical contexts, particularly in specialty care. Providers believed that most clinical teams would readily integrate Vitals into their routine workflow because it saves time; delivers accurate, consistently collected vitals; and may reduce reporting errors. Providers and veterans suggested training and support materials that could improve Vitals adoption and implementation. Conclusions: While remote collection of vital readings has been described in the literature, this is one of the first accounts of testing a contactless vital signs measurement tool among providers and patients. If ongoing initiatives demonstrate accuracy in its readings, Vitals could enhance telemedicine by providing accurate and automatic reporting and recording of vitals; sending patients? vital readings (pending provider approval) directly to their electronic medical record; saving provider and patient time; and potentially reducing necessity of some home-based biometric devices. Understanding usability issues before US Food and Drug Administration approval of Vitals and its implementation could contribute to a seamless introduction of Vitals to VA providers and patients. UR - https://formative.jmir.org/2024/1/e60491 UR - http://dx.doi.org/10.2196/60491 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441645 ID - info:doi/10.2196/60491 ER - TY - JOUR AU - McCullough, May Julie Elizabeth AU - Sinclair, Marlene AU - Gillender, Jonathan AU - McCrossan, Brian AU - Slater, F. Paul AU - Browne, Rosie AU - Casey, Frank PY - 2024/10/22 TI - Touching Technology?Parents? Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study JO - JMIR Pediatr Parent SP - e54598 VL - 7 KW - congenital heart disease KW - pediatric cardiology KW - pediatric cardiologist KW - pediatric KW - parent KW - digital health KW - digital technology KW - digital intervention KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultation KW - remote patient monitoring KW - technology acceptance KW - videoconferencing consultations N2 - Background: Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. Objective: This project aimed to investigate parents? experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. Methods: This study?s design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual?s intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents? experiences were explored using recorded interviews and analyzed thematically. Results: In total, 29 children aged 4?1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents? prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child?s medical team. Furthermore, parents noted the savings on time, money, and childcare. Conclusions: While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents. UR - https://pediatrics.jmir.org/2024/1/e54598 UR - http://dx.doi.org/10.2196/54598 ID - info:doi/10.2196/54598 ER - TY - JOUR AU - Kennedy, Blair Ann AU - Harb, Tarasidis Anna AU - Schockling, Chloe AU - Ray, Jackson Lauren AU - Palomo, Jennifer AU - Russ-Sellers, Rebecca PY - 2024/10/16 TI - Understanding the Values, Qualities, and Preferences of Patients in Their Relationships With Obstetrics and Gynecology Providers: Cross-Sectional Survey With a Mixed Methods Approach JO - J Particip Med SP - e58096 VL - 16 KW - communication KW - obstetrics KW - gynecology KW - trust KW - barriers to care KW - patient-provider relationships N2 - Background: The patient-provider relationship in obstetrics and gynecology (OBGYN) is uniquely complex due to the sensitive nature of examinations and topics. Patients often prefer health care providers who share similar racial, ethnic, gender, or linguistic backgrounds, particularly in sensitive health care situations, to improve communication and comfort, though historically, specific gender preferences for OBGYNs have not been evident. Objective: This study aims to describe the values, qualities, and preferences of patients in their relationships with OBGYN providers. Methods: This cross-sectional survey, conducted from October 2019 to December 2019, involved 1039 US OBGYN patients and used a mixed methods approach, integrating quantitative responses and qualitative insights from open-ended questions. Recruitment was facilitated through targeted social media campaigns, and the survey aimed to capture detailed patient preferences and barriers to care by assessing responses on provider traits, patient experiences, and demographic factors. The study?s rigorous data collection and analysis were designed to fill gaps identified in previous research on patient-provider relationships in OBGYN care. Results: The findings underscore the paramount importance of trust and comfort, with listening skills identified as crucial. A notable finding is the marked preference for same-gender providers, observed in 80.7% (545/675) of participants. Primary barriers to seeking care reported included daily commitments, highlighting the need for accessible and flexible care options. Conclusions: The study highlights a significant shift from previous scientific findings in patient preferences toward gender concordance and trust in OBGYN settings, diverging from previous research. These results emphasize the need for patient-centered care and tailored communication strategies to enhance patient experiences and outcomes. Future research should focus on diverse populations to broaden the findings? applicability and explore the impact of recent shifts in health care policies. UR - https://jopm.jmir.org/2024/1/e58096 UR - http://dx.doi.org/10.2196/58096 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412870 ID - info:doi/10.2196/58096 ER - TY - JOUR AU - Sze, Ping Kai AU - Fong, Wei Qi AU - De Roza, Giovanna Jacqueline AU - Lee, Sing Eng AU - Tan, Yun Shu PY - 2024/10/15 TI - Exploring Physicians? Perceptions of Digital Health?s Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study JO - J Med Internet Res SP - e53705 VL - 26 KW - patient-physician relationship KW - patient communication KW - trust KW - primary care medicine KW - digital health KW - primary care KW - longitudinal care KW - policy KW - implementation N2 - Background: Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. Objective: This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. Methods: This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. Results: We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised ?social and personal,? ?technical and material,? and ?organization and policy? factors. Conclusions: The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship. UR - https://www.jmir.org/2024/1/e53705 UR - http://dx.doi.org/10.2196/53705 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53705 ER - TY - JOUR AU - Suzumoto, Jun AU - Mori, Yukiko AU - Kuroda, Tomohiro PY - 2024/10/9 TI - Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study JO - JMIR Med Inform SP - e56263 VL - 12 KW - health information exchange KW - audit log KW - Japan KW - HIE KW - audit KW - logs KW - usage KW - medical informatics KW - rate KW - hospitals KW - electronic health record N2 - Background: Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown. Objective: This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan. Methods: We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker?s profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type?s monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE. Results: We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470?0.487) for hospitals, 0.243 (0.230?0.247) for medical clinics, and 0.030 (0.024?0.048) for dental clinics. In 51.9% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8% (921/3434) of hospitals, it was between 1 and 10, and in 3% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487?0.529) for the most used HIE and 0.109 (0.0927?0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned. Conclusions: In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets. UR - https://medinform.jmir.org/2024/1/e56263 UR - http://dx.doi.org/10.2196/56263 ID - info:doi/10.2196/56263 ER - TY - JOUR AU - Zigdon, Avi AU - Zwilling, Moti AU - Zigdon, Ofek AU - Reges, Orna PY - 2024/9/30 TI - Health Maintenance Organization?mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study JO - J Med Internet Res SP - e55350 VL - 26 KW - HMO-mHealth KW - mHealth KW - face-to-face KW - digital health KW - digital health apps KW - eHealth KW - HMO-mHealth adoption KW - health care KW - mHealth adoption KW - mobile phone KW - HMO KW - health maintenance organization N2 - Background: Health maintenance organization?mobile health (HMO-mHealth) services have a direct impact on patients? daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. Objective: This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Methods: Israeli adults aged ?18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. Results: A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68%; male: 2025/6321, 32%). Approximately 80.9% (5115/6321) to 88.2% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3% (3498/6321), 52.2% (3301/6321), and 46.9% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95% CI 0.67-0.83; P<.001 and OR 0.82, 95% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95% CI 1.02-1.22; P<.02 to OR 1.38, 95% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. Conclusions: HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups. UR - https://www.jmir.org/2024/1/e55350 UR - http://dx.doi.org/10.2196/55350 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55350 ER - TY - JOUR AU - Liu, Ville AU - Kaila, Minna AU - Koskela, Tuomas PY - 2024/9/26 TI - Triage Accuracy and the Safety of User-Initiated Symptom Assessment With an Electronic Symptom Checker in a Real-Life Setting: Instrument Validation Study JO - JMIR Hum Factors SP - e55099 VL - 11 KW - nurse triage KW - emergency department triage KW - triage KW - symptom assessment KW - health services accessibility KW - telemedicine KW - eHealth KW - remote consultation KW - primary health care KW - primary care KW - urgent care KW - health services research KW - health services N2 - Background: Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS. Objective: This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed. Methods: This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse. Results: Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC?s assessment was 1 triage level higher than the nurse?s triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC?s exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety. Conclusions: The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care. International Registered Report Identifier (IRRID): RR2-10.2196/41423 UR - https://humanfactors.jmir.org/2024/1/e55099 UR - http://dx.doi.org/10.2196/55099 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55099 ER - TY - JOUR AU - Fonseca, Martina AU - MacKenna, Brian AU - Mehrkar, Amir AU - AU - Walters, E. Caroline AU - Hickman, George AU - Pearson, Jonathan AU - Fisher, Louis AU - Inglesby, Peter AU - Bacon, Seb AU - Davy, Simon AU - Hulme, William AU - Goldacre, Ben AU - Koffman, Ofra AU - Bakhai, Minal PY - 2024/9/18 TI - The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e46485 VL - 10 KW - online consultation system KW - remote monitoring KW - triage KW - primary care research KW - health informatics KW - general practice KW - digital primary care KW - electronic health record coding KW - OpenSAFELY KW - trusted research environment N2 - Background: The National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care. Objective: We aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality. Methods: With the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine?Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions. Results: Overall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56% (2157/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to <1 a year prior. However, we found large variations among regions and practices: December 2020 saw the median practice have 0.9 coded instances per 1000 population compared to at least 36 for the highest decile of practices. On sociodemographics, the TPP cohort with OC instances, when compared (univariate analysis) to the cohort with general practitioner consultations, was more predominantly female (661,235/1,087,919, 60.78% vs 9,172,833/17,166,765, 53.43%), aged 18 to 40 years (349,162/1,080,589, 32.31% vs 4,295,711/17,000,942, 25.27%), White (730,389/1,087,919, 67.14% vs 10,887,858/17,166,765, 63.42%), and less deprived (167,889/1,068,887, 15.71% vs 3,376,403/16,867,074, 20.02%). Looking at the eConsultation code through multivariate analysis, it was more commonly recorded among patients with a history of asthma (adjusted odds ratio [aOR] 1.131, 95% CI 1.124-1.137), depression (aOR 1.144, 95% CI 1.138-1.151), or atrial fibrillation (aOR 1.119, 95% CI 1.099-1.139) when compared to other patients with general practitioner consultations, adjusted for long-term conditions, age, and gender. Conclusions: We successfully queried general practice coding activity relevant to the use of OC systems, showing increased adoption and key areas of variation during the pandemic at both sociodemographic and clinical levels. The work can be expanded to support monitoring of coding quality and underlying activity. This study suggests that large-scale impact evaluation studies can be implemented within the OpenSAFELY platform, namely looking at patient outcomes. UR - https://publichealth.jmir.org/2024/1/e46485 UR - http://dx.doi.org/10.2196/46485 UR - http://www.ncbi.nlm.nih.gov/pubmed/39292500 ID - info:doi/10.2196/46485 ER - TY - JOUR AU - Ferreira, Diana AU - Neto, Cristiana AU - Hak, Francini AU - Abelha, António AU - Santos, Manuel AU - Machado, José PY - 2024/9/16 TI - Standardizing Corneal Transplantation Records Using openEHR: Case Study JO - JMIR Med Inform SP - e48407 VL - 12 KW - electronic health record KW - EHR KW - corneal transplantation KW - keratoplasty KW - openEHR KW - data representation KW - data exchange KW - templates KW - archetypes KW - forms KW - standardization N2 - Background: Corneal transplantation, also known as keratoplasty, is a widely performed surgical procedure that aims to restore vision in patients with corneal damage. The success of corneal transplantation relies on the accurate and timely management of patient information, which can be enhanced using electronic health records (EHRs). However, conventional EHRs are often fragmented and lack standardization, leading to difficulties in information access and sharing, increased medical errors, and decreased patient safety. In the wake of these problems, there is a growing demand for standardized EHRs that can ensure the accuracy and consistency of patient data across health care organizations. Objective: This paper proposes the use of openEHR structures for standardizing corneal transplantation records. The main objective of this research was to improve the quality and interoperability of EHRs in corneal transplantation, making it easier for health care providers to capture, share, and analyze clinical information. Methods: A series of sequential steps were carried out in this study to implement standardized clinical records using openEHR specifications. These specifications furnish a methodical approach that ascertains the development of high-quality clinical records. In broad terms, the methodology followed encompasses the conduction of meetings with health care professionals and the modeling of archetypes, templates, forms, decision rules, and work plans. Results: This research resulted in a tailored solution that streamlines health care delivery and meets the needs of medical professionals involved in the corneal transplantation process while seamlessly aligning with contemporary clinical practices. The proposed solution culminated in the successful integration within a Portuguese hospital of 3 key components of openEHR specifications: forms, Decision Logic Modules, and Work Plans. A statistical analysis of data collected from May 1, 2022, to March 31, 2023, allowed for the perception of the use of the new technologies within the corneal transplantation workflow. Despite the completion rate being only 63.9% (530/830), which can be explained by external factors such as patient health and availability of donor organs, there was an overall improvement in terms of task control and follow-up of the patients? clinical process. Conclusions: This study shows that the adoption of openEHR structures represents a significant step forward in the standardization and optimization of corneal transplantation records. It offers a detailed demonstration of how to implement openEHR specifications and highlights the different advantages of standardizing EHRs in the field of corneal transplantation. Furthermore, it serves as a valuable reference for researchers and practitioners who are interested in advancing and improving the exploitation of EHRs in health care. UR - https://medinform.jmir.org/2024/1/e48407 UR - http://dx.doi.org/10.2196/48407 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48407 ER - TY - JOUR AU - Staehelin, Dario AU - Dolata, Mateusz AU - Stöckli, Livia AU - Schwabe, Gerhard PY - 2024/9/10 TI - How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research JO - JMIR Med Inform SP - e57406 VL - 12 KW - patient-provider communication KW - patient-generated data KW - field study KW - chronic care KW - design science research KW - patient-centered care KW - integrated care KW - patient-provider collaboration KW - mobile phone N2 - Background: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers? workflow. Objective: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. Methods: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. Results: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. Conclusions: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care. UR - https://medinform.jmir.org/2024/1/e57406 UR - http://dx.doi.org/10.2196/57406 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57406 ER - TY - JOUR AU - Ferguson, M. Jacqueline AU - Van Campen, James AU - Slightam, Cindie AU - Greene, Liberty AU - Heyworth, Leonie AU - Zulman, M. Donna PY - 2024/9/9 TI - Evaluation of the Veterans Health Administration?s Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study JO - J Med Internet Res SP - e59089 VL - 26 KW - veterans KW - health care access KW - video-based care KW - telehealth KW - barriers to care KW - telemedicine N2 - Background: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. Objective: We sought to evaluate the reach and impact of VHA?s Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. Methods: We examined the reach of VHA?s Connected Device Program using national secondary data from VHA?s electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients? demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Results: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. Conclusions: This evaluation of VHA?s Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention. UR - https://www.jmir.org/2024/1/e59089 UR - http://dx.doi.org/10.2196/59089 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250183 ID - info:doi/10.2196/59089 ER - TY - JOUR AU - Faisal, Putra Hiro AU - Nakayama, Masaharu PY - 2024/8/28 TI - Implementation of the World Health Organization Minimum Dataset for Emergency Medical Teams to Create Disaster Profiles for the Indonesian SATUSEHAT Platform Using Fast Healthcare Interoperability Resources: Development and Validation Study JO - JMIR Med Inform SP - e59651 VL - 12 KW - WHO EMT MDS KW - FHIR KW - SATUSEHAT KW - disaster KW - implementation KW - development KW - validation KW - emergency medical team KW - disaster management KW - Indonesia KW - Fast Healthcare Interoperability Resources KW - resources KW - interoperability KW - electronic medical records KW - EMR KW - reporting KW - disaster profile KW - health data KW - health data collection KW - World Health Organization KW - EMT KW - WHO KW - MDS KW - minimum dataset N2 - Background: The National Disaster Management Agency (Badan Nasional Penanggulangan Bencana) handles disaster management in Indonesia as a health cluster by collecting, storing, and reporting information on the state of survivors and their health from various sources during disasters. Data were collected on paper and transferred to Microsoft Excel spreadsheets. These activities are challenging because there are no standards for data collection. The World Health Organization (WHO) introduced a standard for health data collection during disasters for emergency medical teams (EMTs) in the form of a minimum dataset (MDS). Meanwhile, the Ministry of Health of Indonesia launched the SATUSEHAT platform to integrate all electronic medical records in Indonesia based on Fast Healthcare Interoperability Resources (FHIR). Objective: This study aims to implement the WHO EMT MDS to create a disaster profile for the SATUSEHAT platform using FHIR. Methods: We extracted variables from 2 EMT MDS medical records?the WHO and Association of Southeast Asian Nations (ASEAN) versions?and the daily reporting form. We then performed a mapping process to match these variables with the FHIR resources and analyzed the gaps between the variables and base resources. Next, we conducted profiling to see if there were any changes in the selected resources and created extensions to fill the gap using the Forge application. Subsequently, the profile was implemented using an open-source FHIR server. Results: The total numbers of variables extracted from the WHO EMT MDS, ASEAN EMT MDS, and daily reporting forms were 30, 32, and 46, with the percentage of variables matching FHIR resources being 100% (30/30), 97% (31/32), and 85% (39/46), respectively. From the 40 resources available in the FHIR ID core, we used 10, 14, and 9 for the WHO EMT MDS, ASEAN EMT MDS, and daily reporting form, respectively. Based on the gap analysis, we found 4 variables in the daily reporting form that were not covered by the resources. Thus, we created extensions to address this gap. Conclusions: We successfully created a disaster profile that can be used as a disaster case for the SATUSEHAT platform. This profile may standardize health data collection during disasters. UR - https://medinform.jmir.org/2024/1/e59651 UR - http://dx.doi.org/10.2196/59651 ID - info:doi/10.2196/59651 ER - TY - JOUR AU - Ganeshan, Smitha AU - Goldstein, Joshua AU - Sohn, Young-Jin AU - Pollack, Amie AU - Phillips, S. Russell AU - Rotenstein, Lisa PY - 2024/8/27 TI - Impact of COVID-19 on Characteristics and Funding of U.S. Healthcare Startups: Retrospective Review JO - JMIR Form Res SP - e56327 VL - 8 KW - artificial intelligence KW - venture capital KW - COVID-19 KW - health care startup KW - health care KW - AI KW - retrospective study KW - telehealth KW - telemedicine KW - pandemic KW - patients KW - digital health KW - coronavirus N2 - Background: The rise of telehealth and telemedicine during the pandemic allowed patients and providers to develop a sense of comfort with telehealth, which may have increased the demand for virtual-first care solutions with spillover effects into venture capital funding. Objective: We aimed to understand the size and type of digital health investments occurring in the prepandemic and pandemic periods. Methods: We examined health care companies founded from March 14, 2019, to March 14, 2020 (prepandemic) versus those founded from March 15, 2020, to March 14, 2022, after pandemic onset. Data were obtained from Crunchbase, a publicly available database that catalogs information about venture capital investments for companies. We also compared companies founded prepandemic to those founded after the first year of the pandemic (pandemic steady-state). We performed a Wilcoxon rank sum test to compare median funding amounts. We compared the 2 groups of companies according to the type of funding round raised, geography, health care subcategory, total amount of funding per year since founding, and number of founders. Results: There were 2714 and 2218 companies founded prepandemic and during the pandemic, respectively. The companies were similarly distributed across geographies in the prepandemic and pandemic periods (P=.46) with no significant differences in the number of founders (P=.32). There was a significant difference in total funding per year since founding between prepandemic and pandemic companies (US $10.8 million vs US $20.9 million; P<.001). The distribution of funding rounds differed significantly for companies founded in prepandemic and pandemic periods (P<.001). On excluding data from the first year of the pandemic, there were 581 companies founded in the pandemic steady-state period from March 14, 2021, to March 14, 2022. Companies founded prepandemic had a significantly greater mean number of founders than those founded during the pandemic (P=.02). There was no significant difference in total funding per year since founding between prepandemic and steady-state pandemic companies (US $10.8 million vs US $14.4 million; P=.34). The most common types of health care companies included wellness, biotech/biopharma, and software companies. Distributions of companies across health care subcategories were not significantly different before and during the pandemic. However, significant differences were identified when data from the first year of the pandemic were excluded (P<.001). Companies founded during the steady-state pandemic period were significantly more likely to be classified as artificial intelligence (7.3% vs 4.7%; P=.005), software (17.3% vs 12.7%; P=.002), and insurance (3.3% vs 1.7%; P=.003), and were significantly less likely to be classified as health care diagnostics (2.4% vs 5.1%; P=.002). Conclusions: We demonstrate no significant changes in the types of health care companies founded before versus during the pandemic, although significant differences emerge when comparing prepandemic companies to those founded after the first year of the pandemic. UR - https://formative.jmir.org/2024/1/e56327 UR - http://dx.doi.org/10.2196/56327 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56327 ER - TY - JOUR AU - Zainal, Humairah AU - Hui, Xiao Xin AU - Thumboo, Julian AU - Fong, Warren AU - Yong, Kok Fong PY - 2024/8/27 TI - Patients? Expectations of Doctors? Clinical Competencies in the Digital Health Care Era: Qualitative Semistructured Interview Study Among Patients JO - JMIR Hum Factors SP - e51972 VL - 11 KW - digital health KW - clinical competence KW - patient engagement KW - qualitative research KW - Singapore KW - mobile phone N2 - Background: Digital technologies have impacted health care delivery globally, and are increasingly being deployed in clinical practice. However, there is limited research on patients? expectations of doctors? clinical competencies when using digital health care technologies (DHTs) in medical care. Understanding these expectations can reveal competency gaps, enhance patient confidence, and contribute to digital innovation initiatives. Objective: This study explores patients? perceptions of doctors? use of DHTs in clinical care. Using Singapore as a case study, it examines patients? expectations regarding doctors? communication, diagnosis, and treatment skills when using telemedicine, health apps, wearable devices, electronic health records, and artificial intelligence. Methods: Findings were drawn from individual semistructured interviews with patients from outpatient clinics. Participants were recruited using purposive sampling. Data were analyzed qualitatively using thematic analysis. Results: Twenty-five participants from different backgrounds and with various chronic conditions participated in the study. They expected doctors to be adept in handling medical data from apps and wearable devices. For telemedicine, participants expected a level of assessment of their medical conditions akin to in-person consultations. In addition, they valued doctors recognizing when a physical examination was necessary. Interestingly, eye contact was appreciated but deemed nonessential by participants across all age bands when electronic health records were used, as they valued the doctor?s efficiency more than eye contact. Nonetheless, participants emphasized the need for empathy throughout the clinical encounter regardless of DHT use. Furthermore, younger participants had a greater expectation for DHT use among doctors compared to older ones, who preferred DHTs as a complement rather than a replacement for clinical skills. The former expected doctors to be knowledgeable about the algorithms, principles, and purposes of DHTs such as artificial intelligence technologies to better assist them in diagnosis and treatment. Conclusions: By identifying patients? expectations of doctors amid increasing health care digitalization, this study highlights that while basic clinical skills remain crucial in the digital age, the role of clinicians needs to evolve with the introduction of DHTs. It has also provided insights into how DHTs can be integrated effectively into clinical settings, aligning with patients? expectations and preferences. Overall, the findings offer a framework for high-income countries to harness DHTs in enhancing health care delivery in the digital era. UR - https://humanfactors.jmir.org/2024/1/e51972 UR - http://dx.doi.org/10.2196/51972 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51972 ER - TY - JOUR AU - Marsh, Meghan AU - Shah, Rafia Syeda AU - Munce, P. Sarah E. AU - Perrier, Laure AU - Lee, Joan Tin-Suet AU - Colella, F. Tracey J. AU - Kokorelias, Marie Kristina PY - 2024/8/19 TI - Characteristics of Existing Online Patient Navigation Interventions: Scoping Review JO - JMIR Med Inform SP - e50307 VL - 12 KW - online KW - patient navigation KW - peer navigation KW - patient navigation interventions KW - online patient navigation interventions KW - scoping review KW - patient portals KW - social care services KW - online medical tools KW - eHealth KW - telehealth KW - personal support KW - social care KW - patient navigation intervention N2 - Background: Patient navigation interventions (PNIs) can provide personalized support and promote appropriate coordination or continuation of health and social care services. Online PNIs have demonstrated excellent potential for improving patient knowledge, transition readiness, self-efficacy, and use of services. However, the characteristics (ie, intervention type, mode of delivery, duration, frequency, outcomes and outcome measures, underlying theories or mechanisms of change of the intervention, and impact) of existing online PNIs to support the health and social needs of individuals with illness remain unclear. Objective: This scoping review of the existing literature aims to identify the characteristics of existing online PNIs reported in the literature. Methods: A scoping review based on the guidelines outlined in the Joanna Briggs Institute framework was conducted. A search for peer-reviewed literature published between 1989 and 2022 on online PNIs was conducted using MEDLINE, CINAHL, Embase, PsycInfo, and Cochrane Library databases. Two independent reviewers conducted 2 levels of screening. Data abstraction was conducted to outline key study characteristics (eg, study design, population, and intervention characteristics). The data were analyzed using descriptive statistics and qualitative content analysis. Results: A total of 100 studies met the inclusion criteria. Our findings indicate that a variety of study designs are used to describe and evaluate online PNIs, with literature being published between 2003 and 2022 in Western countries. Of these studies, 39 (39%) studies were randomized controlled trials. In addition, we noticed an increase in reported online PNIs since 2019. The majority of studies involved White females with a diagnosis of cancer and a lack of participants aged 70 years or older was observed. Most online PNIs provide support through navigation, self-management and lifestyle changes, counseling, coaching, education, or a combination of support. Variation was noted in terms of mode of delivery, duration, and frequency. Only a small number of studies described theoretical frameworks or change mechanisms to guide intervention. Conclusions: To our knowledge, this is the first review to comprehensively synthesize the existing literature on online PNIs, by focusing on the characteristics of interventions and studies in this area. Inconsistency in reporting the country of publication, population characteristics, duration and frequency of interventions, and a lack of the use of underlying theories and working mechanisms to inform intervention development, provide guidance for the reporting of future online PNIs. UR - https://medinform.jmir.org/2024/1/e50307 UR - http://dx.doi.org/10.2196/50307 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50307 ER - TY - JOUR AU - van der Mee, M. Frederieke A. AU - Schaper, Fleur AU - Jansen, Jesse AU - Bons, P. Judith A. AU - Meex, R. Steven J. AU - Cals, L. Jochen W. PY - 2024/8/12 TI - Enhancing Patient Understanding of Laboratory Test Results: Systematic Review of Presentation Formats and Their Impact on Perception, Decision, Action, and Memory JO - J Med Internet Res SP - e53993 VL - 26 KW - electronic health record KW - patient access to records KW - patient portal KW - laboratory test results KW - clinical laboratory information systems KW - health communication KW - health informatics KW - patient engagement KW - patient involvement N2 - Background: Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients? processing of the information. Objective: This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients? information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory. Methods: The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool. Results: A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants? satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants? perception. Additionally, horizontal line bars significantly decreased participants? tendency to search for information or to contact their physician, compared with numerical values with reference ranges. Conclusions: In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants? cognitive perception and perception of communication while decreasing participants? tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients? information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients? information processing. UR - https://www.jmir.org/2024/1/e53993 UR - http://dx.doi.org/10.2196/53993 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53993 ER - TY - JOUR AU - Winder, Rachel AU - Campbell, L. John AU - Akter, Nurunnahar AU - Aminu, Q. Abodunrin AU - Lambert, Jeffrey AU - Cockcroft, Emma AU - Thomas, Chloe AU - Clark, E. Christopher AU - Bryce, Carol AU - Sussex, Jon AU - Atherton, Helen AU - Marriott, Christine AU - Abel, Gary PY - 2024/8/7 TI - Exploring How Patients Are Supported to Use Online Services in Primary Care in England Through ?Digital Facilitation?: Survey Study JO - J Med Internet Res SP - e56528 VL - 26 KW - primary care KW - online services KW - access to online health care services KW - general practice KW - survey KW - digital support KW - inequalities KW - remote consultation KW - health services research KW - digital technology N2 - Background: Health service policy in many jurisdictions is driving greater investment into digital primary care services. While some patients and practices may benefit, there are concerns that not all are able or wish to access primary care services online. ?Digital facilitation? is the ?range of processes, procedures, and personnel seeking to support patients in their uptake and use of online services? and may address such concerns. Objective: As part of a multimethod research program, we undertook surveys of practice staff and patients to gain insight into the support being offered by practices and explore patients? experiences of this support. Methods: General practices from 4 regions of England were sent a questionnaire exploring the modes of digital facilitation offered, the personnel involved in its delivery, and views on the motivations and drivers for providing support. Moreover, 12,822 patients registered with 62 general practices (predominantly those providing practice survey responses) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services. Results: Almost one-third of practices (156/500, 31.2%) responded to the practice survey, with most reporting using passive modes of digital facilitation (eg, display, leaflets, and SMS text messages) and few using active modes (eg, offering tablets or computers or using practice champions). However, 90.9% (130/143) reported providing ad hoc support. Practices agreed that it was the responsibility of both the practice (105/144, 72.9%) and the wider National Health Service (118/143, 82.5%) to support patients in using online services and that providing such support benefited the practice (126/144, 87.5%) and their patients (132/144, 91.7%). Nearly a quarter of the patients (3051/12,822, 23.8%) responded to the patient survey, with few (522/3051, 17.11% or less) reporting awareness of any modes of digital facilitation apart from text messages and emails (1205/3051, 39.5%) and only 13.36% (392/2935) reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of 4 outcomes: being aware of, or of using, digital facilitation efforts, or being told about or being helped to use online services (all P<.05), particularly with regard to being helped to use online services (adjusted odds ratio for patients aged 85 years versus those aged 55-64 years: 0.08, 95% CI 0.02-0.36). However, ethnic minority participants or those for whom their first language was not English had positive associations with these outcomes. Conclusions: General practices recognize that patients would benefit from support to access online services. However, the support provided is often passive or ad hoc, and patients were seldom aware of digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support for all patients, particularly to provide targeted support for older patients. UR - https://www.jmir.org/2024/1/e56528 UR - http://dx.doi.org/10.2196/56528 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56528 ER - TY - JOUR AU - Koenig, R. Leah AU - Ko, Jennifer AU - Upadhyay, D. Ushma PY - 2024/8/5 TI - Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review JO - J Med Internet Res SP - e50749 VL - 26 KW - medication abortion KW - telehealth KW - virtual clinics KW - abortion KW - access KW - policy KW - health equity N2 - Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women?s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic?s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. UR - https://www.jmir.org/2024/1/e50749 UR - http://dx.doi.org/10.2196/50749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50749 ER - TY - JOUR AU - Jiang, Hongxun AU - Mi, Ziyue AU - Xu, Wei PY - 2024/7/30 TI - Online Medical Consultation Service?Oriented Recommendations: Systematic Review JO - J Med Internet Res SP - e46073 VL - 26 KW - online health community KW - online medical consultation KW - personalized recommendations KW - 2-sided matching KW - load balancing N2 - Background: Online health communities have given rise to a new e-service known as online medical consultations (OMCs), enabling remote interactions between physicians and patients. To address challenges, such as patient information overload and uneven distribution of physician visits, online health communities should develop OMC-oriented recommenders. Objective: We aimed to comprehensively investigate what paradigms lead to the success of OMC-oriented recommendations. Methods: A literature search was conducted through e-databases, including PubMed, ACM Digital Library, Springer, and ScienceDirect, from January 2011 to December 2023. This review included all papers directly and indirectly related to the topic of health care?related recommendations for online services. Results: The search identified 611 articles, of which 26 (4.3%) met the inclusion criteria. Despite the growing academic interest in OMC recommendations, there remains a lack of consensus among researchers on the definition of e-service?oriented recommenders. The discussion highlighted 3 key factors influencing recommender success: features, algorithms, and metrics. It advocated for moving beyond traditional e-commerce?oriented recommenders to establish an innovative theoretical framework for e-service?oriented recommenders and addresses critical technical issues regarding 2-sided personalized recommendations. Conclusions: This review underscores the essence of e-services, particularly in knowledge- and labor-intensive domains such as OMCs, where patients seek interpretable recommendations due to their lack of domain knowledge and physicians must balance their energy levels to avoid overworking. Our study?s findings shed light on the importance of customizing e-service?oriented personalized recommendations to meet the distinct expectations of 2-sided users considering their cognitive abilities, decision-making perspectives, and preferences. To achieve this, a paradigm shift is essential to develop unique attributes and explore distinct content tailored for both parties involved. UR - https://www.jmir.org/2024/1/e46073 UR - http://dx.doi.org/10.2196/46073 UR - http://www.ncbi.nlm.nih.gov/pubmed/38777810 ID - info:doi/10.2196/46073 ER - TY - JOUR AU - Ge, Xiaochen AU - Chappell, Paul AU - Ledger, Jean AU - Bakhai, Minal AU - Clarke, M. Geraldine PY - 2024/7/26 TI - The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey JO - J Med Internet Res SP - e51272 VL - 26 KW - general practice KW - online consultation KW - patient experience KW - modern general practice KW - sociodemographic health inequalities KW - General Practice Patient Survey KW - cross-sectional study N2 - Background: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients? primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. Objective: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). Methods: We categorized practices as ?low-use? or ?high-use? according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models?shorter ?free text? input with an embedded single workflow OC system (FT practices) and longer ?mixed text? input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience?overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. Results: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8% (odds ratio [OR] 0.802, 95% CI 0.782-0.823) less likely to report a good overall experience; 24.5% (OR 0.755, 95% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9% (OR 0.811, 95% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8% (OR 1.278, 95% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups?patients from urban and deprived areas, younger patients, and non-White patients. Conclusions: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients. UR - https://www.jmir.org/2024/1/e51272 UR - http://dx.doi.org/10.2196/51272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51272 ER - TY - JOUR AU - Subramani, Yamini AU - Querney, Jill AU - Singh, Priyanka AU - Zhang, Yifan AU - Fochesato, Lee-Anne AU - Fatima, Nida AU - Wood, Natasha AU - Nagappa, Mahesh PY - 2024/7/25 TI - Preoperative Anesthesia Virtual Video Consultations in a Preadmission Clinic: Quality Improvement Study JO - JMIR Perioper Med SP - e57541 VL - 7 KW - preoperative evaluation KW - preadmission clinic KW - telemedicine KW - remote KW - virtual care KW - remote consultation KW - video consultation KW - telehealth KW - online health KW - digital health KW - perioperative medicine KW - preoperative KW - eMedicine KW - surgery KW - consultation KW - safety KW - assessment KW - workflow KW - implementation KW - integration KW - hospital N2 - Background: The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. Objective: This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. Methods: A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. Results: The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. Conclusions: The quality improvement process significantly enhanced the institution?s preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies. UR - https://periop.jmir.org/2024/1/e57541 UR - http://dx.doi.org/10.2196/57541 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57541 ER - TY - JOUR AU - Shang, Di AU - Williams, Cynthia AU - Culiqi, Hera PY - 2024/7/24 TI - Telehealth Uptake Among Hispanic People During COVID-19: Retrospective Observational Study JO - JMIR Med Inform SP - e57717 VL - 12 KW - telehealth KW - telemedicine KW - ICT KW - eHealth KW - e-health KW - Hispanic KW - health equity KW - health access KW - Hispanics KW - digital divide KW - usage KW - utilization KW - equity KW - inequity KW - inequities KW - access KW - accessibility KW - Spanish KW - observational KW - demographic KW - demographics KW - socioeconomic KW - socioeconomics KW - information and communication technology N2 - Background: The Hispanic community represents a sizeable community that experiences inequities in the US health care system. As the system has moved toward digital health platforms, evaluating the potential impact on Hispanic communities is critical. Objective: The study aimed to investigate demographic, socioeconomic, and behavioral factors contributing to low telehealth use in Hispanic communities. Methods: We used a retrospective observation study design to examine the study objectives. The COVID-19 Research Database Consortium provided the Analytics IQ PeopleCore consumer data and Office Alley claims data. The study period was from March 2020 to April 2021. Multiple logistic regression was used to determine the odds of using telehealth services. Results: We examined 3,478,287 unique Hispanic patients, 16.6% (577,396) of whom used telehealth. Results suggested that patients aged between 18 and 44 years were more likely to use telehealth (odds ratio [OR] 1.07, 95% CI 1.05-1.1; P<.001) than patients aged older than 65 years. Across all age groups, patients with high incomes were at least 20% more likely to use telehealth than patients with lower incomes (P<.001); patients who had a primary care physician (P=.01), exhibited high medical usage (P<.001), or were interested in exercise (P=.03) were more likely to use telehealth; patients who had unhealthy behaviors such as smoking and alcohol consumption were less likely to use telehealth (P<.001). Male patients were less likely than female patients to use telehealth among patients aged 65 years and older (OR 0.94, 95% CI 0.93-0.95; P<.001), while male patients aged between 18 and 44 years were more likely to use telehealth (OR 1.05, 95% CI 1.03-1.07; P<.001). Among patients younger than 65 years, full-time employment was positively associated with telehealth use (P<.001). Patients aged between 18 and 44 years with high school or less education were 2% less likely to use telehealth (OR 0.98, 95% CI 0.97-0.99; P=.005). Results also revealed a positive association with using WebMD (WebMD LLC) among patients aged older than 44 years (P<.001), while there was a negative association with electronic prescriptions among those who were aged between 18 and 44 years (P=.009) and aged between 45 and 64 years (P=.004). Conclusions: This study demonstrates that telehealth use among Hispanic communities is dependent upon factors such as age, gender, education, socioeconomic status, current health care engagement, and health behaviors. To address these challenges, we advocate for interdisciplinary approaches that involve medical professionals, insurance providers, and community-based services actively engaging with Hispanic communities and promoting telehealth use. We propose the following recommendations: enhance access to health insurance, improve access to primary care providers, and allocate fiscal and educational resources to support telehealth use. As telehealth increasingly shapes health care delivery, it is vital for professionals to facilitate the use of all available avenues for accessing care. UR - https://medinform.jmir.org/2024/1/e57717 UR - http://dx.doi.org/10.2196/57717 ID - info:doi/10.2196/57717 ER - TY - JOUR AU - Meltzer, Ellen AU - Wilshusen, Laurie AU - Abdulwadood, Isra AU - Yee, Claire AU - Sherman, Amy AU - Strader, Kelli AU - Thomley, Barbara AU - Millstine, Denise AU - Tilburt, Jon AU - Fields, Heather AU - Bergstrom, Larry AU - Patchett, David AU - Camoriano, John AU - Bauer, Brent PY - 2024/7/22 TI - Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination JO - JMIR Form Res SP - e56312 VL - 8 KW - telemedicine KW - TELE KW - patient experience KW - communication skills KW - integrative medicine KW - face-to-face KW - F2F KW - encounters N2 - Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage ?top box? scores (ie, the percentage of respondents who selected the most positive response category on the survey, ?very good?), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine. UR - https://formative.jmir.org/2024/1/e56312 UR - http://dx.doi.org/10.2196/56312 UR - http://www.ncbi.nlm.nih.gov/pubmed/39037767 ID - info:doi/10.2196/56312 ER - TY - JOUR AU - Morrison, Lisa AU - Saynor, Louise Zoe AU - Kirk, Alison AU - McCann, Lisa PY - 2024/7/15 TI - Revolutionizing Care: Unleashing the Potential of Digital Health Technology in Physiotherapy Management for People With Cystic Fibrosis JO - JMIR Rehabil Assist Technol SP - e55718 VL - 11 KW - cystic fibrosis KW - physiotherapy KW - digital technology KW - telehealth KW - cystic fibrosis transmembrane regulator modulators KW - telemedicine KW - digital health technology KW - DHTs KW - digital health KW - physical therapy KW - physical activity KW - exercise KW - monitoring KW - physiotherapists KW - user KW - experience KW - remote KW - virtual care KW - consultation KW - consultations KW - eConsultations KW - preferences KW - digital divide KW - access KW - accessible KW - accessibility KW - attitude KW - perception KW - attitudes KW - opinion KW - perceptions KW - perspectives KW - eHealth KW - online health KW - therapy UR - https://rehab.jmir.org/2024/1/e55718 UR - http://dx.doi.org/10.2196/55718 ID - info:doi/10.2196/55718 ER - TY - JOUR AU - Shalev, Ligat AU - Eitan, Renana AU - Rose, J. Adam PY - 2024/7/15 TI - The Use of Telepsychiatry Services in Emergency Settings: Scoping Review JO - J Med Internet Res SP - e51814 VL - 26 KW - implementation science KW - emergency department KW - telepsychiatry KW - organizational innovation KW - eHealth KW - mHealth KW - scoping review KW - implementation KW - psychiatric patient KW - clinical outcome KW - rural KW - feasible KW - acceptable KW - effectiveness KW - electronic database N2 - Background: Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP?s effectiveness in the ED setting, as well as the process of implementing TP in this setting. Objective: This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. Methods: The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. Results: A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. Conclusions: Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP?s effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment. UR - https://www.jmir.org/2024/1/e51814 UR - http://dx.doi.org/10.2196/51814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51814 ER - TY - JOUR AU - Wosny, Marie AU - Strasser, Maria Livia AU - Hastings, Janna PY - 2024/7/15 TI - The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study JO - J Med Internet Res SP - e56095 VL - 26 KW - health care KW - health care technology KW - health care information technology KW - hospital information technology KW - clinical information systems KW - health care professionals KW - experience KW - frustration KW - clinician burnout KW - technology implementation KW - paradoxes KW - digital tool KW - digital tools KW - hospital KW - hospitals KW - qualitative interview study KW - interview KW - interviews KW - Switzerland KW - thematic analysis N2 - Background: Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians? well-being. Objective: The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. Methods: Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. Results: Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs? experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. Conclusions: Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges. UR - https://www.jmir.org/2024/1/e56095 UR - http://dx.doi.org/10.2196/56095 UR - http://www.ncbi.nlm.nih.gov/pubmed/39008341 ID - info:doi/10.2196/56095 ER - TY - JOUR AU - Charifson, Mia AU - Wen, Timothy AU - Zell, Bonnie AU - Vaidya, Priyanka AU - Rios, I. Cynthia AU - Fagbohun, Funsho C. AU - Fulcher, Isabel PY - 2024/7/12 TI - Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study JO - JMIR Mhealth Uhealth SP - e55617 VL - 12 KW - blood pressure KW - hypertension KW - remote patient monitoring KW - pregnancy KW - digital health KW - remote monitoring KW - user engagement KW - users KW - connected KW - unconnected KW - comparison KW - patient engagement KW - prospective pregnancy cohort KW - device KW - devices KW - female KW - females KW - women KW - logistic regression KW - Poisson UR - https://mhealth.jmir.org/2024/1/e55617 UR - http://dx.doi.org/10.2196/55617 ID - info:doi/10.2196/55617 ER - TY - JOUR AU - Zhang, Kun AU - Huang, Qiyuan AU - Wang, Qiaosong AU - Li, Chengyang AU - Zheng, Qirong AU - Li, Zhuoyue AU - Xu, Dan AU - Xie, Cuiling AU - Zhang, Mingqi AU - Lin, Rongjin PY - 2024/7/9 TI - Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e51538 VL - 26 KW - telemedicine KW - digital health KW - web-based KW - type 1 diabetes mellitus KW - children KW - adolescents KW - glycemic control KW - chronic disease management KW - randomized controlled trials KW - meta-analysis KW - mobile phone N2 - Background: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. Objective: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. Methods: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. Results: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI ?0.33 to ?0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI ?0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD ?0.15, 95% CI ?0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non?youth-specific quality of life (MD ?0.24, 95% CI ?0.45 to ?0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD ?0.41, 95% CI ?0.62 to ?0.20; P<.001), studies that lasted <6 months (MD ?0.32, 95% CI ?0.48 to ?0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD ?0.37, 95% CI ?0.53 to ?0.21; P<.001), and studies with medication dose adjustment (MD ?0.25, 95% CI ?0.37 to ?0.12; P<.001). Conclusions: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life. UR - https://www.jmir.org/2024/1/e51538 UR - http://dx.doi.org/10.2196/51538 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51538 ER - TY - JOUR AU - Dhunnoo, Pranavsingh AU - Kemp, Bridie AU - McGuigan, Karen AU - Meskó, Bertalan AU - O?Rourke, Vicky AU - McCann, Michael PY - 2024/7/9 TI - Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review JO - J Med Internet Res SP - e53266 VL - 26 KW - telemedicine KW - internet-based consultation KW - chronic illnesses KW - cyberpsychology KW - digital health KW - scoping review N2 - Background: Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. Objective: With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. Methods: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. Results: Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality?s convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. Conclusions: For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits. UR - https://www.jmir.org/2024/1/e53266 UR - http://dx.doi.org/10.2196/53266 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980704 ID - info:doi/10.2196/53266 ER - TY - JOUR AU - Atherton, Helen AU - Eccles, Abi AU - Poltawski, Leon AU - Dale, Jeremy AU - Campbell, John AU - Abel, Gary PY - 2024/7/8 TI - Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study JO - J Med Internet Res SP - e51931 VL - 26 KW - appointment KW - patient appointments KW - online systems KW - primary health care KW - general practice KW - qualitative research KW - secondary data analysis KW - mobile phone N2 - Background: Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. Objective: This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients? views regarding online appointment booking arrangements. Methods: This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. Results: The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. Conclusions: Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice. UR - https://www.jmir.org/2024/1/e51931 UR - http://dx.doi.org/10.2196/51931 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51931 ER - TY - JOUR AU - Schmalstieg-Bahr, Katharina AU - Colombo, Giovanna Miriam AU - Koch, Roland AU - Szecsenyi, Joachim AU - Völker, Friedrich AU - Blozik, Elisabeth Eva AU - Scherer, Martin PY - 2024/6/28 TI - Intramural Health Care Through Video Consultations and the Need for Referrals and Hospital Admissions: Retrospective Quantitative Subanalysis of an Evaluation Study JO - Interact J Med Res SP - e44906 VL - 13 KW - intramural health care KW - prison KW - telemedicine KW - primary care KW - family medicine KW - referral KW - hospital admission KW - admission rate KW - intramural KW - penal KW - video consult KW - e-consult KW - remote care KW - virtual care KW - health care delivery KW - service delivery KW - health care system N2 - Background: In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates. Objective: This study aims to quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison. Methods: In 5 German prisons, a mixed methods evaluation study was conducted to assess feasibility, acceptance, and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses quantitative data from these consultations (June 2018 to February 2019) in addition to data from a sixth prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters. Results: At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 78%). In 68% (n=294) of all encounters, the patient was asked to consult a physician again if symptoms persisted or got worse. In 26% (n=115), a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4% (n=17) of the cases. Only in 2% (n=8) of the consultations, a hospital admission was needed. Usually, hospital admissions were the result of unscheduled consultations, and the videoconferencing system was the method of communication in 88% (n=7) of these cases, while 12% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode. Conclusions: Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary. UR - https://www.i-jmr.org/2024/1/e44906 UR - http://dx.doi.org/10.2196/44906 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/44906 ER - TY - JOUR AU - Lahat, Adi AU - Sharif, Kassem AU - Zoabi, Narmin AU - Shneor Patt, Yonatan AU - Sharif, Yousra AU - Fisher, Lior AU - Shani, Uria AU - Arow, Mohamad AU - Levin, Roni AU - Klang, Eyal PY - 2024/6/27 TI - Assessing Generative Pretrained Transformers (GPT) in Clinical Decision-Making: Comparative Analysis of GPT-3.5 and GPT-4 JO - J Med Internet Res SP - e54571 VL - 26 KW - ChatGPT KW - chat-GPT KW - chatbot KW - chatbots KW - chat-bot KW - chat-bots KW - natural language processing KW - NLP KW - artificial intelligence KW - AI KW - machine learning KW - ML KW - algorithm KW - algorithms KW - predictive model KW - predictive models KW - predictive analytics KW - predictive system KW - practical model KW - practical models KW - internal medicine KW - ethics KW - ethical KW - ethical dilemma KW - ethical dilemmas KW - bioethics KW - emergency medicine KW - EM medicine KW - ED physician KW - emergency physician KW - emergency doctor N2 - Background: Artificial intelligence, particularly chatbot systems, is becoming an instrumental tool in health care, aiding clinical decision-making and patient engagement. Objective: This study aims to analyze the performance of ChatGPT-3.5 and ChatGPT-4 in addressing complex clinical and ethical dilemmas, and to illustrate their potential role in health care decision-making while comparing seniors? and residents? ratings, and specific question types. Methods: A total of 4 specialized physicians formulated 176 real-world clinical questions. A total of 8 senior physicians and residents assessed responses from GPT-3.5 and GPT-4 on a 1-5 scale across 5 categories: accuracy, relevance, clarity, utility, and comprehensiveness. Evaluations were conducted within internal medicine, emergency medicine, and ethics. Comparisons were made globally, between seniors and residents, and across classifications. Results: Both GPT models received high mean scores (4.4, SD 0.8 for GPT-4 and 4.1, SD 1.0 for GPT-3.5). GPT-4 outperformed GPT-3.5 across all rating dimensions, with seniors consistently rating responses higher than residents for both models. Specifically, seniors rated GPT-4 as more beneficial and complete (mean 4.6 vs 4.0 and 4.6 vs 4.1, respectively; P<.001), and GPT-3.5 similarly (mean 4.1 vs 3.7 and 3.9 vs 3.5, respectively; P<.001). Ethical queries received the highest ratings for both models, with mean scores reflecting consistency across accuracy and completeness criteria. Distinctions among question types were significant, particularly for the GPT-4 mean scores in completeness across emergency, internal, and ethical questions (4.2, SD 1.0; 4.3, SD 0.8; and 4.5, SD 0.7, respectively; P<.001), and for GPT-3.5?s accuracy, beneficial, and completeness dimensions. Conclusions: ChatGPT?s potential to assist physicians with medical issues is promising, with prospects to enhance diagnostics, treatments, and ethics. While integration into clinical workflows may be valuable, it must complement, not replace, human expertise. Continued research is essential to ensure safe and effective implementation in clinical environments. UR - https://www.jmir.org/2024/1/e54571 UR - http://dx.doi.org/10.2196/54571 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54571 ER - TY - JOUR AU - Bratches, R. Reed W. AU - Cohen, Jeffrey AU - Carpenter-Song, Elizabeth AU - Mistler, Lisa AU - Barr, J. Paul PY - 2024/6/26 TI - The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial JO - JMIR Form Res SP - e57519 VL - 8 KW - feasibility KW - acceptability KW - amyotrophic lateral sclerosis KW - digital intervention KW - ALS KW - video recording N2 - Background: Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. Objective: The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. Methods: This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70%), percentage of participants watching videos (target: 75%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. Results: Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). Conclusions: Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. Trial Registration: ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403 UR - https://formative.jmir.org/2024/1/e57519 UR - http://dx.doi.org/10.2196/57519 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57519 ER - TY - JOUR AU - Wallman, Andy AU - Svärdsudd, Kurt AU - Bobits, Kent AU - Wallman, Thorne PY - 2024/6/26 TI - Antibiotic Prescribing by Digital Health Care Providers as Compared to Traditional Primary Health Care Providers: Cohort Study Using Register Data JO - J Med Internet Res SP - e55228 VL - 26 KW - telehealth prescribing KW - physical-primary health care KW - internet-primary health care KW - antibiotics KW - prescription KW - infectious disease KW - antibiotic KW - prescriptions KW - prescribing KW - telehealth KW - health care KW - traditional KW - digital KW - telemedicine KW - virtual care KW - Swedish KW - Sweden KW - primary care KW - quality of care KW - online setting KW - ePrescription KW - ePrescriptions KW - ePrescribing KW - eHealth KW - compare KW - comparison KW - online consultation KW - digital care KW - patient record KW - patient records KW - mobile phone N2 - Background:  ?Direct-to-consumer (DTC) telemedicine? is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients? use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC. Objective:  This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic. Methods:  Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 Sörmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used. Results:  A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3% (11,609/124,398) of physical-PHC appointments as compared with 6.1% (2201/35,840) of internet-PHC appointments. In addition, 61.3% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment. Conclusions:  Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines. UR - https://www.jmir.org/2024/1/e55228 UR - http://dx.doi.org/10.2196/55228 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55228 ER - TY - JOUR AU - Wang, Ye AU - Shi, Changjing AU - Wang, Xinyun AU - Meng, Hua AU - Chen, Junqiang PY - 2024/6/17 TI - The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis JO - JMIR Form Res SP - e56687 VL - 8 KW - static characteristics of physicians KW - internet hospitals KW - telemedicine KW - statistical analysis KW - online consultation KW - web-based consultation KW - teleconsultation KW - physician KW - patient N2 - Background: Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor?s clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor?s credentials and accomplishments patients prioritize during their selection process. Objective: Our primary aim is to delve deeper into the correlation between physicians? static characteristics?such as their qualifications, experiences, and profiles on the internet?and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction. Methods: We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors? internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice. Results: The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (?=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001). Conclusions: Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction. UR - https://formative.jmir.org/2024/1/e56687 UR - http://dx.doi.org/10.2196/56687 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885498 ID - info:doi/10.2196/56687 ER - TY - JOUR AU - Wekenborg, Katharina Magdalena AU - Förster, Katharina AU - Schweden, Florian AU - Weidemann, Robin AU - Bechtolsheim, von Felix AU - Kirschbaum, Clemens AU - Weitz, Jürgen AU - Ditzen, Beate PY - 2024/6/17 TI - Differences in Physicians? Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study JO - J Med Internet Res SP - e49581 VL - 26 KW - physicians KW - digital transformation KW - chronic stress KW - hair cortisol concentration KW - work stressors KW - work resources N2 - Background: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. Objective: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. Methods: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55% women) submitted self-collected hair samples for cortisol analysis. Results: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. Conclusions: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics. UR - https://www.jmir.org/2024/1/e49581 UR - http://dx.doi.org/10.2196/49581 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885014 ID - info:doi/10.2196/49581 ER - TY - JOUR AU - Nyein, Phyu Kyi AU - Condron, Claire PY - 2024/6/17 TI - Communication and Contextual Factors in Robotic-Assisted Surgical Teams: Protocol for Developing a Taxonomy JO - JMIR Res Protoc SP - e54910 VL - 13 KW - communication KW - teams KW - robotic surgery KW - robotic-assisted KW - simulation N2 - Background: Robotic-assisted surgery (RAS) has been rapidly integrated into surgical practice in the past few decades. The setup in the operating theater for RAS differs from that for open or laparoscopic surgery such that the operating surgeon sits at a console separate from the rest of the surgical team and the patient. Communication and team dynamics are altered due to this physical separation and visual barriers imposed by the robotic equipment. However, the factors that might comprise effective communication among members of RAS teams and the contextual factors that facilitate or inhibit effective communication in RAS remain unknown. Objective: We aim to develop a taxonomy of communication behaviors and contextual factors that influence communication in RAS teams. We also aim to examine the patterns of communication behaviors based on gender. Methods: We will first perform a scoping review on communication in RAS to develop a preliminary taxonomy of communication based on the existing literature. We will then conduct semistructured interviews with RAS team members, including the surgeon, assisting surgeon or trainee, bedside or first assistant, nurses, and anesthetists. Participants will represent different disciplines, including urology, general surgery, and gynecology, and have a range of experiences in RAS. We will use a reflexive thematic analysis to analyze the data and further refine the taxonomy. We will also observe live robotic surgeries at Royal College of Surgeons in Ireland (RCSI)?affiliated hospitals. We will observe varying lengths and conditions of RAS procedures to a capture a wide range of communication behaviors and contextual factors to help finalize the taxonomy. Although we anticipate conducting 30 interviews and 30 observations, we will collect data until we achieve data sufficiency. We will conduct data collection in parallel with data analysis such that if we identify a new behavior in an interview, we will follow up with questions related to that behavior in additional interviews and/or observations. Results: The taxonomy from this project will include a list of actionable communication behaviors, contextual factors, their descriptions, and examples. As of May 2024, this project has been approved by the RCSI Research and Ethics Committee. Data collection started in June 2024 and will continue throughout the year. We plan to publish the findings as meaningful results emerge in our data analysis in 2024 and 2025. Conclusions: The results from this project will be used to observe and train surgical teams in a simulated environment to effectively communicate with each other and prevent communication breakdowns. The developed taxonomy will also add to the knowledge base on the role of gender in communication in RAS and produce recommendations that can be incorporated into training. Overall, this project will contribute to the improvement of communication skills of surgical teams and the quality and safety of patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/54910 UR - https://www.researchprotocols.org/2024/1/e54910 UR - http://dx.doi.org/10.2196/54910 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885018 ID - info:doi/10.2196/54910 ER - TY - JOUR AU - Masanneck, Lars AU - Schmidt, Linea AU - Seifert, Antonia AU - Kölsche, Tristan AU - Huntemann, Niklas AU - Jansen, Robin AU - Mehsin, Mohammed AU - Bernhard, Michael AU - Meuth, G. Sven AU - Böhm, Lennert AU - Pawlitzki, Marc PY - 2024/6/14 TI - Triage Performance Across Large Language Models, ChatGPT, and Untrained Doctors in Emergency Medicine: Comparative Study JO - J Med Internet Res SP - e53297 VL - 26 KW - emergency medicine KW - triage KW - artificial intelligence KW - large language models KW - ChatGPT KW - untrained doctors KW - doctor KW - doctors KW - comparative study KW - digital health KW - personnel KW - staff KW - cohort KW - Germany KW - German N2 - Background: Large language models (LLMs) have demonstrated impressive performances in various medical domains, prompting an exploration of their potential utility within the high-demand setting of emergency department (ED) triage. This study evaluated the triage proficiency of different LLMs and ChatGPT, an LLM-based chatbot, compared to professionally trained ED staff and untrained personnel. We further explored whether LLM responses could guide untrained staff in effective triage. Objective: This study aimed to assess the efficacy of LLMs and the associated product ChatGPT in ED triage compared to personnel of varying training status and to investigate if the models? responses can enhance the triage proficiency of untrained personnel. Methods: A total of 124 anonymized case vignettes were triaged by untrained doctors; different versions of currently available LLMs; ChatGPT; and professionally trained raters, who subsequently agreed on a consensus set according to the Manchester Triage System (MTS). The prototypical vignettes were adapted from cases at a tertiary ED in Germany. The main outcome was the level of agreement between raters? MTS level assignments, measured via quadratic-weighted Cohen ?. The extent of over- and undertriage was also determined. Notably, instances of ChatGPT were prompted using zero-shot approaches without extensive background information on the MTS. The tested LLMs included raw GPT-4, Llama 3 70B, Gemini 1.5, and Mixtral 8x7b. Results: GPT-4?based ChatGPT and untrained doctors showed substantial agreement with the consensus triage of professional raters (?=mean 0.67, SD 0.037 and ?=mean 0.68, SD 0.056, respectively), significantly exceeding the performance of GPT-3.5?based ChatGPT (?=mean 0.54, SD 0.024; P<.001). When untrained doctors used this LLM for second-opinion triage, there was a slight but statistically insignificant performance increase (?=mean 0.70, SD 0.047; P=.97). Other tested LLMs performed similar to or worse than GPT-4?based ChatGPT or showed odd triaging behavior with the used parameters. LLMs and ChatGPT models tended toward overtriage, whereas untrained doctors undertriaged. Conclusions: While LLMs and the LLM-based product ChatGPT do not yet match professionally trained raters, their best models? triage proficiency equals that of untrained ED doctors. In its current form, LLMs or ChatGPT thus did not demonstrate gold-standard performance in ED triage and, in the setting of this study, failed to significantly improve untrained doctors? triage when used as decision support. Notable performance enhancements in newer LLM versions over older ones hint at future improvements with further technological development and specific training. UR - https://www.jmir.org/2024/1/e53297 UR - http://dx.doi.org/10.2196/53297 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875696 ID - info:doi/10.2196/53297 ER - TY - JOUR AU - Chen, Dongjin AU - Han, Wenchao AU - Yang, Yili AU - Pan, Jay PY - 2024/6/10 TI - Doctors? Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study JO - JMIR Mhealth Uhealth SP - e49040 VL - 12 KW - medical platforms KW - doctor-patient communication KW - social networking apps KW - thematic content analysis KW - China N2 - Background: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients? mobile app adoption behavior; however, they offer limited insights into doctors? personal preferences among a variety of choices of mobile apps. Objective: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? Methods: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. Results: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees? perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors? affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Conclusions: Our findings contribute to a nuanced understanding of doctors? adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns. UR - https://mhealth.jmir.org/2024/1/e49040 UR - http://dx.doi.org/10.2196/49040 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857491 ID - info:doi/10.2196/49040 ER - TY - JOUR AU - Hawrysz, Liliana AU - Kludacz-Alessandri, Magdalena AU - Walczak, Renata PY - 2024/6/10 TI - Predictive Factors of Physicians? Satisfaction and Quality of Work Under Teleconsultation Conditions: Structural Equation Analysis JO - JMIR Hum Factors SP - e47810 VL - 11 KW - perceived ease of use KW - perceived usefulness KW - physicians? satisfaction KW - behavioral intention to use telemedicine KW - health care quality KW - technology acceptance model KW - TAM KW - COVID-19: telemedicine N2 - Background: The COVID-19 pandemic contributed to an increase in teleconsultation adoption in the Polish primary health care system. It is expected that in the long run, teleconsultations will successfully replace a significant part of face-to-face visits. Therefore, a significant challenge facing primary health care facilities (PHCs) is the acceptance of teleconsultations by their users, especially physicians. Objective: This study aimed to explore physicians? acceptance of teleconsultations during the COVID-19 pandemic in Poland. Methods: A representative survey was conducted among 361 physicians of PHCs across Poland in 2021. For the purposes of the study, we developed a modified Technology Acceptance Model (TAM) model. Based on the modified TAM, we analyzed the impact of perceived usefulness (PU), perceived ease of use (PEU), and intention to use teleconsultation (INT) on physicians? satisfaction (SAT) and quality of work (Q). The psychometric properties of the research instrument were examined using exploratory factor analysis. Finally, structural equation modeling was used for data analysis. Results: The results indicated a generally high level of PU (mean 3.85-4.36, SD 0.87-1.18), PEU (mean 3.81-4.60, SD 0.60-1.42), INT (mean 3.87-4.22, SD 0.89-1.12), and SAT (mean 3.55-4.13, SD 0.88-1.16); the lowest rated dimension in TAM was Q (mean 3.28-3.73, SD 1.06-1.26). The most important independent variable was PU. The influence of PU on INT (estimate=0.63, critical ratio [CR]=15.84, P<.001) and of PU on SAT (estimate=0.44, CR= 9.53, P<.001) was strong. INT was also a key factor influencing SAT (estimate=0.4, CR=8.57, P<.001). A weaker relationship was noted in the effect of PEU on INT (estimate=0.17, CR=4.31, P<.001). In turn, Q was positively influenced by INT (estimate=0.179, CR=3.64, P<.001), PU (estimate=0.246, CR=4.79, P<.001), PEU (estimate=0.18, CR=4.93, P<.001), and SAT (estimate=0.357, CR=6.97, P<.001). All paths between the constructs (PU, PEU, INT, SAT, and Q) were statistically significant, which highlights the multifaceted nature of the adoption of teleconsultations among physicians. Conclusions: Our findings provide strong empirical support for the hypothesized relationships in TAM. The findings suggest that the PU and PEU of teleconsultation have a significant impact on the intention of physicians to adopt teleconsultation. This results in an improvement in the satisfaction of Polish physicians with the use of teleconsultation and an increase in Q. The study contributes to both theory and practice by identifying important prognostic factors affecting physicians? acceptance of teleconsultation systems. UR - https://humanfactors.jmir.org/2024/1/e47810 UR - http://dx.doi.org/10.2196/47810 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857081 ID - info:doi/10.2196/47810 ER - TY - JOUR AU - Wang, Panzhang AU - Yu, Lei AU - Li, Tao AU - Zhou, Liang AU - Ma, Xin PY - 2024/6/7 TI - Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study JO - JMIR Mhealth Uhealth SP - e54642 VL - 12 KW - overcrowding KW - overcrowded KW - crowding KW - smartphone KW - queueing KW - pretriage KW - self-service KW - triage KW - emergency KW - urgent KW - ambulatory KW - mHealth KW - mobile health KW - workflow KW - health care management KW - hospital N2 - Background: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. Objective: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. Methods: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. Results: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7% vs 8.8%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for ?ease of task completion? (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), ?satisfaction with completion time? (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and ?satisfaction with support? (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3% vs 93.3%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. Conclusions: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED. UR - https://mhealth.jmir.org/2024/1/e54642 UR - http://dx.doi.org/10.2196/54642 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848554 ID - info:doi/10.2196/54642 ER - TY - JOUR AU - Thomas, Claire Donna AU - Litherland, Frances Eva AU - Masso, Sarah AU - Raymundo, Gianina AU - Keep, Melanie PY - 2024/6/7 TI - Clinicians? Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health JO - JMIR Form Res SP - e46300 VL - 8 KW - telehealth KW - pediatric KW - allied health KW - focus group KW - decision-making KW - community-based KW - counseling KW - speech pathology KW - occupational therapy KW - clinical services N2 - Background: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. Objective: The aim of this study is to explore clinicians? decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians? perceptions of telehealth utility beyond COVID-19 lockdowns. Methods: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community?based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. Results: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: ?flexible telehealth use,? ?telehealth can be superior to in-person therapy,? and ?fear that in-person services may be replaced.? Conclusions: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience. UR - https://formative.jmir.org/2024/1/e46300 UR - http://dx.doi.org/10.2196/46300 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848121 ID - info:doi/10.2196/46300 ER - TY - JOUR AU - Martin, Tobias AU - Veldeman, Sarah AU - Großmann, Heidrun AU - Fuchs-Frohnhofen, Paul AU - Czaplik, Michael AU - Follmann, Andreas PY - 2024/6/6 TI - Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study JO - JMIR Aging SP - e55471 VL - 7 KW - telemedicine KW - televisits KW - telehealth KW - eHealth KW - electronic health KW - older adult care KW - nursing homes KW - change management KW - implementation science KW - technology transfer KW - innovation transfer KW - long-term adoption KW - COVID-19 crisis KW - postpandemic KW - coronavirus KW - digitalization N2 - Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses? workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. UR - https://aging.jmir.org/2024/1/e55471 UR - http://dx.doi.org/10.2196/55471 UR - http://www.ncbi.nlm.nih.gov/pubmed/38842915 ID - info:doi/10.2196/55471 ER - TY - JOUR AU - Zheng, Di AU - Shang, Yanhong AU - Ni, Jian AU - Peng, Ling AU - Tan, Xiaoming AU - Dai, Zhaoxia AU - Zhao, Yizhuo AU - Gu, Aiqin AU - Wang, Jiying AU - Song, Yanyan AU - Li, Xiaofeng AU - Zhang, Junping AU - Heng, Wei AU - Zhang, Cuiying AU - Liu, Chunling AU - Li, Hui AU - Du, Yingying AU - Xu, Jianfang AU - Wu, Dan AU - Cai, Xuwei AU - Meng, Rui AU - Dong, Xiaorong AU - Ruan, Yaoping AU - Jiang, Liyan PY - 2024/6/5 TI - Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study JO - JMIR Cancer SP - e45331 VL - 10 KW - telehealth KW - real-world data KW - patient engagement KW - lung carcinoma KW - patient-reported outcomes N2 - Background: Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. Objective: The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician?s perspective. Methods: A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform?s registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. Results: Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. Conclusions: This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions. UR - https://cancer.jmir.org/2024/1/e45331 UR - http://dx.doi.org/10.2196/45331 UR - http://www.ncbi.nlm.nih.gov/pubmed/38838304 ID - info:doi/10.2196/45331 ER - TY - JOUR AU - Rzewuska Díaz, Magdalena AU - Locock, Louise AU - Keen, Andrew AU - Melvin, Mike AU - Myhill, Anthony AU - Ramsay, Craig PY - 2024/6/4 TI - Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study JO - J Med Internet Res SP - e48092 VL - 26 KW - outpatient care KW - teleconsultation KW - asynchronous communication KW - implementation KW - mixed methods research KW - qualitative research KW - hospital data N2 - Background: Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. Objective: We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. Methods: Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service?s effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. Results: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian?s population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication?including the use of the term assessment instead of appointment?may increase patient acceptance. Conclusions: Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion. UR - https://www.jmir.org/2024/1/e48092 UR - http://dx.doi.org/10.2196/48092 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833695 ID - info:doi/10.2196/48092 ER - TY - JOUR AU - Seuren, Martinus Lucas AU - Shaw, Sara PY - 2024/5/31 TI - How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography JO - J Med Internet Res SP - e51695 VL - 26 KW - delivery of health care KW - remote consultation KW - carer KW - telemedicine KW - videoconferencing KW - language KW - linguistics KW - gestures KW - physiotherapy KW - heart failure KW - care KW - patient care KW - feasibility KW - safety KW - communication KW - mobile phone N2 - Background: Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient?s behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. Objective: This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. Methods: We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. Results: Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. Conclusions: Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services. UR - https://www.jmir.org/2024/1/e51695 UR - http://dx.doi.org/10.2196/51695 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819900 ID - info:doi/10.2196/51695 ER - TY - JOUR AU - Nabelsi, Véronique AU - Lévesque-Chouinard, Annabelle PY - 2024/5/30 TI - Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians? and Specialists? Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study JO - JMIR Form Res SP - e52921 VL - 8 KW - eConsult KW - electronic consultation KW - digital health solutions KW - primary care providers KW - specialists KW - United Theory of Acceptance and Use of Technology KW - UTAUT KW - Task-Technology Fit KW - TTF KW - technology acceptance N2 - Background: Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients? medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs?, specialists?, and patients? satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs? and specialists? acceptance of eConsult services in Quebec, Canada, and worldwide. Objective: This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. Methods: A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. Results: Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. Conclusions: This study provides a better understanding of the factors influencing PCPs? and specialists? intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users? need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service. UR - https://formative.jmir.org/2024/1/e52921 UR - http://dx.doi.org/10.2196/52921 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814689 ID - info:doi/10.2196/52921 ER - TY - JOUR AU - Paatela, Satu AU - Kyytsönen, Maiju AU - Saranto, Kaija AU - Kinnunen, Ulla-Mari AU - Vehko, Tuulikki PY - 2024/5/29 TI - Experiences of Electronic Health Records? and Client Information Systems? Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study JO - J Med Internet Res SP - e46954 VL - 26 KW - practical nurse KW - information and communication technology KW - electronic health record KW - client information system KW - documentation KW - mobile technology N2 - Background: The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today?s era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients? homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities. Objective: This study aims to analyze practical nurses? experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device. Methods: A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings. Results: The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses? office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not. Conclusions: To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use. UR - https://www.jmir.org/2024/1/e46954 UR - http://dx.doi.org/10.2196/46954 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809583 ID - info:doi/10.2196/46954 ER - TY - JOUR AU - Legg, David AU - Napierala, Hendrik AU - Holzinger, Felix AU - Slagman, Anna PY - 2024/5/29 TI - Where Do I Go When My Doctor?s Office Is Closed? The Availability of Out-of-Hours Care Information on Primary Care Practitioners? Websites JO - JMIR Form Res SP - e50857 VL - 8 KW - out of hours KW - primary care KW - telephone triage KW - websites KW - care information UR - https://formative.jmir.org/2024/1/e50857 UR - http://dx.doi.org/10.2196/50857 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809600 ID - info:doi/10.2196/50857 ER - TY - JOUR AU - Cermak, A. Carly AU - Read, Heather AU - Jeffs, Lianne PY - 2024/5/28 TI - Health Care Professionals? Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study JO - JMIR Form Res SP - e53056 VL - 8 KW - COVID-19 KW - information and communication technology KW - health care provider experiences KW - web-based care KW - interview N2 - Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. UR - https://formative.jmir.org/2024/1/e53056 UR - http://dx.doi.org/10.2196/53056 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805250 ID - info:doi/10.2196/53056 ER - TY - JOUR AU - Odebunmi, O. Olufeyisayo AU - Hughes, D. Tamera AU - Waters, R. Austin AU - Urick, Y. Benjamin AU - Herron, Caroline AU - Wangen, Mary AU - Rohweder, Catherine AU - Ferrari, M. Renée AU - Marciniak, W. Macary AU - Wheeler, B. Stephanie AU - Brenner, T. Alison AU - Shah, D. Parth PY - 2024/5/23 TI - Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey JO - J Med Internet Res SP - e50205 VL - 26 KW - community pharmacy KW - telehealth KW - telemedicine KW - telepharmacy KW - pharmacy service quality KW - patient willingness KW - willingness KW - cross-sectional KW - national survey KW - telehealth cost N2 - Background: Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients? willingness to use telehealth services, and we sought to investigate this. Objective: This study aims to examine respondents? (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. Methods: We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. Results: Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. Conclusions: Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable. UR - https://www.jmir.org/2024/1/e50205 UR - http://dx.doi.org/10.2196/50205 UR - http://www.ncbi.nlm.nih.gov/pubmed/38780994 ID - info:doi/10.2196/50205 ER - TY - JOUR AU - Aledia, S. Anna AU - Dangodara, A. Amish AU - Amin, A. Aanya AU - Amin, N. Alpesh PY - 2024/5/16 TI - Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study JO - J Med Internet Res SP - e55623 VL - 26 KW - COVID-19 KW - electronic consultation KW - eConsult KW - e-consult KW - inpatient KW - consultations KW - pandemic KW - infectious KW - novel coronavirus KW - coronavirus KW - patients KW - patient KW - staff KW - health care KW - health care providers KW - tool KW - tools KW - effectiveness N2 - Background: Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. Objective: We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. Methods: This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). Results: There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. Conclusions: An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value. UR - https://www.jmir.org/2024/1/e55623 UR - http://dx.doi.org/10.2196/55623 UR - http://www.ncbi.nlm.nih.gov/pubmed/38754103 ID - info:doi/10.2196/55623 ER - TY - JOUR AU - Maugeri, Andrea AU - Barchitta, Martina AU - Basile, Guido AU - Agodi, Antonella PY - 2024/5/16 TI - Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature JO - J Med Internet Res SP - e50088 VL - 26 KW - telemedicine KW - eHealth KW - digital medicine KW - COVID-19 KW - Google Trends KW - bibliometric KW - Google KW - data spanning KW - accessibility KW - cost reduction KW - cost KW - noncommunicable disease KW - mobile health KW - awareness KW - policy decision N2 - Background: Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. Objective: The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. Methods: Google Trends data were retrieved using the search topics ?telemedicine? or ?e-health? to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms ?telemedicine? or ?eHealth? (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. Results: Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=?22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. Conclusions: Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives. UR - https://www.jmir.org/2024/1/e50088 UR - http://dx.doi.org/10.2196/50088 UR - http://www.ncbi.nlm.nih.gov/pubmed/38753427 ID - info:doi/10.2196/50088 ER - TY - JOUR AU - Bienzeisler, Jonas AU - Becker, Guido AU - Erdmann, Bernadett AU - Kombeiz, Alexander AU - Majeed, W. Raphael AU - Röhrig, Rainer AU - Greiner, Felix AU - Otto, Ronny AU - Otto-Sobotka, Fabian AU - PY - 2024/5/14 TI - The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study JO - J Med Internet Res SP - e45593 VL - 26 KW - EHR KW - emergency medicine KW - AKTIN, process management KW - crowding KW - triage system KW - electronic health record KW - health care KW - treatment KW - emergency department N2 - Background: The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. Objective: This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. Methods: We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. Results: The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Conclusions: Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster. UR - https://www.jmir.org/2024/1/e45593 UR - http://dx.doi.org/10.2196/45593 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743464 ID - info:doi/10.2196/45593 ER - TY - JOUR AU - Zakiyah, Neily AU - Marulin, Dita AU - Alfaqeeh, Mohammed AU - Puspitasari, Melyani Irma AU - Lestari, Keri AU - Lim, Keat Ka AU - Fox-Rushby, Julia PY - 2024/4/30 TI - Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review JO - J Med Internet Res SP - e53500 VL - 26 KW - digital health KW - telemonitoring KW - telehealth KW - heart failure KW - cost-effectiveness KW - systematic review KW - mobile phone N2 - Background: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. Objective: This study?s objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. Methods: A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). Conclusions: Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. Trial Registration: PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc UR - https://www.jmir.org/2024/1/e53500 UR - http://dx.doi.org/10.2196/53500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687991 ID - info:doi/10.2196/53500 ER - TY - JOUR AU - Avdagovska, Melita AU - Kuziemsky, Craig AU - Koosha, Helia AU - Hadizadeh, Maliheh AU - Pauly, P. Robert AU - Graham, Timothy AU - Stafinski, Tania AU - Bigam, David AU - Kassam, Narmin AU - Menon, Devidas PY - 2024/4/29 TI - Exploring the Impact of In Basket Metrics on the Adoption of a New Electronic Health Record System Among Specialists in a Tertiary Hospital in Alberta: Descriptive Study JO - J Med Internet Res SP - e53122 VL - 26 KW - electronic health records KW - In Basket KW - metrics KW - descriptive study KW - inpatients N2 - Background: Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout. Objective: This study aims to document metrics related to the In Basket communication hub (time in In Basket per day, time in In Basket per appointment, In Basket messages received per day, and turnaround time) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities. Methods: A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into medical and surgical based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: medical FTE <0.5, medical FTE >0.5, and surgical (all of whom reported FTE >0.5). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities. Results: A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the time in In Basket per day metric and 1.84 minutes on average in the time in In Basket per appointment metric. The time for the providers to mark messages as done (turnaround time) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less connected time (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as done (turnaround time). Conclusions: We observed a range of patterns with no consistent direction. There does not seem to be evidence of a ?learning curve,? which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers? satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area. UR - https://www.jmir.org/2024/1/e53122 UR - http://dx.doi.org/10.2196/53122 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684079 ID - info:doi/10.2196/53122 ER - TY - JOUR AU - Holder, Kai AU - Feinglass, Joe AU - Niznik, Charlotte AU - Yee, M. Lynn PY - 2024/4/26 TI - Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System: Retrospective Cohort Study JO - JMIR Mhealth Uhealth SP - e51637 VL - 12 KW - patient portal KW - secure messaging KW - telehealth KW - health literacy KW - health disparities KW - disparity KW - disparities KW - telemedicine KW - information and communication technology KW - ICT KW - portals KW - messaging KW - use KW - technology use KW - pregnant KW - pregnancy KW - maternal KW - obstetric KW - obstetrics KW - prenatal KW - antenatal KW - demographic KW - demographics N2 - Background: The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals. Objective: The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic. Methods: This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system?s Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ?3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (?5 messages), moderate (6-14 messages), or frequent (?15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse. Results: Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non?English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity. Conclusions: Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging. UR - https://mhealth.jmir.org/2024/1/e51637 UR - http://dx.doi.org/10.2196/51637 ID - info:doi/10.2196/51637 ER - TY - JOUR AU - Harnik, Alexander Michael AU - Scheidegger, Alina AU - Blättler, Larissa AU - Nemecek, Zdenek AU - Sauter, C. Thomas AU - Limacher, Andreas AU - Reisig, Florian AU - grosse Holtforth, Martin AU - Streitberger, Konrad PY - 2024/4/29 TI - Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain JO - JMIR Form Res SP - e53154 VL - 8 KW - acceptance KW - satisfaction KW - patient preferences KW - COVID-19 pandemic KW - health care providers KW - phone consultations KW - pain therapy KW - eHealth services KW - patient care KW - health care delivery KW - telemedicine KW - chronic pain KW - preference N2 - Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients? preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients? preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients? preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; ?22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; ?22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. UR - https://formative.jmir.org/2024/1/e53154 UR - http://dx.doi.org/10.2196/53154 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684086 ID - info:doi/10.2196/53154 ER - TY - JOUR AU - Gotra, Milena AU - Lindberg, Katharine AU - Jasinski, Nicholas AU - Scarisbrick, David AU - Reilly, Shannon AU - Perle, Jonathan AU - Miller, Liv AU - Mahoney III, James PY - 2024/4/29 TI - Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study JO - JMIR Form Res SP - e50303 VL - 8 KW - COVID-19 pandemic KW - mental health KW - social worker KW - psychologist KW - neuropsychologist KW - academic medical center KW - community mental health KW - private practice KW - Veteran?s Affairs hospital KW - longitudinal questionnaire study KW - COVID-19 KW - implementation KW - telemental health KW - hybrid model KW - availability N2 - Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. UR - https://formative.jmir.org/2024/1/e50303 UR - http://dx.doi.org/10.2196/50303 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683653 ID - info:doi/10.2196/50303 ER - TY - JOUR AU - Loriot, Amélie AU - Larceneux, Fabrice AU - Guillard, Valérie AU - Bertocchio, Jean-Philippe PY - 2024/4/26 TI - Patients? Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study JO - J Med Internet Res SP - e45702 VL - 26 KW - telehealth KW - teleconsultation KW - social representations KW - perceived proximity KW - semiotic square N2 - Background: In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions. Objective: We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients. Methods: This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology. Results: We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 ?paths? through which adherence to telehealth may improve. Conclusions: Our semiotic square illustrating patients? adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools. UR - https://www.jmir.org/2024/1/e45702 UR - http://dx.doi.org/10.2196/45702 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669676 ID - info:doi/10.2196/45702 ER - TY - JOUR AU - Kim, Jiyeong AU - Cai, Ran Zhuo AU - Chen, L. Michael AU - Onyeka, Sonia AU - Ko, M. Justin AU - Linos, Eleni PY - 2024/4/26 TI - Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022 JO - JMIR Public Health Surveill SP - e51279 VL - 10 KW - telehealth KW - telemedicine KW - digital health KW - e-health KW - e-medicine KW - utilization KW - population-based study KW - clinical practice KW - healthcare delivery KW - sociodemographic factor KW - COVID-19 KW - pandemic N2 - Background: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease?s emergence. Objective: We aim to comprehensively assess telehealth use and its associated factors in the United States. Methods: This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (?18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Results: Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers? recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ?75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. Conclusions: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research. UR - https://publichealth.jmir.org/2024/1/e51279 UR - http://dx.doi.org/10.2196/51279 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669075 ID - info:doi/10.2196/51279 ER - TY - JOUR AU - Kötting, Lukas AU - Anand-Kumar, Vinayak AU - Keller, Maria Franziska AU - Henschel, Tobias Nils AU - Lippke, Sonia PY - 2024/4/26 TI - Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study JO - JMIR Hum Factors SP - e48218 VL - 11 KW - clinical care KW - health action process approach KW - HAPA KW - intention KW - communication behavior KW - patient safety KW - patient education KW - internet intervention KW - dropout KW - digital health KW - behavior change KW - prediction KW - obstetric KW - pregnant women KW - pregnancy KW - safe communication KW - health behaviors KW - obstetric care N2 - Background: In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective: This study fills this research gap by applying a web-app aiming at improving pregnant women?s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods: In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results: We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (?=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (?=.017; comparative fit index=0.994; Tucker?Lewis index=0.971; root mean square error of approximation=0.055). Conclusions: Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration: ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735 UR - https://humanfactors.jmir.org/2024/1/e48218 UR - http://dx.doi.org/10.2196/48218 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669073 ID - info:doi/10.2196/48218 ER - TY - JOUR AU - Kim, Yuyoung AU - Kim, Minjung AU - Kim, Jinwoo AU - Song, Tae-Jin PY - 2024/4/25 TI - Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility JO - J Med Internet Res SP - e56417 VL - 26 KW - dysarthria KW - stroke KW - smartphone KW - speech therapy KW - app KW - acute and early subacute KW - feasibility KW - mobile phone N2 - Background: Dysarthria is a common poststroke speech disorder affecting communication and psychological well-being. Traditional speech therapy is effective but often poses challenges in terms of accessibility and patient adherence. Emerging smartphone-based therapies may offer promising alternatives for the treatment of poststroke dysarthria. Objective: This study aimed to assess the efficacy and feasibility of smartphone-based speech therapy for improving speech intelligibility in patients with acute and early subacute poststroke dysarthria. This study also explored the impact of the intervention on psychological well-being, user experience, and overall feasibility in a clinical setting. Methods: Participants were divided into 2 groups for this randomized, evaluator-blinded trial. The intervention group used a smartphone-based speech therapy app for 1 hour per day, 5 days per week, for 4 weeks, with guideline-based standard stroke care. The control group received standard guideline-based stroke care and rehabilitation. Speech intelligibility, psychological well-being, quality of life, and user acceptance were assessed using repeated measures ANOVA. Results: In this study, 40 patients with poststroke dysarthria were enrolled, 32 of whom completed the trial (16 in each group). The intervention group showed significant improvements in speech intelligibility compared with the control group. This was evidenced by improvements from baseline (F1,30=34.35; P<.001), between-group differences (F1,30=6.18; P=.02), and notable time-by-group interactions (F1,30=6.91; P=.01). Regarding secondary outcomes, the intervention led to improvements in the percentage of correct consonants over time (F1,30=5.57; P=.03). In addition, significant reductions were noted in the severity of dysarthria in the intervention group over time (F1,30=21.18; P<.001), with a pronounced group effect (F1,30=5.52; P=.03) and time-by-group interaction (F1,30=5.29; P=.03). Regarding quality of life, significant improvements were observed as measured by the EQ-5D-3L questionnaire (F1,30=13.25; P<.001) and EQ-VAS (F1,30=7.74; P=.009) over time. The adherence rate to the smartphone-based app was 64%, with over half of the participants completing all the sessions. The usability of the app was rated high (system usability score 80.78). In addition, the intervention group reported increased self-efficacy in using the app compared with the control group (F1,30=10.81; P=.003). Conclusions: The smartphone-based speech therapy app significantly improved speech intelligibility, articulation, and quality of life in patients with poststroke dysarthria. These findings indicate that smartphone-based speech therapy can be a useful assistant device in the management of poststroke dysarthria, particularly in the acute and early subacute stroke stages. Trial Registration: ClinicalTrials.gov NCT05146765; https://clinicaltrials.gov/ct2/show/NCT05146765 UR - https://www.jmir.org/2024/1/e56417 UR - http://dx.doi.org/10.2196/56417 UR - http://www.ncbi.nlm.nih.gov/pubmed/38509662 ID - info:doi/10.2196/56417 ER - TY - JOUR AU - Liu, Xiaoxiao AU - Guo, Huijing AU - Wang, Le AU - Hu, Mingye AU - Wei, Yichan AU - Liu, Fei AU - Wang, Xifu PY - 2024/4/25 TI - Effect of Prosocial Behaviors on e-Consultations in a Web-Based Health Care Community: Panel Data Analysis JO - J Med Internet Res SP - e52646 VL - 26 KW - prosocial behaviors KW - proactive behaviors KW - reactive behaviors KW - reputations KW - e-consultation volume KW - live streaming N2 - Background: Patients using web-based health care communities for e-consultation services have the option to choose their service providers from an extensive digital market. To stand out in this crowded field, doctors in web-based health care communities often engage in prosocial behaviors, such as proactive and reactive actions, to attract more users. However, the effect of these behaviors on the volume of e-consultations remains unclear and warrants further exploration. Objective: This study investigates the impact of various prosocial behaviors on doctors? e-consultation volume in web-based health care communities and the moderating effects of doctors? digital and offline reputations. Methods: A panel data set containing information on 2880 doctors over a 22-month period was obtained from one of the largest web-based health care communities in China. Data analysis was conducted using a 2-way fixed effects model with robust clustered SEs. A series of robustness checks were also performed, including alternative measurements of independent variables and estimation methods. Results: Results indicated that both types of doctors? prosocial behaviors, namely, proactive and reactive actions, positively impacted their e-consultation volume. In terms of the moderating effects of external reputation, doctors? offline professional titles were found to negatively moderate the relationship between their proactive behaviors and their e-consultation volume. However, these titles did not significantly affect the relationship between doctors? reactive behaviors and their e-consultation volume (P=.45). Additionally, doctors? digital recommendations from patients negatively moderated both the relationship between doctors? proactive behaviors and e-consultation volume and the relationship between doctors? reactive behaviors and e-consultation volume. Conclusions: Drawing upon functional motives theory and social exchange theory, this study categorizes doctors? prosocial behaviors into proactive and reactive actions. It provides empirical evidence that prosocial behaviors can lead to an increase in e-consultation volume. This study also illuminates the moderating roles doctors? digital and offline reputations play in the relationships between prosocial behaviors and e-consultation volume. UR - https://www.jmir.org/2024/1/e52646 UR - http://dx.doi.org/10.2196/52646 UR - http://www.ncbi.nlm.nih.gov/pubmed/38663006 ID - info:doi/10.2196/52646 ER - TY - JOUR AU - Haimi, Motti AU - Sergienko, Ruslan PY - 2024/4/24 TI - Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis JO - JMIR Aging SP - e52317 VL - 7 KW - telemedicine KW - digital health KW - older adults KW - COVID-19 KW - use KW - digital divide KW - usability KW - pandemic KW - telehealth KW - Israel KW - working-hours telehealth visits KW - after-hours consultation KW - teleconsultation KW - eHealth KW - mobile health KW - mHealth KW - wearables KW - mobile phone N2 - Background: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. Objective: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. Methods: We explored the use characteristics of older adults (aged ?65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient?s personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Results: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Conclusions: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability. UR - https://aging.jmir.org/2024/1/e52317 UR - http://dx.doi.org/10.2196/52317 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656768 ID - info:doi/10.2196/52317 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Hajek, André PY - 2024/4/23 TI - Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - JMIR Aging SP - e50938 VL - 7 KW - telemedicine KW - telehealth KW - digital health KW - service use KW - COVID-19 N2 - Background: The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective: The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods: Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19?related determinants were examined using multiple Firth logistic regressions. Results: Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions: Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances. UR - https://aging.jmir.org/2024/1/e50938 UR - http://dx.doi.org/10.2196/50938 ID - info:doi/10.2196/50938 ER - TY - JOUR AU - Kummer, R. Benjamin AU - Busis, A. Neil PY - 2024/4/11 TI - Beyond Audio-Video Telehealth: Perspective on the Current State and Future Directions of Digital Neurological Care in the United States JO - JMIR Neurotech SP - e46736 VL - 3 KW - asynchronous telehealth KW - chronic condition management KW - COVID-19 KW - digital health KW - digital neurology KW - eConsult KW - endemic KW - interprofessional consultation KW - neurological apps KW - neurological care KW - neurology KW - principal care management KW - remote patient monitoring KW - technology KW - telehealth legislation KW - telehealth KW - teleneurology N2 - Background: The COVID-19 pandemic transformed neurological care by both requiring digital health modalities to reach patients and profoundly lowering barriers to digital health adoption. This combination of factors has given rise to a distinctive, emerging care model in neurology characterized by new technologies, care arrangements, and uncertainties. As the pandemic transitions to an endemic, there is a need to characterize the current and future states of this unique period in neurology. Objective: We sought to describe the current state of the pandemic- and postpandemic-related changes in neurological care and offer a view of the possible future directions of the field. Methods: We reviewed several themes across the ?new digital normal? in neurology, including trends in technology adoption, barriers to technology access, newly available telehealth services, unresolved questions, and an outlook on the future of digital neurology. Results: In this new era of neurological care, we emphasize that synchronous audio-video telehealth remains the predominant form of digital interaction between neurologists and patients, mainly due to pandemic-related regulatory changes and the preexisting, steady adoption of video platforms in the prepandemic era. We also identify a persistent digital divide, with audio-only telehealth remaining a necessity for preserving care access. Asynchronous telehealth methods and services, including care coordination, interprofessional consultations, remote patient monitoring, and teletreatment are becoming increasingly important for neurological care. Finally, we identify several unanswered questions regarding the future of this ?new normal,? including the lasting effects of emergency regulatory changes, the value proposition of telehealth, the future of telehealth reimbursement in neurology, as well as privacy considerations and trade-offs in asynchronous neurological care models. Conclusions: The COVID-19 pandemic has ushered in an era of digital adoption and innovation in neurological care, characterized by novel care models, services, and technologies, as well as numerous unresolved questions regarding the future. UR - https://neuro.jmir.org/2024/1/e46736 UR - http://dx.doi.org/10.2196/46736 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46736 ER - TY - JOUR AU - Der-Martirosian, Claudia AU - Hou, Cynthia AU - Hovsepian, Sona AU - Diarra Carter, Maia AU - Heyworth, Leonie AU - Dobalian, Aram AU - Leung, Lucinda PY - 2024/4/9 TI - Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study JO - JMIR Form Res SP - e52830 VL - 8 KW - interdisciplinary primary care team members KW - NASSS framework KW - nonadoption, abandonment, scale-up, spread, and sustainability KW - primary care KW - telehealth KW - video-based care N2 - Background: With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. Objective: The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. Methods: We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. Results: The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic?visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology?key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system?changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver?s role (eg, participation of caregivers during video visits); (4) health care organization?leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time?capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). Conclusions: This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes. UR - https://formative.jmir.org/2024/1/e52830 UR - http://dx.doi.org/10.2196/52830 UR - http://www.ncbi.nlm.nih.gov/pubmed/38592760 ID - info:doi/10.2196/52830 ER - TY - JOUR AU - Palakshappa, A. Jessica AU - Hale, R. Erica AU - Brown, D. Joshua AU - Kittel, A. Carol AU - Dressler, Emily AU - Rosenthal, E. Gary AU - Cutrona, L. Sarah AU - Foley, L. Kristie AU - Haines, R. Emily AU - Houston II, K. Thomas PY - 2024/4/8 TI - Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System JO - J Med Internet Res SP - e54008 VL - 26 KW - telehealth KW - telemedicine KW - e-health KW - eHealth KW - video visits KW - video KW - ICT KW - information and communication technology KW - survey KW - surveys KW - adoption KW - usability KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - COVID-19 N2 - Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (?Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video??) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. UR - https://www.jmir.org/2024/1/e54008 UR - http://dx.doi.org/10.2196/54008 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587889 ID - info:doi/10.2196/54008 ER - TY - JOUR AU - Medina-García, Rodrigo AU - López-Rodríguez, A. Juan AU - Lozano-Hernández, María Cristina AU - Ruiz Bejerano, Verónica AU - Criscio, Paride AU - Del Cura-González, Isabel AU - PY - 2024/4/5 TI - A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study JO - JMIR Hum Factors SP - e46811 VL - 11 KW - user-centered design KW - multimorbidity KW - comorbid KW - self-care KW - medical informatics KW - primary health care KW - chronic disease KW - chronic condition KW - chronic illness KW - primary care KW - usability KW - telemedicne KW - telehealth KW - information and communication technologies KW - ICT KW - digital health KW - eHealth KW - human-computer interaction N2 - Background: Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between a patient and technology, known as usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure their relevant role in promoting self-care. Objective: The aim of this study was to analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. Methods: A descriptive observational cross-sectional usability study was performed framed in the clinical trial in the primary care health centers of Madrid Health Service of the TeNDER (Affective Based Integrated Care for Better Quality of Life) project. The TeNDER technological tool integrates sensors for monitoring physical and sleep activity along with a mobile app for consulting the data collected and working with self-management tools. This project included patients over 60 years of age who had one or more chronic diseases, at least one of which was mild-moderate cognitive impairment, Parkinson disease, or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate in the usability study. The usability variables investigated were effectiveness, which was determined by the degree of completion and the total number of errors per task; efficiency, evaluated as the average time to perform each task; and satisfaction, quantified by the System Usability Scale. Five tasks were evaluated based on real case scenarios. Usability variables were analyzed according to the sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for task completion. Results: The median age of the 38 participants was 75 (IQR 72.0-79.0) years. There was a slight majority of women (20/38, 52.6%) and the participants had a median of 8 (IQR 7.0-11.0) chronic diseases. Thirty patients completed the usability study, with a usability effectiveness result of 89.3% (134/150 tasks completed). Among the 30 patients, 66.7% (n=20) completed all tasks and 56.7% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level emerged as a facilitating factor for independent task completion (odds ratio 1.79, 95% CI 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction score was 55 (IQR 45.0-62.5) out of 100. Conclusions: Although usability effectiveness was high, the poor efficiency and usability satisfaction scores suggest that there are other factors that may interfere with the results. Multimorbidity was not confirmed to be a key factor affecting the usability of the technological tool. Trial Registration: Clinicaltrials.gov NCT05681065; https://clinicaltrials.gov/study/NCT05681065 UR - https://humanfactors.jmir.org/2024/1/e46811 UR - http://dx.doi.org/10.2196/46811 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578675 ID - info:doi/10.2196/46811 ER - TY - JOUR AU - Nebsbjerg, Amalie Mette AU - Vestergaard, Høstrup Claus AU - Bomholt, Bjørnshave Katrine AU - Christensen, Bondo Morten AU - Huibers, Linda PY - 2024/4/4 TI - Use of Video in Telephone Triage in Out-of-Hours Primary Care: Register-Based Study JO - JMIR Med Inform SP - e47039 VL - 12 KW - primary health care KW - after-hours care KW - referral and consultation KW - general practitioner KW - GP KW - triage KW - remote consultation KW - telemedicine N2 - Background: Out-of-hours primary care (OOH-PC) is challenging due to high workloads, workforce shortages, and long waiting and transportation times for patients. Use of video enables triage professionals to visually assess patients, potentially ending more contacts in a telephone triage contact instead of referring patients to more resource-demanding clinic consultations or home visits. Thus, video use may help reduce use of health care resources in OOH-PC. Objective: This study aimed to investigate video use in telephone triage contacts to OOH-PC in Denmark by studying rate of use and potential associations between video use and patient- and contact-related characteristics and between video use and triage outcomes and follow-up contacts. We hypothesized that video use could serve to reduce use of health care resources in OOH-PC. Methods: This register-based study included all telephone triage contacts to OOH-PC in 4 of the 5 Danish regions from March 15, 2020, to December 1, 2021. We linked data from the OOH-PC electronic registration systems to national registers and identified telephone triage contacts with video use (video contact) and without video use (telephone contact). Calculating crude incidence rate ratios and adjusted incidence rate ratios (aIRRs), we investigated the association between patient- and contact-related characteristics and video contacts and measured the frequency of different triage outcomes and follow-up contacts after video contact compared to telephone contact. Results: Of 2,900,566 identified telephone triage contacts to OOH-PC, 9.5% (n=275,203) were conducted as video contacts. The frequency of video contact was unevenly distributed across patient- and contact-related characteristics; it was used more often for employed young patients without comorbidities who contacted OOH-PC more than 4 hours before the opening hours of daytime general practice. Compared to telephone contacts, notably more video contacts ended with advice and self-care (aIRR 1.21, 95% CI 1.21-1.21) and no follow-up contact (aIRR 1.08, 95% CI 1.08-1.09). Conclusions: This study supports our hypothesis that video contacts could reduce use of health care resources in OOH-PC. Video use lowered the frequency of referrals to a clinic consultation or a home visit and also lowered the frequency of follow-up contacts. However, the results could be biased due to confounding by indication, reflecting that triage GPs use video for a specific set of reasons for encounters. UR - https://medinform.jmir.org/2024/1/e47039 UR - http://dx.doi.org/10.2196/47039 ID - info:doi/10.2196/47039 ER - TY - JOUR AU - Bruce, R. Courtenay AU - Klahn, Steve AU - Randle, Lindsay AU - Li, Xin AU - Sayali, Kelkar AU - Johnson, Barbara AU - Gomez, Melissa AU - Howard, Meagan AU - Schwartz, Roberta AU - Sasangohar, Farzan PY - 2024/4/4 TI - Impacts of an Acute Care Telenursing Program on Discharge, Patient Experience, and Nursing Experience: Retrospective Cohort Comparison Study JO - J Med Internet Res SP - e54330 VL - 26 KW - telenursing KW - telemedicine KW - patient discharge KW - health personnel KW - surveys and questionnaires KW - patient outcome assessment N2 - Background: Despite widespread growth of televisits and telemedicine, it is unclear how telenursing could be applied to augment nurse labor and support nursing. Objective: This study evaluated a large-scale acute care telenurse (ACTN) program to support web-based admission and discharge processes for hospitalized patients. Methods: A retrospective, observational cohort comparison was performed in a large academic hospital system (approximately 2100 beds) in Houston, Texas, comparing patients in our pilot units for the ACTN program (telenursing cohort) between June 15, 2022, and December 31, 2022, with patients who did not participate (nontelenursing cohort) in the same units and timeframe. We used a case mix index analysis to confirm comparable patient cases between groups. The outcomes investigated were patient experience, measured using the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHCPS) survey; nursing experience, measured by a web-based questionnaire with quantitative multiple-choice and qualitative open-ended questions; time of discharge during the day (from electronic health record data); and duration of discharge education processes. Results: Case mix index analysis found no significant case differences between cohorts (P=.75). For the first 4 units that rolled out in phase 1, all units experienced improvement in at least 4 and up to 7 HCAHCPS domains. Scores for ?communication with doctors? and ?would recommend hospital? were improved significantly (P=.03 and P=.04, respectively) in 1 unit in phase 1. The impact of telenursing in phases 2 and 3 was mixed. However, ?communication with doctors? was significantly improved in 2 units (P=.049 and P=.002), and the overall rating of the hospital and the ?would recommend hospital? scores were significantly improved in 1 unit (P=.02 and P=04, respectively). Of 289 nurses who were invited to participate in the survey, 106 completed the nursing experience survey (response rate 106/289, 36.7%). Of the 106 nurses, 101 (95.3%) indicated that the ACTN program was very helpful or somewhat helpful to them as bedside nurses. The only noticeable difference between the telenursing and nontelenursing cohorts for the time of day discharge was a shift in the volume of patients discharged before 2 PM compared to those discharged after 2 PM at a hospital-wide level. The ACTN admissions averaged 12 minutes and 6 seconds (SD 7 min and 29 s), and the discharges averaged 14 minutes and 51 seconds (SD 8 min and 10 s). The average duration for ACTN calls was 13 minutes and 17 seconds (SD 7 min and 52 s). Traditional cohort standard practice (nontelenursing cohort) of a bedside nurse engaging in discharge and admission processes was 45 minutes, consistent with our preimplementation time study. Conclusions: This study shows that ACTN programs are feasible and associated with improved outcomes for patient and nursing experience and reducing time allocated to admission and discharge education. UR - https://www.jmir.org/2024/1/e54330 UR - http://dx.doi.org/10.2196/54330 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573753 ID - info:doi/10.2196/54330 ER - TY - JOUR AU - Zhong, Yuqiong AU - Hahne, Jessica AU - Wang, Xiaomin AU - Wang, Xuxi AU - Wu, Ying AU - Zhang, Xin AU - Liu, Xing PY - 2024/3/29 TI - Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians? Views on Access, Expectations, and Communication JO - J Med Internet Res SP - e47523 VL - 26 KW - China KW - internet hospital KW - health care access KW - telehealth KW - doctor-patient relationship KW - mobile phone N2 - Background: Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. Objective: We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. Methods: We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). Results: Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients? expectations and the reality of limitations regarding both physicians? availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. Conclusions: This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients? expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults. UR - https://www.jmir.org/2024/1/e47523 UR - http://dx.doi.org/10.2196/47523 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551618 ID - info:doi/10.2196/47523 ER - TY - JOUR AU - Jensen, Høpfner Lili Worre AU - Rahbek, Ole AU - Lauritsen, Kildahl Rikke Emilie AU - Kold, Søren AU - Dinesen, Birthe PY - 2024/3/29 TI - Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study JO - JMIR Hum Factors SP - e49696 VL - 11 KW - digital communication KW - patient-provider communication KW - continuity of care KW - interdisciplinary communication KW - hospital discharge KW - orthopedic surgery KW - postoperative care KW - text messaging KW - mobile phone N2 - Background: The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. Objective: This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients? experiences and use of team-based digital communication following hospital discharge (eDialogue). Methods: A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. Results: Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. Conclusions: In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery. UR - https://humanfactors.jmir.org/2024/1/e49696 UR - http://dx.doi.org/10.2196/49696 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551641 ID - info:doi/10.2196/49696 ER - TY - JOUR AU - Zhang, Chunyu AU - Hu, Ning AU - Li, Rui AU - Zhu, Aiping AU - Yu, Zhongguang PY - 2024/3/29 TI - Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis JO - JMIR Form Res SP - e50036 VL - 8 KW - web-based consultation KW - Andersen Behavioral Model KW - qualitative comparative analysis KW - perceived convenience KW - complementary role KW - user's confidence KW - China N2 - Background: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. Objective: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users? perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. Methods: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. Results: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user?s confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user?s confidence. Conclusions: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user?s confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations? application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations. UR - https://formative.jmir.org/2024/1/e50036 UR - http://dx.doi.org/10.2196/50036 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551645 ID - info:doi/10.2196/50036 ER - TY - JOUR AU - Saravanakumar, Sanjeev AU - Ostrovsky, Andrey PY - 2024/3/28 TI - Evaluation of Telehealth Services that are Clinically Appropriate for Reimbursement in the US Medicaid Population: Mixed Methods Study JO - J Med Internet Res SP - e46412 VL - 26 KW - mobile phone KW - telehealth KW - Medicaid reimbursement KW - health equity KW - Center for Medicare & Medicaid Services KW - telemedicine KW - reimbursement KW - digital health KW - Medicaid KW - Public Health Emergency KW - access KW - equity KW - health insurance KW - coverage KW - reimburse KW - equitable KW - health policy KW - telehealth expansion N2 - Background: When the US Department of Health and Human Services instituted a State of Public Health Emergency (PHE) during the COVID-19 pandemic, many telehealth flexibilities were fast-tracked to allow state Medicaid agencies to reimburse new specialty services, sites of care, and mediums such as FaceTime to communicate with patients.. This resulted in expanded access to care for financially vulnerable Medicaid patients, as evidenced by an uptick in telehealth use. Research has mostly focused on telehealth reimbursement for limited use cases such as rural primary care, without broader consideration for how telehealth can be appropriately mainstreamed and maintained. Objective: This study sought to (1) evaluate the continuation of flexible telehealth reimbursement broadly, beyond the COVID-19 pandemic; (2) analyze the clinical effectiveness of the new telehealth services; and (3) offer code-by-code reimbursement guidance to state Medicaid leaders. Methods: We surveyed 10 state Medicaid medical directors (MMDs) who are responsible for the scientific and clinical appropriateness of Medicaid policies in their respective states. Participants were asked to complete an internet-based survey with a list of medical billing codes, grouped by service type, and asked if they believed they should be reimbursed by Medicaid on a permanent basis. Additional questions covered more detailed recommendations, such as reimbursing video with audio versus audio-only, guardrails for certain specialty services, and motivations behind responses. Results: The MMDs felt that the majority of services should be reimbursed via some modality of telehealth after the PHE, with the most support for video combined with audio compared to audio-only. There were exceptions on both ends of the spectrum, where services such as pulmonary diagnostics were not recommended to be reimbursed in any form and services such as psychotherapy for mental health had the most support for audio-only. The vast majority of MMDs were supportive of reimbursement for remote monitoring services, but some preferred to have some reimbursement guardrails. We found that 90% (n=9) of MMDs were supportive of reimbursement for telehealth interprofessional services, while half (n=5) of the respondents felt that there should be continued guardrails for reimbursement. Motivations for continuing reimbursement flexibility were largely attributed to improving access to care, improving outcomes, and improving equity among the Medicaid patient population. Conclusions: There is a strong clinical endorsement to continue the telehealth flexibility enabled by the PHE, primarily for video combined with audio telehealth, with caution against audio-only telehealth in situations where hands-on intervention is necessary for diagnosis or treatment. There is also support for reimbursing remote monitoring services and telehealth interprofessional services, albeit with guardrails. These results are primarily from a perspective of improving access, outcomes, and equity; other state-specific factors such as fiscal impact and technical implementation may need to be taken into account when considering reimbursement decisions on telehealth. UR - https://www.jmir.org/2024/1/e46412 UR - http://dx.doi.org/10.2196/46412 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546706 ID - info:doi/10.2196/46412 ER - TY - JOUR AU - Zhang, Yunxi AU - Lin, Yueh-Yun AU - Lal, S. Lincy AU - Reneker, C. Jennifer AU - Hinton, G. Elizabeth AU - Chandra, Saurabh AU - Swint, Michael J. PY - 2024/3/28 TI - Telehealth Evaluation in the United States: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e55209 VL - 13 KW - cost KW - effectiveness KW - evaluation KW - framework KW - healthcare delivery KW - measurement KW - quality KW - scoping review KW - telehealth KW - United States N2 - Background: The rapid expansion of telehealth services, driven by the COVID-19 pandemic, necessitates systematic evaluation to guarantee the quality, effectiveness, and cost-effectiveness of telehealth services and programs in the United States. While numerous evaluation frameworks have emerged, crafted by various stakeholders, their comprehensiveness is limited, and the overall state of telehealth evaluation remains unclear. Objective: The overarching goal of this scoping review is to create a comprehensive overview of telehealth evaluation, incorporating perspectives from multiple stakeholder categories. Specifically, we aim to (1) map the existing landscape of telehealth evaluation, (2) identify key concepts for evaluation, (3) synthesize existing evaluation frameworks, and (4) identify measurements and assessments considered in the United States. Methods: We will conduct this scoping review in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). This scoping review will consider documents, including reviews, reports, and white papers, published since January 1, 2019. It will focus on evaluation frameworks and associated measurements of telehealth services and programs in the US health care system, developed by telehealth stakeholders, professional organizations, and authoritative sources, excluding those developed by individual researchers, to collect data that reflect the collective expertise and consensus of experts within the respective professional group. Results: The data extracted from selected documents will be synthesized using tools such as tables and figures. Visual aids like Venn diagrams will be used to illustrate the relationships between the evaluation frameworks from various sources. A narrative summary will be crafted to further describe how the results align with the review objectives, facilitating a comprehensive overview of the findings. This scoping review is expected to conclude by August 2024. Conclusions: By addressing critical gaps in telehealth evaluation, this scoping review protocol lays the foundation for a comprehensive and multistakeholder assessment of telehealth services and programs. Its findings will inform policy makers, health care providers, researchers, and other stakeholders in advancing the quality, effectiveness, and cost-effectiveness of telehealth in the US health care system. Trial Registration: OSF Registries osf.io/aytus; https://osf.io/aytus International Registered Report Identifier (IRRID): DERR1-10.2196/55209 UR - https://www.researchprotocols.org/2024/1/e55209 UR - http://dx.doi.org/10.2196/55209 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546709 ID - info:doi/10.2196/55209 ER - TY - JOUR AU - Narayan, Aditya AU - Weng, Kydo AU - Shah, Nirav PY - 2024/3/27 TI - Decentralizing Health Care: History and Opportunities of Web3 JO - JMIR Form Res SP - e52740 VL - 8 KW - Web3 KW - health care KW - patient-centric KW - data ownership KW - decentralization KW - interoperability KW - electronic health record (EHR) KW - privacy KW - blockchain KW - digital transformation KW - digital health care KW - digital health KW - patient KW - patients KW - technological framework KW - security and privacy KW - security UR - https://formative.jmir.org/2024/1/e52740 UR - http://dx.doi.org/10.2196/52740 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536235 ID - info:doi/10.2196/52740 ER - TY - JOUR AU - van den Bosch, C. Stefanie AU - van Dalen, Demi AU - Meinders, Marjan AU - van Goor, Harry AU - Bergé, Stefaan AU - Stommel, Martijn AU - van Dulmen, Sandra PY - 2024/3/27 TI - Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients? Experiences and Characteristics JO - J Med Internet Res SP - e49058 VL - 26 KW - telemedicine KW - video visit KW - remote consultation KW - eHealth KW - patient-centered care KW - COVID-19 KW - mobile phone N2 - Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients? experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation. Objective: This study aims to examine patients? experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible. Methods: A cross-sectional survey study was conducted. Patients aged ?18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients? experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression. Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001). Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better. UR - https://www.jmir.org/2024/1/e49058 UR - http://dx.doi.org/10.2196/49058 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536236 ID - info:doi/10.2196/49058 ER - TY - JOUR AU - Haimi, Motti AU - Wheeler, Quilter Sheila PY - 2024/3/25 TI - Safety in Teletriage by Nurses and Physicians in the United States and Israel: Narrative Review and Qualitative Study JO - JMIR Hum Factors SP - e50676 VL - 11 KW - telephone triage KW - teletriage KW - telehealth KW - telemedicine KW - safety KW - system error KW - human error KW - triage KW - outcome KW - patient safety N2 - Background: The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. Today, telehealth, now subsuming teletriage, has a basic structure and process intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID-19 pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced; however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent. Objective: Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. Methods: We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems? respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. Results: The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms and appear to design studies based on unfounded assumptions. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering nonmedical factors and patient preferences (shared decision-making). Conclusions: Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research on system safety. Research may commingle terminology and widely different, ill-defined groups of decision makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth?s technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements. UR - https://humanfactors.jmir.org/2024/1/e50676 UR - http://dx.doi.org/10.2196/50676 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526526 ID - info:doi/10.2196/50676 ER - TY - JOUR AU - Pomey, Marie-Pascale AU - Le Roux, Enora AU - Nadon, Nathalie AU - Perron, Jessie AU - Barry, Angèle AU - Bémeur, Chantal AU - Poder, G. Thomas AU - Duford, Fernand AU - Laviolette, Louise AU - Tétrault-Lassonde, Johanne AU - Vialaron, Cécile AU - Escalona, J. Manuel AU - Normandin, Louise AU - Huard, Geneviève AU - Girardin, Catherine AU - Rose, Christopher AU - Malas, Kathy AU - Ouellet, Denis AU - Vincent, Catherine PY - 2024/3/22 TI - Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e54440 VL - 13 KW - liver transplantation KW - accompanying patients KW - connected objects KW - health care model KW - digital platform N2 - Background: Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l?Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. Objective: This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention?s cost-effectiveness. Methods: Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. Results: In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. Conclusions: The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. International Registered Report Identifier (IRRID): PRR1-10.2196/54440 UR - https://www.researchprotocols.org/2024/1/e54440 UR - http://dx.doi.org/10.2196/54440 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517464 ID - info:doi/10.2196/54440 ER - TY - JOUR AU - He, Yao AU - Kouabenan, Yves-Rolland AU - Assoa, Henri Paul AU - Puttkammer, Nancy AU - Wagenaar, H. Bradley AU - Xiao, Hong AU - Gloyd, Stephen AU - Hoffman, G. Noah AU - Komena, Pascal AU - Kamelan, Fourier N'zi Pierre AU - Iiams-Hauser, Casey AU - Pongathie, Sanogo Adama AU - Kouakou, Alain AU - Flowers, Jan AU - Abiola, Nadine AU - Kohemun, Natacha AU - Amani, Jean-Bernard AU - Adje-Toure, Christiane AU - Perrone, A. Lucy PY - 2024/3/20 TI - Laboratory Data Timeliness and Completeness Improves Following Implementation of an Electronic Laboratory Information System in Côte d?Ivoire: Quasi-Experimental Study on 21 Clinical Laboratories From 2014 to 2020 JO - JMIR Public Health Surveill SP - e50407 VL - 10 KW - clinical laboratory KW - electronic laboratory information system KW - data quality KW - evaluation KW - impact evaluation KW - time series KW - laboratory KW - information system KW - information systems KW - HIV KW - sexually transmitted infection KW - sexually transmitted disease KW - sexually transmitted KW - lab KW - labs KW - adoption KW - implementation KW - effectiveness N2 - Background: The Ministry of Health in Côte d'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President?s Emergency Plan for AIDS Relief, have been collaborating to develop and implement the Open-Source Enterprise-Level Laboratory Information System (OpenELIS). The system is designed to improve HIV-related laboratory data management and strengthen quality management and capacity at clinical laboratories across the nation. Objective: This evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to HIV care and treatment. Methods: This evaluation used a quasi-experimental design to perform an interrupted time-series analysis to estimate the changes in the level and slope of 3 data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. We collected paper and electronic records on clusters of differentiation 4 (CD4) testing for 48 weeks before OpenELIS adoption until 72 weeks after. Data collection took place at 21 laboratories in 13 health regions that started using OpenELIS between 2014 and 2020. We analyzed the data at the laboratory level. We estimated odds ratios (ORs) by comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS. Results: There was an immediate 5-fold increase in timeliness (OR 5.27, 95% CI 4.33-6.41; P<.001) and an immediate 3.6-fold increase in completeness (OR 3.59, 95% CI 2.40-5.37; P<.001). These immediate improvements were observed starting after OpenELIS installation and then maintained until 72 weeks after OpenELIS adoption. The weekly improvement in the postimplementation trend of completeness was significant (OR 1.03, 95% CI 1.02-1.05; P<.001). The improvement in validity was not statistically significant (OR 1.34, 95% CI 0.69-2.60; P=.38), but validity did not fall below pre-OpenELIS levels. Conclusions: These results demonstrate the value of electronic laboratory information systems in improving laboratory data quality and supporting evidence-based decision-making in health care. These findings highlight the importance of OpenELIS in Côte d'Ivoire and the potential for adoption in other low- and middle-income countries with similar health systems. UR - https://publichealth.jmir.org/2024/1/e50407 UR - http://dx.doi.org/10.2196/50407 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506899 ID - info:doi/10.2196/50407 ER - TY - JOUR AU - Ganeshan, Smitha AU - Liu, W. Andrew AU - Kroeger, Anne AU - Anand, Prerna AU - Seefeldt, Richard AU - Regner, Alexis AU - Vaughn, Diana AU - Odisho, Y. Anobel AU - Mourad, Michelle PY - 2024/3/19 TI - An Electronic Health Record?Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study JO - J Med Internet Res SP - e52071 VL - 26 KW - appointment KW - consultation KW - cost KW - digital health KW - digital tools KW - electronic health record KW - EHR KW - informatics KW - patient access KW - retrospective review KW - revenue KW - self-rescheduling tool KW - self-scheduling KW - waiting time N2 - Background: In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician?s schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. Objective: We evaluated an electronic health record (EHR)?based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. Methods: In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. Results: From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. Conclusions: Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access. UR - https://www.jmir.org/2024/1/e52071 UR - http://dx.doi.org/10.2196/52071 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502159 ID - info:doi/10.2196/52071 ER - TY - JOUR AU - Färber, Andri AU - Schwabe, Christiane AU - Stalder, H. Philipp AU - Dolata, Mateusz AU - Schwabe, Gerhard PY - 2024/3/18 TI - Physicians? and Patients? Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients JO - JMIR Hum Factors SP - e49647 VL - 11 KW - adherence to treatment KW - digital agents KW - eHealth KW - electronic medical records KW - health literacy KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. Objective: This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents?a silent digital expert, a communicative digital expert, and a digital companion (DC). Methods: We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. Results: Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. Conclusions: Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings. UR - https://humanfactors.jmir.org/2024/1/e49647 UR - http://dx.doi.org/10.2196/49647 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498022 ID - info:doi/10.2196/49647 ER - TY - JOUR AU - Xue, Zhaowen AU - Zhang, Yiming AU - Gan, Wenyi AU - Wang, Huajun AU - She, Guorong AU - Zheng, Xiaofei PY - 2024/3/14 TI - Quality and Dependability of ChatGPT and DingXiangYuan Forums for Remote Orthopedic Consultations: Comparative Analysis JO - J Med Internet Res SP - e50882 VL - 26 KW - artificial intelligence KW - ChatGPT KW - consultation KW - musculoskeletal KW - natural language processing KW - remote medical consultation KW - orthopaedic KW - orthopaedics N2 - Background: The widespread use of artificial intelligence, such as ChatGPT (OpenAI), is transforming sectors, including health care, while separate advancements of the internet have enabled platforms such as China?s DingXiangYuan to offer remote medical services. Objective: This study evaluates ChatGPT-4?s responses against those of professional health care providers in telemedicine, assessing artificial intelligence?s capability to support the surge in remote medical consultations and its impact on health care delivery. Methods: We sourced remote orthopedic consultations from ?Doctor DingXiang,? with responses from its certified physicians as the control and ChatGPT?s responses as the experimental group. In all, 3 blindfolded, experienced orthopedic surgeons assessed responses against 7 criteria: ?logical reasoning,? ?internal information,? ?external information,? ?guiding function,? ?therapeutic effect,? ?medical knowledge popularization education,? and ?overall satisfaction.? We used Fleiss ? to measure agreement among multiple raters. Results: Initially, consultation records for a cumulative count of 8 maladies (equivalent to 800 cases) were gathered. We ultimately included 73 consultation records by May 2023, following primary and rescreening, in which no communication records containing private information, images, or voice messages were transmitted. After statistical scoring, we discovered that ChatGPT?s ?internal information? score (mean 4.61, SD 0.52 points vs mean 4.66, SD 0.49 points; P=.43) and ?therapeutic effect? score (mean 4.43, SD 0.75 points vs mean 4.55, SD 0.62 points; P=.32) were lower than those of the control group, but the differences were not statistically significant. ChatGPT showed better performance with a higher ?logical reasoning? score (mean 4.81, SD 0.36 points vs mean 4.75, SD 0.39 points; P=.38), ?external information? score (mean 4.06, SD 0.72 points vs mean 3.92, SD 0.77 points; P=.25), and ?guiding function? score (mean 4.73, SD 0.51 points vs mean 4.72, SD 0.54 points; P=.96), although the differences were not statistically significant. Meanwhile, the ?medical knowledge popularization education? score of ChatGPT was better than that of the control group (mean 4.49, SD 0.67 points vs mean 3.87, SD 1.01 points; P<.001), and the difference was statistically significant. In terms of ?overall satisfaction,? the difference was not statistically significant between the groups (mean 8.35, SD 1.38 points vs mean 8.37, SD 1.24 points; P=.92). According to how Fleiss ? values were interpreted, 6 of the control group?s score points were classified as displaying ?fair agreement? (P<.001), and 1 was classified as showing ?substantial agreement? (P<.001). In the experimental group, 3 points were classified as indicating ?fair agreement,? while 4 suggested ?moderate agreement? (P<.001). Conclusions: ChatGPT-4 matches the expertise found in DingXiangYuan forums? paid consultations, excelling particularly in scientific education. It presents a promising alternative for remote health advice. For health care professionals, it could act as an aid in patient education, while patients may use it as a convenient tool for health inquiries. UR - https://www.jmir.org/2024/1/e50882 UR - http://dx.doi.org/10.2196/50882 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483451 ID - info:doi/10.2196/50882 ER - TY - JOUR AU - Gately, Elizabeth Megan AU - Waller, E. Dylan AU - Metcalf, E. Emily AU - Moo, R. Lauren PY - 2024/3/14 TI - Caregivers? Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners JO - JMIR Rehabil Assist Technol SP - e52049 VL - 11 KW - telemedicine KW - caregivers KW - occupational therapy KW - caregiver KW - care worker KW - telehealth KW - older adults KW - older adult KW - geriatric KW - rural KW - remote KW - OT practitioner KW - web-based KW - national survey KW - role KW - home care KW - clinical support KW - mobile phone N2 - Background: Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults? health- and technology-related challenges may necessitate caregiver assistance. Objective: This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). Methods: A web-based national survey of VHA OT practitioners about caregivers? role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. Results: Of approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ?65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. Conclusions: Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers? challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients? access to video visits. UR - https://rehab.jmir.org/2024/1/e52049 UR - http://dx.doi.org/10.2196/52049 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483462 ID - info:doi/10.2196/52049 ER - TY - JOUR AU - Stults, D. Cheryl AU - Mazor, M. Kathleen AU - Cheung, Michael AU - Ruo, Bernice AU - Li, Martina AU - Walker, Amanda AU - Saphirak, Cassandra AU - Vaida, Florin AU - Singh, Sonal AU - Fisher, A. Kimberly AU - Rosen, Rebecca AU - Yood, Robert AU - Garber, Lawrence AU - Longhurst, Christopher AU - Kallenberg, Gene AU - Yu, Edward AU - Chan, Albert AU - Millen, Marlene AU - Tai-Seale, Ming PY - 2024/3/14 TI - Patients? Perspectives on Plans Generated During Primary Care Visits and Self-Reported Adherence at 3 Months: Data From a Randomized Trial JO - J Particip Med SP - e50242 VL - 16 KW - primary care KW - survey KW - patient adherence KW - adherence KW - self-reported KW - surveys KW - content analysis KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - plan KW - plans KW - willingness KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives N2 - Background: Effective primary care necessitates follow-up actions by the patient beyond the visit. Prior research suggests room for improvement in patient adherence. Objective: This study sought to understand patients? views on their primary care visits, the plans generated therein, and their self-reported adherence after 3 months. Methods: As part of a large multisite cluster randomized pragmatic trial in 3 health care organizations, patients completed 2 surveys?the first within 7 days after the index primary care visit and another 3 months later. For this analysis of secondary outcomes, we combined the results across all study participants to understand patient adherence to care plans. We recorded patient characteristics and survey responses. Cross-tabulation and chi-square statistics were used to examine bivariate associations, adjusting for multiple comparisons when appropriate. We used multivariable logistic regression to assess how patients? intention to follow, agreement, and understanding of their plans impacted their plan adherence, allowing for differences in individual characteristics. Qualitative content analysis was conducted to characterize the patient?s self-reported plans and reasons for adhering (or not) to the plan 3 months later. Results: Of 2555 patients, most selected the top box option (9=definitely agree) that they felt they had a clear plan (n=2011, 78%), agreed with the plan (n=2049, 80%), and intended to follow the plan (n=2108, 83%) discussed with their provider at the primary care visit. The most common elements of the plans reported included reference to exercise (n=359, 14.1%), testing (laboratory, imaging, etc; n=328, 12.8%), diet (n=296, 11.6%), and initiation or adjustment of medications; (n=284, 11.1%). Patients who strongly agreed that they had a clear plan, agreed with the plan, and intended to follow the plan were all more likely to report plan completion 3 months later (P<.001) than those providing less positive ratings. Patients who reported plans related to following up with the primary care provider (P=.008) to initiate or adjust medications (P?.001) and to have a specialist visit were more likely to report that they had completely followed the plan (P=.003). Adjusting for demographic variables, patients who indicated intent to follow their plan were more likely to follow-through 3 months later (P<.001). Patients? reasons for completely following the plan were mainly that the plan was clear (n=1114, 69.5%), consistent with what mattered (n=1060, 66.1%), and they were determined to carry through with the plan (n=887, 53.3%). The most common reasons for not following the plan were lack of time (n=217, 22.8%), having decided to try a different approach (n=105, 11%), and the COVID-19 pandemic impacted the plan (n=105, 11%). Conclusions: Patients? initial assessment of their plan as clear, their agreement with the plan, and their initial willingness to follow the plan were all strongly related to their self-reported completion of the plan 3 months later. Patients whose plans involved lifestyle changes were less likely to report that they had ?completely? followed their plan. Trial Registration: ClinicalTrials.gov NCT03385512; https://clinicaltrials.gov/study/NCT03385512 International Registered Report Identifier (IRRID): RR2-10.2196/30431 UR - https://jopm.jmir.org/2024/1/e50242 UR - http://dx.doi.org/10.2196/50242 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483458 ID - info:doi/10.2196/50242 ER - TY - JOUR AU - Hofner, Michael AU - Hurnaus, Patrick AU - DiStefano, Dan AU - Philip, Shaji AU - Kim, Sarah AU - Shaw, Julie AU - Waring, Chander Avantika PY - 2024/3/13 TI - Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study JO - JMIR Diabetes SP - e53835 VL - 9 KW - asynchronous KW - blood pressure KW - cardiology KW - chronic disease KW - cohort KW - diabetes mellitus therapy KW - diabetes KW - diabetics KW - eHealth KW - e-health KW - HbA1c KW - health disparities KW - heart KW - hemoglobin A1c KW - hypertension therapy KW - hypertension KW - hypertensive KW - remote care KW - retrospective KW - telehealth KW - telemedicine KW - virtual care N2 - Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients? first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by ?1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by ?2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by ?2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by ?1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. UR - https://diabetes.jmir.org/2024/1/e53835 UR - http://dx.doi.org/10.2196/53835 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363585 ID - info:doi/10.2196/53835 ER - TY - JOUR AU - Canfell, J. Oliver AU - Woods, Leanna AU - Meshkat, Yasaman AU - Krivit, Jenna AU - Gunashanhar, Brinda AU - Slade, Christine AU - Burton-Jones, Andrew AU - Sullivan, Clair PY - 2024/3/11 TI - The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis JO - J Med Internet Res SP - e47715 VL - 26 KW - electronic medical record KW - electronic health record KW - health care professionals KW - patients KW - patient satisfaction KW - hospitals KW - eHealth KW - attitude KW - perception KW - systematic KW - digital hospital KW - digital hospitals KW - experience KW - satisfaction N2 - Background: The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. Objective: This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. Results: A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians? ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. Conclusions: Clinicians? experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care. UR - https://www.jmir.org/2024/1/e47715 UR - http://dx.doi.org/10.2196/47715 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466978 ID - info:doi/10.2196/47715 ER - TY - JOUR AU - Jensen, Høpfner Lili Worre AU - Rahbek, Ole AU - Lauritsen, Kildahl Rikke Emilie AU - Kold, Søren AU - Dinesen, Birthe PY - 2024/3/8 TI - Health Care Professionals? Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study JO - JMIR Hum Factors SP - e53391 VL - 11 KW - CFIR KW - Consolidated Framework for Implementation Research KW - digital communication KW - hospital discharge KW - implementation science KW - interdisciplinary communication KW - orthopedic surgery KW - patient-provider communication KW - postoperative care KW - qualitative research KW - text messaging N2 - Background: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs? needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. Objective: This study aimed to (1) investigate HCPs? perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). Methods: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. Results: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. Conclusions: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources. UR - https://humanfactors.jmir.org/2024/1/e53391 UR - http://dx.doi.org/10.2196/53391 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457798 ID - info:doi/10.2196/53391 ER - TY - JOUR AU - Jiang, Yun AU - Hwang, Misun AU - Cho, Youmin AU - Friese, R. Christopher AU - Hawley, T. Sarah AU - Manojlovich, Milisa AU - Krauss, C. John AU - Gong, Yang PY - 2024/3/8 TI - The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study JO - J Med Internet Res SP - e47685 VL - 26 KW - digital technology KW - patient safety KW - patient participation KW - patient-reported outcomes KW - drug-related side effects and adverse reactions N2 - Background: Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients? various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients? just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients? transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. Objective: We aim to assess oncology patients? perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. Methods: A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants? perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants? technology acceptance through bivariate correlation analyses and multiple logistic regressions. Results: Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). Conclusions: In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care. UR - https://www.jmir.org/2024/1/e47685 UR - http://dx.doi.org/10.2196/47685 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457204 ID - info:doi/10.2196/47685 ER - TY - JOUR AU - Chien, Shih-Ying AU - Wong, May-Kuen Alice AU - Tseng, Winston AU - Hu, Han-Chung AU - Cho, Hsiu-Ying PY - 2024/3/7 TI - Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study JO - JMIR Hum Factors SP - e51150 VL - 11 KW - chronic lung diseases KW - home-based pulmonary rehabilitation KW - telehealth KW - remote health care N2 - Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. UR - https://humanfactors.jmir.org/2024/1/e51150 UR - http://dx.doi.org/10.2196/51150 UR - http://www.ncbi.nlm.nih.gov/pubmed/38452366 ID - info:doi/10.2196/51150 ER - TY - JOUR AU - Maltz, Amnon AU - Rashkovich, Stella AU - Sarid, Adi AU - Cohen, Yafit AU - Landau, Tamar AU - Saifer, Elina AU - Amorai Belkin, Neta AU - Alcalay, Tamar PY - 2024/3/6 TI - The Framing Effect of Digital Textual Messages on Uptake Rates of Medical Checkups: Field Study JO - JMIR Public Health Surveill SP - e45379 VL - 10 KW - field experiment KW - nudge KW - cancer screening KW - mammography KW - vaccination KW - framing KW - fecal occult blood test (FOBT) KW - behavior change N2 - Background: Health care authorities often use text messages to enhance compliance with medical recommendations. The effectiveness of different message framings has been studied extensively over the past 3 decades. Recently, health care providers have begun using digital media platforms to disseminate health-related messages. Objective: This study aimed to examine the effectiveness of some of the most widely used message framings on the uptake rates of medical checkups. Methods: This study used a large-scale digital outreach campaign conducted by Maccabi Healthcare Services (MHS) during 2020-2021, involving a total of 113,048 participants. MHS members aged 50-74 years were invited to take their recommended medical actions from the following list: human papillomavirus (HPV), mammography, abdominal aortic aneurysm, fecal occult blood test (FOBT), and pneumococcal vaccination. Each member was randomly assigned to receive 1 of 6 message framings: control (neutrally framed; n=20,959, 18.5%), gains (benefits of compliance; n=20,393, 18%), losses (negative consequences of noncompliance; n=15,165, 13.4%), recommendation (a recommendation by an authoritative figure, in this context by a physician; n=20,584, 18.2%), implementation intentions (linking potential outcomes to future reactions; n=20,701, 18.3%), and empowerment (emphasizing personal responsibility for maintaining good health; n=15,246, 13.5%). The time frames for measuring a successful intervention were 14 days for scheduling screenings (ie, HPV, mammography, or abdominal aortic aneurysm), 30 days for performing the FOBT, and 60 days for receiving pneumococcal vaccination. We also examined the effectiveness of media channels (text message or email) on uptake rates and whether the subject-line length is correlated with message-opening rates. Results: No significant effect of message framing on uptake rates of medical checkups was observed. The rates of appointments for screening ranged from 12.9% to 14.1% across treatments. Based on a chi-square test, there was no evidence to reject the null hypothesis that these compliance rates are independent of the treatments (P=.35). The uptake rates for the FOBT and pneumococcal vaccination ranged from 23.3% to 23.8% across treatments, and we could not reject the hypothesis that they are independent of the treatments (P=.88). We also found that emails are more effective than text messages (P<.001) and that the subject-line length is negatively correlated with message-opening rates. Conclusions: No evidence was found for an effect of the 5 message framings on uptake rates of medical checkups. To enhance compliance rates, public health officials may consider alternative framings. Furthermore, media channels and the subject-line length should be given careful consideration in the planning stages of health care campaigns. Trial Registration: AEA RCT Registry AEARCTR-0006317; https://www.socialscienceregistry.org/trials/6317/history/201365 UR - https://publichealth.jmir.org/2024/1/e45379 UR - http://dx.doi.org/10.2196/45379 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446543 ID - info:doi/10.2196/45379 ER - TY - JOUR AU - Lussier, Maxime AU - Couture, Mélanie AU - Giroux, Sylvain AU - Aboujaoudé, Aline AU - Ngankam, Kenfack Hubert AU - Pigot, Hélène AU - Gaboury, Sébastien AU - Bouchard, Kevin AU - Bottari, Carolina AU - Belchior, Patricia AU - Paré, Guy AU - Bier, Nathalie PY - 2024/2/29 TI - Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study JO - JMIR Res Protoc SP - e52284 VL - 13 KW - action design research KW - protocol KW - activities of daily living KW - older adults KW - cognitive deficits KW - telemonitoring KW - public health care system KW - home care services N2 - Background: Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors? Autonomy program (SAPA [Soutien à l?autonomie des personnes âgées]) project was initiated within this context, embracing an innovative research approach that combines action research and design science. Objective: This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context. Methods: This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project. Results: The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients? ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients? homes, and detailed results will be presented in future papers. Conclusions: To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging. International Registered Report Identifier (IRRID): RR1-10.2196/52284 UR - https://www.researchprotocols.org/2024/1/e52284 UR - http://dx.doi.org/10.2196/52284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38422499 ID - info:doi/10.2196/52284 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Hoffmann, Josephine Marie AU - Nübel, Jonathan AU - Ignatyev, Yury AU - Heinze, Martin AU - Butter, Christian AU - Haase-Fielitz, Anja PY - 2024/2/20 TI - Acceptance of Telemedicine by Specialists and General Practitioners in Cardiology Care: Cross-Sectional Survey Study JO - JMIR Form Res SP - e49526 VL - 8 KW - acceptance KW - adoption KW - cardiac KW - cardiology KW - cross sectional KW - health services research KW - heart KW - preference KW - survey KW - telecardiology KW - telehealth KW - telemedicine N2 - Background: In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. Objective: We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. Methods: We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. Results: We contacted 929 physicians. Of those 12.1% (112/929) completed the questionnaires. Participants were 56% male (54/97), 29% female (28/97), and 2% (2/97) diverse (median age 50 years). About 16% (18/112) of the respondents currently use telemedicine daily, 14.3% (16/112) 3-4 times a week, and 43% (48/112) did not use telemedicine at all. Overall, 35.1% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8%, both), consultation (57/97, 58.8%), and extending follow-up time (59/97, 60.8%). Reported barriers to implementation were mostly administration (26/97, 26.8%), inadequate reimbursement (25/97, 25.8%), and the purchase of technology equipment (23/97, 23.7%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50% of the participants. Conclusions: Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology. UR - https://formative.jmir.org/2024/1/e49526 UR - http://dx.doi.org/10.2196/49526 UR - http://www.ncbi.nlm.nih.gov/pubmed/38376898 ID - info:doi/10.2196/49526 ER - TY - JOUR AU - Li, Zhaoying AU - Lei, Yating AU - Bui, Quoc AU - DePaul, Olivia AU - Nicol, E. Ginger AU - Mohr, C. David AU - Lee, I. Sunghoon AU - Fong, M. Mandy W. AU - Metts, L. Christopher AU - Tomazin, E. Stephanie AU - Wong, K. Alex W. PY - 2024/2/19 TI - A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial JO - JMIR Rehabil Assist Technol SP - e50863 VL - 11 KW - digital intervention KW - feasibility KW - mobile health KW - participation KW - rehabilitation KW - self-efficacy KW - self-management KW - stroke KW - technology KW - telehealth KW - telemedicine KW - text messaging N2 - Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System?s Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. Trial Registration: ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137&rank=1 UR - https://rehab.jmir.org/2024/1/e50863 UR - http://dx.doi.org/10.2196/50863 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373029 ID - info:doi/10.2196/50863 ER - TY - JOUR AU - Kokkonen, Jorma AU - Mustonen, Pirjo AU - Heikkilä, Eija AU - Leskelä, Riikka-Leena AU - Pennanen, Paula AU - Krühn, Kati AU - Jalkanen, Arto AU - Laakso, Jussi-Pekka AU - Kempers, Jari AU - Väisänen, Sami AU - Torkki, Paulus PY - 2024/2/7 TI - Effectiveness of Telemonitoring in Reducing Hospitalization and Associated Costs for Patients With Heart Failure in Finland: Nonrandomized Pre-Post Telemonitoring Study JO - JMIR Mhealth Uhealth SP - e51841 VL - 12 KW - cost KW - Finland KW - heart failure KW - hospital KW - resource use KW - telemonitoring N2 - Background: Many patients with chronic heart failure (HF) experience a reduced health status, leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventing readmissions and related costs remains scarce. Objective: This study assessed the effectiveness of adding a telemonitoring solution to the standard of care (SOC) for the prevention of hospitalization and related costs in patients with HF in Finland. Methods: We performed a nonrandomized pre-post telemonitoring study to estimate health care costs and resource use during 6 months on SOC followed by 6 months on SOC with a novel telemonitoring solution. The telemonitoring solution consisted of a digital platform for patient-reported symptoms and daily weight and blood pressure measurements, automatically generated alerts triggering phone calls with secondary care nurses, and rapid response to alerts by treating physicians. Telemonitoring solution data were linked to patient register data on primary care, secondary care, and hospitalization. The patient register of the Southern Savonia Social and Health Care Authority (Essote) was used. Eligible patients had at least 1 hospital admission within the last 12 months and self-reported New York Heart Association class II-IV from the central hospital in the Southern Savonia region. Results: Out of 50 recruited patients with HF, 43 completed the study and were included in the analysis. The hospitalization-related cost decreased (49%; P=.03) from ?2189 (95% CI ?1384-?2994; a currency exchange rate of EUR ?1=US $1.10589 is applicable) during SOC to ?1114 (95% CI ?425-?1803) during telemonitoring. The number of patients with at least 1 hospitalization due to HF was reduced by 70% (P=.002) from 20 (47%) out of 43patients during SOC to 6 (14%) out of 43 patients in telemonitoring. The estimated mean total health care cost per patient was ?3124 (95% CI ?2212-?4036) during SOC and ?2104 (95% CI ?1313-?2895) during telemonitoring, resulting in a 33% reduction (P=.07) in costs with telemonitoring. Conclusions: The results suggest that the telemonitoring solution can reduce hospital-related costs for patients with HF with a recent hospital admission. UR - https://mhealth.jmir.org/2024/1/e51841 UR - http://dx.doi.org/10.2196/51841 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324366 ID - info:doi/10.2196/51841 ER - TY - JOUR AU - Dawson, Rik AU - Gilchrist, Heidi AU - Pinheiro, Marina AU - Nelson, Karn AU - Bowes, Nina AU - Sherrington, Cathie AU - Haynes, Abby PY - 2024/2/7 TI - Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions JO - JMIR Aging SP - e53010 VL - 7 KW - physiotherapy KW - telehealth KW - telephysiotherapy KW - exercise KW - aged care KW - qualitative methods KW - behavior change KW - technology KW - virtual care N2 - Background: Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. Objective: This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. Methods: A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders? experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. Results: All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult?friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom?s convenience, use of tailored web-based exercise resources, and companionable local support. Conclusions: This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult?friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864 UR - https://aging.jmir.org/2024/1/e53010 UR - http://dx.doi.org/10.2196/53010 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324369 ID - info:doi/10.2196/53010 ER - TY - JOUR AU - Onseng, Pansiree AU - Jiraporncharoen, Wichuda AU - Moonkayaow, Sasiwimon AU - Veerasirikul, Pimchai AU - Wiwatkunupakarn, Nutchar AU - Angkurawaranon, Chaisiri AU - Pinyopornpanish, Kanokporn PY - 2024/2/7 TI - Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study JO - JMIR Aging SP - e48132 VL - 7 KW - telehomecare KW - telemedicine KW - telehealth KW - caregivers KW - older adults KW - attitudes N2 - Background: In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. Objective: This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. Methods: This qualitative study used semistructured interviews to explore caregivers? perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. Results: The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. Conclusions: Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare. UR - https://aging.jmir.org/2024/1/e48132 UR - http://dx.doi.org/10.2196/48132 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324373 ID - info:doi/10.2196/48132 ER - TY - JOUR AU - Li, Yiwen AU - Pope, Charlene AU - Damonte, Jennifer AU - Spates, Tanika AU - Maa, April AU - Chen, Suephy AU - Yeung, Howa PY - 2024/2/7 TI - Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis JO - JMIR Dermatol SP - e50352 VL - 7 KW - telemedicine KW - dermatology KW - eye KW - implementation science KW - stakeholder participation KW - veterans? health N2 - Background: Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members? engagement in telespecialty care. Objective: This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). Methods: In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. Results: In total, 3 themes were identified from participants? experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. Conclusions: This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans. UR - https://derma.jmir.org/2024/1/e50352 UR - http://dx.doi.org/10.2196/50352 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324360 ID - info:doi/10.2196/50352 ER - TY - JOUR AU - Carter, Jocelyn AU - Swack, Natalia AU - Isselbacher, Eric AU - Donelan, Karen AU - Thorndike, Anne PY - 2024/2/6 TI - Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e55687 VL - 13 KW - heart failure KW - digital platform KW - remote monitoring KW - home-based care KW - health worker KW - social needs care KW - community health worker N2 - Background: Interventions focused on remote monitoring and social needs care have shown promise in improving clinical outcomes for patients with heart failure (HF). However, patient willingness to use technology as well as concerns about access in underresourced settings have limited digital platform implementation and adoption. There is little research in HF populations examining the effect of a combined digital and social needs care intervention that could enhance patient engagement in digital platform use while closing gaps in care related to social determinants of health. Here, we describe the protocol for a clinical trial of a digitally enabled community health worker intervention designed for patients with HF. Objective: This study aims to describe the protocol for a randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of an intervention that combines remote monitoring with a digital platform and community health worker (CHW) social needs care for patients with HF who are transitioning from hospital to home. Given the elevated morbidity and mortality, identifying comprehensive and patient-centered interventions at the time of hospital care transitions that can improve clinical outcomes, impact cost, and augment the quality of care for this cohort is a priority. Methods: This trial randomized adult inpatient participants (n=50) with a diagnosis of HF receiving care at a single academic health care institution to the 30-day intervention (digital platform+CHW pairing+usual care) or the 30-day control (CHW pairing+usual care) arms. All study participants completed baseline questionnaires and 30-day exit interviews and questionnaires. The primary outcomes will be acceptability, feasibility, and preliminary effectiveness. Results: This clinical trial opened for enrollment in September 2022 and was completed in June 2023. Initial results are expected to be published in the spring of 2024, and analysis is currently underway. Feasibility outcome measures will include the use rates of the biometric sensor (average hours per day), the digital blood pressure monitor (average times per day), the weight scale (average times per day), and the completion of the symptoms questionnaire (average times per day). The acceptability outcome will be measured by the patients? response to the truthfulness of the statement that they would be willing to use the digital platform in the future (response options: very true, somewhat true, or not true). Preliminary effectiveness will be measured by tracking 30-day clinical outcomes (hospital readmissions, emergency room visits, and missed primary care and cardiology appointments). Conclusions: The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of supportive home-based social needs care to enhance engagement and the potential effectiveness of clinically focused digital platforms. These results may inform the construction of a future multi-institutional trial designed to test the true effectiveness of this intervention in HF. Trial Registration: ClinicalTrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008 International Registered Report Identifier (IRRID): DERR1-10.2196/55687 UR - https://www.researchprotocols.org/2024/1/e55687 UR - http://dx.doi.org/10.2196/55687 UR - http://www.ncbi.nlm.nih.gov/pubmed/38216543 ID - info:doi/10.2196/55687 ER - TY - JOUR AU - Cook, Nicole AU - Hoopes, Megan AU - Biel, M. Frances AU - Cartwright, Natalie AU - Gordon, Michelle AU - Sills, Marion PY - 2024/2/5 TI - Early Results of an Initiative to Assess Exposure to Firearm Violence in Ambulatory Care: Descriptive Analysis of Electronic Health Record Data JO - JMIR Public Health Surveill SP - e47444 VL - 10 KW - gun violence KW - firearm injury KW - surveillance KW - primary care KW - public health KW - ambulatory care KW - electronic health record KW - violence KW - burden KW - emergency department KW - data KW - risk factor N2 - Background:  Current research on firearm violence is largely limited to patients who received care in emergency departments or inpatient acute care settings or who died. This is because standardized disease classification codes for firearm injury only represent bodily trauma. As a result, research on pathways and health impacts of firearm violence is largely limited to people who experienced acute bodily trauma and does not include the estimated millions of individuals who were exposed to firearm violence but did not sustain acute injury. Assessing and collecting data on exposure to firearm violence in ambulatory care settings can expand research and more fully frame the public health issue. Objective: The aim of the study is to evaluate the demographic and clinical characteristics of patients who self-reported exposure to firearm violence during a behavioral health visit. Methods: This study assessed early data from an initiative implemented in 2022 across a national network of ambulatory behavioral health centers to support trauma-informed care by integrating structured data fields on trauma exposure into an electronic health record behavioral health patient assessment form (SmartForm), as such variables are generally not included in standard outpatient medical records. We calculated descriptive statistics on clinic characteristics, patient demographics, and select clinical conditions among clinics that chose to implement the SmartForm and among patients who reported an exposure to firearm violence. Data on patient counts are limited to positive reports of exposure to firearm violence, and the representativeness of firearm exposure among all patients could not be calculated due to unknown variability in the implementation of the SmartForm. Results: There were 323 of 629 (51%) clinics that implemented the SmartForm and reported at least 1 patient exposed to firearm violence. In the first 11 months of implementation, 3165 patients reported a recent or past exposure to firearm violence across the 323 clinics. Among patients reporting exposure, 52.7% (n=1669) were male, 38.8% (n=1229) were Black, 45.7% (n=1445) had posttraumatic stress disorder, 37.5% (n=1186) had a substance abuse disorder (other than nicotine), and 11.7% (n=371) had hypertension. Conclusions: Current research on firearm violence using standardized data is limited to acute care settings and death data. Early results from an initiative across a large network of behavioral health clinics demonstrate that a high number of clinics chose to implement the SmartForm, resulting in thousands of patients reporting exposure to firearm violence. This study demonstrates that collecting standardized data on firearm violence exposure in ambulatory care settings is feasible. This study further demonstrates that resultant data from ambulatory settings can be used for meaningful analysis in describing populations affected by firearm violence. The results of this study hold promise for further collection of structured data on exposure to firearm violence in ambulatory settings. UR - https://publichealth.jmir.org/2024/1/e47444 UR - http://dx.doi.org/10.2196/47444 UR - http://www.ncbi.nlm.nih.gov/pubmed/38315521 ID - info:doi/10.2196/47444 ER - TY - JOUR AU - Bargeri, Silvia AU - Castellini, Greta AU - Vitale, Antonino Jacopo AU - Guida, Stefania AU - Banfi, Giuseppe AU - Gianola, Silvia AU - Pennestrì, Federico PY - 2024/2/2 TI - Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review JO - J Med Internet Res SP - e50090 VL - 26 KW - telemedicine KW - systematic review KW - patient-reported outcomes measures KW - PROMs KW - patient-reported experience measures KW - PREMs KW - rehabilitation KW - musculoskeletal disorder KW - condition KW - musculoskeletal KW - patient-reported KW - telerehabilitation KW - orthopedics KW - meta-analyses KW - osteoarthritis KW - accessibility KW - health care N2 - Background: Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. Objective: We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. Methods: We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. Results: Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed ?telerehabilitation? (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, ?physical function?) were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. Conclusions: Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. Trial Registration: PROSPERO CRD42022347366; https://osf.io/pxedm/ UR - https://www.jmir.org/2024/1/e50090 UR - http://dx.doi.org/10.2196/50090 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306156 ID - info:doi/10.2196/50090 ER - TY - JOUR AU - Khodabakhshian, Nairy AU - Gaeul Lee, Kyla AU - Marawi, Tulip AU - Sorkhou, Maryam AU - Vyravanathan, Sobiga AU - Harnett, Nicole PY - 2024/2/1 TI - Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53901 VL - 13 KW - communication KW - medical education KW - patient-facing KW - scoping review KW - technology KW - virtual reality N2 - Background: Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education. Objective: The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education. Methods: A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non?communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. Results: As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods. Conclusions: The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care?specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry. International Registered Report Identifier (IRRID): DERR1-10.2196/53901 UR - https://www.researchprotocols.org/2024/1/e53901 UR - http://dx.doi.org/10.2196/53901 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300671 ID - info:doi/10.2196/53901 ER - TY - JOUR AU - Tran, C. Karen AU - Mak, Meagan AU - Kuyper, M. Laura AU - Bittman, Jesse AU - Mangat, Birinder AU - Lindsay, Heather AU - Kim Sing, Chad AU - Xu, Liang AU - Wong, Hubert AU - Dawes, Martin AU - Khan, Nadia AU - Ho, Kendall PY - 2024/1/30 TI - Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study JO - JMIR Form Res SP - e49592 VL - 8 KW - hypertension KW - remote-home monitoring KW - feasibility study KW - health monitor KW - telehealth KW - pilot study KW - mobile phone KW - monitoring KW - telemonitoring KW - blood pressure KW - emergency department KW - morbidity KW - mortality KW - primary care KW - physician care KW - management KW - hypertension medication N2 - Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Objective: Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Methods: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient?s condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. Results: A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ?80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by ?13/?5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. Conclusions: HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control. UR - https://formative.jmir.org/2024/1/e49592 UR - http://dx.doi.org/10.2196/49592 UR - http://www.ncbi.nlm.nih.gov/pubmed/38111177 ID - info:doi/10.2196/49592 ER - TY - JOUR AU - Lau, Po Bobo Hi AU - Tang, Kum Catherine So AU - Holroyd, Eleanor AU - Wong, Wai William Chi PY - 2024/1/26 TI - Challenges and Implications for Menopausal Health and Help-Seeking Behaviors in Midlife Women From the United States and China in Light of the COVID-19 Pandemic: Web-Based Panel Surveys JO - JMIR Public Health Surveill SP - e46538 VL - 10 KW - menopause KW - help-seeking KW - health beliefs KW - telehealth KW - COVID-19 KW - women KW - menopausal health KW - women's health KW - online survey KW - awareness KW - digital health KW - symptom management KW - health education N2 - Background: The global population of women of menopausal age is quickly increasing. The COVID-19 pandemic has led to an accelerated increase in the use of telehealth services, especially technological solutions targeting women?s health. Understanding the factors behind midlife women?s help-seeking behaviors amidst the pandemic will assist in the development of person-centered holistic telehealth solutions targeting menopausal and postreproductive health. Objective: This study aimed to compare the factors underlying help-seeking for menopausal distress among midlife women in the United States and China. Methods: We conducted 2 web-based panel surveys in the United States using Amazon Mechanical Turk and in China using Credamo between July and October 2022. A total of 1002 American and 860 Chinese women aged between 40 and 65 years took part in the survey. The survey was designed based on the Health Belief Model with questions related to their menopausal knowledge, perceived severity of menopausal symptoms, perceived susceptibility to menopausal distress, perceived benefits of help-seeking, perceived COVID-19? and non?COVID-19?related barriers against help-seeking, self-efficacy, and motivation to seek help. Structural equations models were fitted for the data using full information maximum likelihood to manage missing data. Results: Knowledge was not directly related to help-seeking motivation in both samples. Among the Chinese sample, knowledge was negatively related to perceived severity but positively related to COVID-19?related barriers; in turn, higher perceived severity, benefits, COVID-19?related barriers, and self-efficacy and lower non?COVID-19?related barriers were related to more motivation to seek help. In the US sample, knowledge was negatively related to perceived severity, susceptibility, benefits, barriers (COVID-19? and non?COVID-19?related), and self-efficacy; in turn, higher self-efficacy, COVID-19?related barriers, and benefits were associated with more help-seeking motivation. The factors explained 53% and 45.3% of the variance of help-seeking motivation among the American and Chinese participants, respectively. Conclusions: This study revealed disparate pathways between knowledge, health beliefs, and the motivation for help-seeking among American and Chinese midlife women with respect to menopausal distress. Our findings show that knowledge may not directly influence help-seeking motivation. Instead, perceived benefits and self-efficacy consistently predicted help-seeking motivation. Interestingly, concern over COVID-19 infection was related to higher help-seeking motivation in both samples. Hence, our findings recommend the further development of telehealth services to (1) develop content beyond health education and symptom management that serves to enhance the perceived benefits of addressing women?s multidimensional menopausal health needs, (2) facilitate patient?care provider communication with a focus on self-efficacy and a propensity to engage in help-seeking behaviors, and (3) target women who have greater midlife health concerns in the postpandemic era. UR - https://publichealth.jmir.org/2024/1/e46538 UR - http://dx.doi.org/10.2196/46538 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277194 ID - info:doi/10.2196/46538 ER - TY - JOUR AU - Azzolini, Claudio AU - Premi, Elias AU - Donati, Simone AU - Falco, Andrea AU - Torreggiani, Aldo AU - Sicurello, Francesco AU - Baj, Andreina AU - Azzi, Lorenzo AU - Orro, Alessandro AU - Porta, Giovanni AU - Azzolini, Giovanna AU - Sorrentino, Marco AU - Melillo, Paolo AU - Testa, Francesco AU - Simonelli, Francesca AU - Giardina, Gianfranco AU - Paolucci, Umberto PY - 2024/1/26 TI - Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report JO - JMIR Med Inform SP - e42847 VL - 12 KW - telemedicine KW - ophthalmology KW - eHealth KW - informatics platform KW - health care professional KW - patient care KW - information technology KW - data warehouse N2 - Background: Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). Objective: We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. Methods: A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called ?modules? were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. Implementation (Results): Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. Conclusions: Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change. UR - https://medinform.jmir.org/2024/1/e42847 UR - http://dx.doi.org/10.2196/42847 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277199 ID - info:doi/10.2196/42847 ER - TY - JOUR AU - Walker, Tim AU - Buckingham, Ann Sarah AU - Poole, Ria AU - Elliott, Roland Lewis AU - Menneer, Tamaryn AU - Tu, Gengyang AU - Morrissey, Karyn PY - 2024/1/26 TI - Telephone-Based Training Intervention for Using Digital Communication Technologies for Social Housing Residents During the COVID-19 Pandemic: Mixed Methods Feasibility and Acceptability Evaluation JO - JMIR Form Res SP - e45506 VL - 8 KW - digital training KW - telephone-based KW - social housing KW - feasibility KW - acceptability KW - communication technologies KW - sociodigital inequalities KW - mobile phone N2 - Background: In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. Objective: This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging). Methods: Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority?s Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention. Results: Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size). Conclusions: Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies. UR - https://formative.jmir.org/2024/1/e45506 UR - http://dx.doi.org/10.2196/45506 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277209 ID - info:doi/10.2196/45506 ER - TY - JOUR AU - Sharma, Pravesh AU - Kamath, Celia AU - Brockman, A. Tabetha AU - Roche, Anne AU - Sinicrope, Pamela AU - Jiang, Ruoxiang AU - Decker, A. Paul AU - Pazdernik, Vanessa AU - Patten, Christi PY - 2024/1/24 TI - Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study JO - JMIR Form Res SP - e50572 VL - 8 KW - digital health KW - telemedicine KW - telehealth KW - video visits KW - appointments KW - SDoH, social determinants of health KW - social determinants KW - appointment KW - users KW - sociodemographic KW - prevention KW - discomfort KW - video communication KW - communication KW - willingness KW - mobile phone N2 - Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ?18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, ?Have you ever had a video appointment with a healthcare provider?? ?Yes? respondents were defined as ?users? (adapted to video appointments), and ?no? respondents were defined as ?persistent nonusers? of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients? decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients? negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a ?digital health coordinator? could be assigned to assist with various digital health solutions. UR - https://formative.jmir.org/2024/1/e50572 UR - http://dx.doi.org/10.2196/50572 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265855 ID - info:doi/10.2196/50572 ER - TY - JOUR AU - Qian, Lei AU - Sy, S. Lina AU - Hong, Vennis AU - Glenn, C. Sungching AU - Ryan, S. Denison AU - Nelson, C. Jennifer AU - Hambidge, J. Simon AU - Crane, Bradley AU - Zerbo, Ousseny AU - DeSilva, B. Malini AU - Glanz, M. Jason AU - Donahue, G. James AU - Liles, Elizabeth AU - Duffy, Jonathan AU - Xu, Stanley PY - 2024/1/23 TI - Impact of the COVID-19 Pandemic on Health Care Utilization in the Vaccine Safety Datalink: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e48159 VL - 10 KW - COVID-19 pandemic KW - health care utilization KW - telehealth KW - inpatient KW - emergency department KW - outpatient KW - vaccine safety KW - electronic health record KW - resource allocation KW - difference-in-difference KW - interrupted time series analysis N2 - Background: Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers for strategic planning, as well as to researchers when designing studies that use observational electronic health record data during the pandemic period. Objective: This study aimed to evaluate the changes in health care utilization across all care settings among a large, diverse, and insured population in the United States during the COVID-19 pandemic. Methods: We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages from January 1, 2017, to December 31, 2021. The visit rates per person-year were calculated monthly during the study period for 4 health care settings combined as well as by inpatient, emergency department (ED), outpatient, and telehealth settings, both among all members and members without COVID-19. Difference-in-difference analysis and interrupted time series analysis were performed to assess the changes in visit rates from the prepandemic period (January 2017 to February 2020) to the early pandemic period (April-December 2020) and the later pandemic period (July-December 2021), respectively. An exploratory analysis was also conducted to assess trends through June 2023 at one of the largest sites, Kaiser Permanente Southern California. Results: The study included more than 11 million members from 2017 to 2021. Compared with the prepandemic period, we found reductions in visit rates during the early pandemic period for all in-person care settings. During the later pandemic period, overall use reached 8.36 visits per person-year, exceeding the prepandemic level of 7.49 visits per person-year in 2019 (adjusted percent change 5.1%, 95% CI 0.6%-9.9%); inpatient and ED visits returned to prepandemic levels among all members, although they remained low at 0.095 and 0.241 visits per person-year, indicating a 7.5% and 8% decrease compared to pre-pandemic levels among members without COVID-19, respectively. Telehealth visits, which were approximately 42% of the volume of outpatient visits during the later pandemic period, were increased by 97.5% (95% CI 86.0%-109.7%) from 0.865 visits per person-year in 2019 to 2.35 visits per person-year in the later pandemic period. The trends in Kaiser Permanente Southern California were similar to those of the entire study population. Visit rates from January 2022 to June 2023 were stable and appeared to be a continuation of the use levels observed at the end of 2021. Conclusions: Telehealth services became a mainstay of the health care system during the late COVID-19 pandemic period. Inpatient and ED visits returned to prepandemic levels, although they remained low among members without evidence of COVID-19. Our findings provide valuable information for strategic resource allocation for postpandemic patient care and for designing observational studies involving the pandemic period. UR - https://publichealth.jmir.org/2024/1/e48159 UR - http://dx.doi.org/10.2196/48159 UR - http://www.ncbi.nlm.nih.gov/pubmed/38091476 ID - info:doi/10.2196/48159 ER - TY - JOUR AU - Khairat, Saif AU - John, Roshan AU - Pillai, Malvika AU - McDaniel, Philip AU - Edson, Barbara PY - 2024/1/19 TI - Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study JO - Online J Public Health Inform SP - e50962 VL - 16 KW - telehealth KW - telemedicine KW - tele-urgent care KW - virtual urgent care KW - nonemergency care KW - televisit KW - phone visit KW - video visit KW - urgent care KW - health services research KW - COVID-19 KW - health disparities KW - insurance status KW - cross-sectional study N2 - Background: Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients? choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. Objective: This study aimed to investigate patients? characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. Methods: We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Results: Of 1803 telemedicine visits, 1278 (70.9%) patients were women, 730 (40.5%) were aged 18 to 34 years, and 1423 (78.9%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Conclusions: Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation. UR - https://ojphi.jmir.org/2024/1/e50962 UR - http://dx.doi.org/10.2196/50962 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241073 ID - info:doi/10.2196/50962 ER - TY - JOUR AU - Waheed, Atif Muhammad AU - Al Mannai, Lolwa AU - Khudadad, Hanan AU - Alenbawi, Jamil AU - Mansaray, Aminata Mariama AU - Al Abdulla, Samya PY - 2024/1/18 TI - Assessment of Qatar?s Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study JO - JMIR Form Res SP - e42753 VL - 8 KW - COVID-19 KW - COVID Response Service KW - community call center KW - virtual consultations N2 - Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. Objective: This study aims to comprehensively examine the community call center?s operations and their significant role during the COVID-19 pandemic. Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19?related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls. Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises. UR - https://formative.jmir.org/2024/1/e42753 UR - http://dx.doi.org/10.2196/42753 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085918 ID - info:doi/10.2196/42753 ER - TY - JOUR AU - Wu, Man AU - Li, Chaoyang AU - Hu, Ting AU - Zhao, Xueyang AU - Qiao, Guiyuan AU - Gao, Xiaolian AU - Zhu, Xinhong AU - Yang, Fen PY - 2024/1/17 TI - Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e50787 VL - 12 KW - telecare KW - depression KW - anxiety KW - quality of life KW - older adults KW - meta-analysis N2 - Background: Depression is the most common psychiatric disorder among older adults. Despite the effectiveness of pharmacological and psychological therapies, many patients with late-life depression (LLD) are unable to access timely treatment. Telecare has been shown to be effective in addressing patients' psychosocial issues, while its effectiveness in serving patients with LLD remains unclear. Objective: This study aimed to evaluate the effectiveness of telecare in reducing depression and anxiety symptoms and improving quality of life (QoL) in patients with LLD. Methods: Databases including the Cochrane Library, Web of Science, PubMed, Embase, and EBSCO were searched for randomized controlled trials (RCTs) evaluating the effectiveness of telecare for LLD from database establishment to December 28, 2022. Results: A total of 12 RCTs involving 1663 participants were identified in this study. The meta-analysis showed that (1) telecare significantly reduced depressive symptoms in patients with LLD compared to those in usual care (UC; standardized mean difference [SMD]=?0.46, 95% CI ?0.53 to ?0.38; P<.001), with the best improvement observed within 3 months of intervention (SMD=?0.72, 95% CI ?1.16 to ?0.28; P<.001); (2) other scales appeared more effective than the Patient Health Questionnaire-9 for LLD in telecare interventions (SMD=?0.65, 95% CI ?0.96 to ?0.35; P<.001); (3) telecare was more effective than telephone-based interventions for remote monitoring of LLD (SMD=?1.13, 95% CI ?1.51 to ?0.76; P<.001); (4) the reduction of depressive symptoms was more pronounced in patients with LLD with chronic conditions (SMD=?0.67, 95% CI ?0.89 to ?0.44; P<.001); (5) telecare was more effective for LLD in Europe and the Americas than in other regions (SMD=?0.73, 95% CI ?0.99 to ?0.47; P<.001); (6) telecare significantly reduced anxiety symptoms in patients with LLD (SMD=?0.53, 95% CI ?0.73 to ?0.33; P=.02); and (7) there was no significant improvement in the psychological components of QoL in patients with LLD compared to those receiving UC (SMD=0.30, 95% CI 0.18-0.43; P=.80). Conclusions: Telecare is a promising modality of care for treatment, which can alleviate depression and anxiety symptoms in patients with LLD. Continued in-depth research into the effectiveness of telecare in treating depression could better identify where older patients would benefit from this intervention. UR - https://mhealth.jmir.org/2024/1/e50787 UR - http://dx.doi.org/10.2196/50787 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231546 ID - info:doi/10.2196/50787 ER - TY - JOUR AU - Burns, K. Sarah AU - Krishnamurti, Tamar AU - Doan, T. Tran AU - Hanmer, Janel AU - Hoberman, Alejandro AU - Kahn, M. Jeremy AU - Schweiberger, Kelsey AU - Ray, N. Kristin PY - 2024/1/16 TI - Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study JO - JMIR Pediatr Parent SP - e49170 VL - 7 KW - telemedicine KW - telehealth KW - acute care KW - acute KW - pediatrics KW - pediatric KW - family medicine KW - family-centered KW - child KW - children KW - parent KW - parents KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - expectation KW - expectations N2 - Background: Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). Objective: This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. Methods: We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children?s acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Results: Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). Conclusions: In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care?based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care. UR - https://pediatrics.jmir.org/2024/1/e49170 UR - http://dx.doi.org/10.2196/49170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38227360 ID - info:doi/10.2196/49170 ER - TY - JOUR AU - Geng, Shuang AU - He, Yuqin AU - Duan, Liezhen AU - Yang, Chen AU - Wu, Xusheng AU - Liang, Gemin AU - Niu, Ben PY - 2024/1/11 TI - The Association Between Linguistic Characteristics of Physicians? Communication and Their Economic Returns: Mixed Method Study JO - J Med Internet Res SP - e42850 VL - 26 KW - web-based health care KW - instrumental communication KW - affective communication KW - linguistic features KW - economic returns KW - linguistic inquiry and word count N2 - Background: Web-based health care has the potential to improve health care access and convenience for patients with limited mobility, but its success depends on active physician participation. The economic returns of internet-based health care initiatives are an important factor that can motivate physicians to continue their participation. Although several studies have examined the communication patterns and influences of web-based health consultations, the correlation between physicians? communication characteristics and their economic returns remains unexplored. Objective: This study aims to investigate how the linguistic features of 2 modes of physician-patient communication, instrumental and affective, determine the physician?s economic returns, measured by the honorarium their patients agree to pay per consultation. We also examined the moderating effects of communication media (web-based text messages and voice messages) and the compounding effects of different communication features on economic returns. Methods: We collected 40,563 web-based consultations from 528 physicians across 4 disease specialties on a large, web-based health care platform in China. Communication features were extracted using linguistic inquiry and word count, and we used multivariable linear regression and K-means clustering to analyze the data. Results: We found that the use of cognitive processing language (ie, words related to insight, causation, tentativeness, and certainty) in instrumental communication and positive emotion?related words in affective communication were positively associated with the economic returns of physicians. However, the extensive use of discrepancy-related words could generate adverse effects. We also found that the use of voice messages for service delivery magnified the effects of cognitive processing language but did not moderate the effects of affective processing language. The highest economic returns were associated with consultations in which the physicians used few expressions related to negative emotion; used more terms associated with positive emotions; and later, used instrumental communication language. Conclusions: Our study provides empirical evidence about the relationship between physicians? communication characteristics and their economic returns. It contributes to a better understanding of patient-physician interactions from a professional-client perspective and has practical implications for physicians and web-based health care platform executives. UR - https://www.jmir.org/2024/1/e42850 UR - http://dx.doi.org/10.2196/42850 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206657 ID - info:doi/10.2196/42850 ER - TY - JOUR AU - Buawangpong, Nida AU - Pinyopornpanish, Kanokporn AU - Pliannuom, Suphawita AU - Nantsupawat, Nopakoon AU - Wiwatkunupakarn, Nutchar AU - Angkurawaranon, Chaisiri AU - Jiraporncharoen, Wichuda PY - 2024/1/10 TI - Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study JO - JMIR Aging SP - e52031 VL - 7 KW - telemedicine KW - telehealth KW - chronic disease KW - multimorbidity KW - older adults KW - mobile phone N2 - Background: Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions. Objective: This study aims to explore the perceptions about telemedicine among older patients with multimorbidity. Methods: A qualitative study was conducted using semistructured interviews. The interview questions examined older adults? perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines. Results: In total, 29 patients with multimorbidity?21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years?were included. Overall, 4 themes and 7 subthemes emerged: theme 1?perceived benefit of telemedicine among older adults with multimorbidities, theme 2?appropriate use of telemedicine for multimorbid care, theme 3?telemedicine system catering to the needs of older patients, and theme 4?respect patients? decision to decline to use telemedicine. Conclusions: Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services. UR - https://aging.jmir.org/2024/1/e52031 UR - http://dx.doi.org/10.2196/52031 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198201 ID - info:doi/10.2196/52031 ER - TY - JOUR AU - Chang, Hao-Yun AU - Wu, Hui-Wen AU - Hung, Chi-Sheng AU - Chen, Ying-Hsien AU - Huang, Ching-Chang AU - Yang, Li-Tan AU - Hwang, Shin-Tsyr AU - Yu, Jiun-Yu AU - Lee, Jen-Kuang AU - Ho, Yi-Lwun PY - 2024/1/8 TI - Costs and Cardiovascular Benefits of a Fourth-Generation Synchronous Telehealth Program on Mortality and Cardiovascular Outcomes for Patients With Atrial Fibrillation: Retrospective Cohort Study JO - J Med Internet Res SP - e48748 VL - 26 KW - atrial fibrillation KW - cardiovascular death KW - fourth-generation synchronous program KW - ischemic stroke KW - telehealth N2 - Background: The prevalence of atrial fibrillation (AF) continues to increase in modern aging society. Patients with AF are at high risk for multiple adverse cardiovascular events, including heart failure, stroke, and mortality. Improved medical care is needed for patients with AF to enhance their quality of life and limit their medical resource utilization. With advances in the internet and technology, telehealth programs are now widely used in medical care. A fourth-generation telehealth program offers synchronous and continuous medical attention in response to physiological parameters measured at home. Although we have previously shown the benefits of this telehealth program for some patients with a high risk of cardiovascular disease, its benefits for patients with AF remains uncertain. Objective: This study aims to investigate the benefits of participating in a fourth-generation telehealth program for patients with AF in relation to cardiovascular outcomes. Methods: This was a retrospective cohort study. We retrospectively searched the medical records database of a tertiary medical center in Northern Taiwan between January 2007 and December 2017. We screened 5062 patients with cardiovascular disease and enrolled 537 patients with AF, of which 279 participated in the telehealth program and 258 did not. Bias was reduced using the inverse probability of treatment weighting adjustment based on the propensity score. Outcomes were collected and analyzed, including all-cause readmission, admission for heart failure, acute coronary syndrome, ischemic stroke, systemic embolism, bleeding events, all-cause mortality, and cardiovascular death within the follow-up period. Total medical expenses and medical costs in different departments were also compared. Subgroup analyses were conducted on ischemic stroke stratified by several subgroup variables. Results: The mean follow-up period was 3.0 (SD 1.7) years for the telehealth group and 3.4 (SD 1.9) years for the control group. After inverse probability of treatment weighting adjustment, the patients in the telehealth program had significantly fewer ischemic strokes (2.0 vs 4.5 events per 100 person-years; subdistribution hazard ratio [SHR] 0.45, 95% CI 0.22-0.92) and cardiovascular deaths (2.5 vs 5.9 events per 100 person-years; SHR 0.43, 95% CI 0.18-0.99) at the follow-up. The telehealth program particularly benefited patients comorbid with vascular disease (SHR 0.11, 95% CI 0.02-0.53 vs SHR 1.16, 95% CI 0.44-3.09; P=.01 for interaction). The total medical expenses during follow-up were similar in the telehealth and control groups. Conclusions: This study demonstrated the benefits of participating in the fourth-generation telehealth program for patients with AF by significantly reducing their ischemic stroke risk while spending the same amount on medical expenses. UR - https://www.jmir.org/2024/1/e48748 UR - http://dx.doi.org/10.2196/48748 UR - http://www.ncbi.nlm.nih.gov/pubmed/38190237 ID - info:doi/10.2196/48748 ER - TY - JOUR AU - He, Xianying AU - Cui, Fangfang AU - Lyu, Minzhao AU - Sun, Dongxu AU - Zhang, Xu AU - Shi, Jinming AU - Zhang, Yinglan AU - Jiang, Shuai AU - Zhao, Jie PY - 2024/1/5 TI - Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis JO - J Med Internet Res SP - e45020 VL - 26 KW - telemedicine KW - service statistics KW - efficiency KW - quality management N2 - Background: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. Objective: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. Methods: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. Results: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. Conclusions: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions. UR - https://www.jmir.org/2024/1/e45020 UR - http://dx.doi.org/10.2196/45020 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180795 ID - info:doi/10.2196/45020 ER - TY - JOUR AU - Weidener, Lukas AU - Fischer, Michael PY - 2024/1/5 TI - Artificial Intelligence in Medicine: Cross-Sectional Study Among Medical Students on Application, Education, and Ethical Aspects JO - JMIR Med Educ SP - e51247 VL - 10 KW - artificial intelligence KW - AI technology KW - medicine KW - medical education KW - medical curriculum KW - medical school KW - AI ethics KW - ethics N2 - Background: The use of artificial intelligence (AI) in medicine not only directly impacts the medical profession but is also increasingly associated with various potential ethical aspects. In addition, the expanding use of AI and AI-based applications such as ChatGPT demands a corresponding shift in medical education to adequately prepare future practitioners for the effective use of these tools and address the associated ethical challenges they present. Objective: This study aims to explore how medical students from Germany, Austria, and Switzerland perceive the use of AI in medicine and the teaching of AI and AI ethics in medical education in accordance with their use of AI-based chat applications, such as ChatGPT. Methods: This cross-sectional study, conducted from June 15 to July 15, 2023, surveyed medical students across Germany, Austria, and Switzerland using a web-based survey. This study aimed to assess students? perceptions of AI in medicine and the integration of AI and AI ethics into medical education. The survey, which included 53 items across 6 sections, was developed and pretested. Data analysis used descriptive statistics (median, mode, IQR, total number, and percentages) and either the chi-square or Mann-Whitney U tests, as appropriate. Results: Surveying 487 medical students across Germany, Austria, and Switzerland revealed limited formal education on AI or AI ethics within medical curricula, although 38.8% (189/487) had prior experience with AI-based chat applications, such as ChatGPT. Despite varied prior exposures, 71.7% (349/487) anticipated a positive impact of AI on medicine. There was widespread consensus (385/487, 74.9%) on the need for AI and AI ethics instruction in medical education, although the current offerings were deemed inadequate. Regarding the AI ethics education content, all proposed topics were rated as highly relevant. Conclusions: This study revealed a pronounced discrepancy between the use of AI-based (chat) applications, such as ChatGPT, among medical students in Germany, Austria, and Switzerland and the teaching of AI in medical education. To adequately prepare future medical professionals, there is an urgent need to integrate the teaching of AI and AI ethics into the medical curricula. UR - https://mededu.jmir.org/2024/1/e51247 UR - http://dx.doi.org/10.2196/51247 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180787 ID - info:doi/10.2196/51247 ER - TY - JOUR AU - Shao, Huige AU - Liu, Chaoyuan AU - Tang, Li AU - Wang, Bian AU - Xie, Hebin AU - Zhang, Yiyu PY - 2023/12/28 TI - Factors Influencing the Behavioral Intentions and Use Behaviors of Telemedicine in Patients With Diabetes: Web-Based Survey Study JO - JMIR Hum Factors SP - e46624 VL - 10 KW - diabetes mellitus KW - telemedicine KW - survey KW - China KW - behavioral intention KW - acceptance KW - technology KW - technology use KW - diabetic KW - outpatient KW - eHealth KW - remote care KW - older adult patients KW - low income KW - diabetes KW - type 1 KW - type 2 N2 - Background: Telemedicine has great potential for diabetes management. The COVID-19 pandemic has boosted the development of telemedicine. However, the factors influencing the behavioral intentions to use and use behaviors of telemedicine in patients with diabetes in China are not clear. Objective: We aimed to understand the determinants of behavioral intention to use telemedicine based on an extended Unified Theory of Acceptance and Use of Technology model and to identify demographic factors associated with telemedicine use in patients with diabetes in China. Methods: Patients with diabetes who are aged ?18 years were surveyed from February 1 to February 7, 2023. We distributed the survey link in 3 WeChat groups including a total of 988 patients with diabetes from the outpatient department or patients discharged from Changsha Central Hospital. Structural equation modeling was used to understand the determinants of behavioral intention. A multivariate logistic regression analysis was used to identify the demographic factors associated with telemedicine use. Results: In total, 514 questionnaires were collected. Of the respondents, 186 (36.2%) were diagnosed with COVID-19. The measurement model showed acceptable reliability, convergent validity, discriminant validity, and data fit indices. The model explained 63.8% of the variance in behavioral intention. Social influence, performance expectancy, and facilitating conditions positively influenced behavioral intention (?=.463, P<.001; ?=.153, P=.02; and ?=.257, P=.004, respectively). Perceived susceptibility, perceived severity, and effort expectancy had no significant impact on behavioral intention (all P>.05). The overall use of telemedicine was 20.6% (104/514). After adjusting for the behavioral intention score, the multivariate regression analysis showed that age, education, and family income were associated with telemedicine use. Telemedicine use was higher in the 40 to 59 years and 18 to 39 years age groups than in the ?60 years age group (odds ratio [OR] 4.35, 95% CI 1.84-10.29, P=.001; OR 9.20, 95% CI 3.40-24.88, P<.001, respectively). Telemedicine use was higher in the senior high school and the university and more groups than in junior high school education and less group (OR 2.45, 95% CI 1.05-5.73, P=.04; OR 2.63, 95% CI 1.11-6.23, P=.03, respectively). Patients with a higher family income used telemedicine more often than the patients who had an annual family income ?¥10,000 (CNY ¥1=US $0.1398; ¥10,000-¥50,000 group: OR 3.90, 95% CI 1.21-12.51, P=.02; ¥50,000-¥100,000 group: OR 3.91, 95% CI 1.19-12.79, P=.02; >¥100,000 group: OR 4.63, 95% CI 1.41-15.27, P=.01). Conclusions: Social influence, performance expectancy, and facilitating conditions positively affected the behavioral intention of patients with diabetes to use telemedicine. Young patients, highly educated patients, and patients with high family income use telemedicine more often. Promoting behavioral intention and paying special attention to the needs of older adult patients, patients with low income, and patients with low levels of education are needed to encourage telemedicine use. UR - https://humanfactors.jmir.org/2023/1/e46624 UR - http://dx.doi.org/10.2196/46624 UR - http://www.ncbi.nlm.nih.gov/pubmed/38153781 ID - info:doi/10.2196/46624 ER - TY - JOUR AU - Lu, Jiao AU - Bai, Jingyan AU - Zhao, Heng AU - Zhang, Xiaoxiao PY - 2023/12/26 TI - The Effect of ?Offline-to-Online? Trust Transfer on the Utilization of Online Medical Consultation Among Chinese Rural Residents: Experimental Study JO - J Med Internet Res SP - e43430 VL - 25 KW - "offline-to-online" trust transfer KW - online medical consultation KW - health care services utilization KW - Chinese rural residents KW - direct and family spillover effects N2 - Background: Online medical consultation can serve as a valuable means for rural residents to access high-quality health care resources, thereby mitigating the geographic and economic disadvantages prevalent in rural areas. Nevertheless, due to lower cognitive abilities, rural residents often face challenges in trusting and making effective use of online medical consultations. More likely, adopting a bounded rational decision-making model that facilitates the ?offline-to-online? trust transfer could prove to be a potentially effective approach. This strategy aims to encourage less technologically experienced rural residents to trust and make use of online medical consultations. Objective: This study aims to characterize the status of ?offline-to-online? trust transfer among rural residents in the context of internet health care, and analyze its direct impact on facilitating the utilization of online medical consultation. Additionally, we investigate the family spillover effect of ?offline-to-online? trust transfer in promoting the use of online medical consultation among rural family members, considering its distributional effect across various education levels of the population. Methods: A multistage stratified random sampling method was used to survey participants in rural areas of China from July to September 2021, encompassing a total of 2597 rural residents from 960 rural households. Propensity score values were estimated using logit regression, and the propensity score matching method, using the K-nearest neighbor matching, radius matching, and kernel matching methods, was applied to create matched treatment and control samples of rural residents based on their experience of ?offline-to-online? trust transfer. Subsequently, we calculated average treatment effect scores to compare the differences in utilizing online medical consultation between the treatment and control rural samples. Results: As many as 551/960 (57.4%) rural residents experienced an ?offline-to-online? trust transfer, with a higher likelihood observed in the older population with lower levels of education and higher satisfaction with local health care services. Furthermore, rural residents who underwent ?offline-to-online? trust transfer were 37%-40% more likely to utilize online medical consultation compared with those who did not experience this trust transfer. Additionally, family members of householders who underwent ?offline-to-online? trust transfer were 25%-28% more likely to utilize online medical consultation than those whose householders did not experience this trust transfer. Notably, when compared with populations with high-level education, the ?offline-to-online? trust transfer had more significant direct and spillover effects on the utilization of online medical consultation services among rural residents with low-level education. Conclusions: To enhance the ?offline-to-online? trust transfer among rural residents and its facilitation in their utilization of online medical consultation, as well as other mobile health (mHealth) and ubiquitous health (uHealth) services, we recommend that online health care providers adopt a ?patient-oriented? service model. This approach aims to elevate rural residents? satisfaction with local health care services and harness the trust-building functions inherent in physician-patient relationships and among family members. UR - https://www.jmir.org/2023/1/e43430 UR - http://dx.doi.org/10.2196/43430 UR - http://www.ncbi.nlm.nih.gov/pubmed/38147370 ID - info:doi/10.2196/43430 ER - TY - JOUR AU - Benmessaoud, Camila AU - Pfisterer, J. Kaylen AU - De Leon, Anjelica AU - Saragadam, Ashish AU - El-Dassouki, Noor AU - Young, M. Karen G. AU - Lohani, Raima AU - Xiong, Ting AU - Pham, Quynh PY - 2023/12/25 TI - Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study JO - JMIR Hum Factors SP - e45035 VL - 10 KW - digital therapeutics KW - disease management KW - heart failure KW - informal caregivers KW - mHealth KW - mobile health KW - shared care KW - telemedicine N2 - Background: The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care ?Caretown for Medly,? which empowers ICs to concurrently expand patients? self-care abilities while acknowledging ICs? eagerness to provide greater support. Objective: We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly. Methods: We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint?s ability to quickly ?solve big problems and test new ideas,? which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the ?KTA Sprint.? Results: We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care?s synergistic benefits. Features were designed for customizability to suit the patient?s condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care. Conclusions: These disease-invariant features were designed to address ICs? needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads. UR - https://humanfactors.jmir.org/2023/1/e45035 UR - http://dx.doi.org/10.2196/45035 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145480 ID - info:doi/10.2196/45035 ER - TY - JOUR AU - Brown, C. Riley C. AU - Keating, E. Shelley AU - Owen, J. Patrick AU - Jansons, S. Paul AU - McVicar, Jenna AU - Askew, D. Christopher AU - Clanchy, M. Kelly AU - Maddison, Ralph AU - Maiorana, Andrew AU - Robinson, M. Suzanne AU - Mundell, L. Niamh PY - 2023/12/21 TI - Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study JO - J Med Internet Res SP - e46370 VL - 25 KW - telehealth KW - coronavirus KW - telemedicine KW - eHealth KW - rehabilitation KW - qualitative study KW - exercise KW - exercise physiology KW - clinician KW - engagement KW - interview KW - tool KW - implementation KW - effectiveness N2 - Background: The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. Objective: This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). Methods: Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. Results: A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the ?relational space? are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. Conclusions: Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted. UR - https://www.jmir.org/2023/1/e46370 UR - http://dx.doi.org/10.2196/46370 UR - http://www.ncbi.nlm.nih.gov/pubmed/38127430 ID - info:doi/10.2196/46370 ER - TY - JOUR AU - Yamashita, Masashi AU - Kamiya, Kentaro AU - Hamazaki, Nobuaki AU - Uchida, Shota AU - Noda, Takumi AU - Maekawa, Emi AU - Ako, Junya PY - 2023/12/20 TI - Effects of Acute Phase Intensive Physical Activity (ACTIVE-PA) Monitoring and Education for Cardiac Patients: Pilot Study of a Randomized Controlled Trial JO - J Med Internet Res SP - e42235 VL - 25 KW - physical activity KW - monitoring KW - information and communication technology KW - cardiovascular disease KW - cardiovascular KW - cardiology KW - exercise KW - RCT KW - randomized KW - cardiac rehabilitation KW - fitness KW - accelerometer KW - physiotherapy KW - hospitalized KW - hospitalization KW - in-patient N2 - Background: Although physical activity (PA) decreases dramatically during hospitalization, an effective intervention method has not yet been established for this issue. We recently developed a multiperson PA monitoring system using information and communication technology (ICT) that can provide appropriate management and feedback about PA at the bedside or during rehabilitation. This ICT-based PA monitoring system can store accelerometer data on a tablet device within a few seconds and automatically display a graphical representation of activity trends during hospitalization. Objective: This randomized pilot study aims to estimate the feasibility and effect size of an educational PA intervention using our ICT monitoring system for in-hospital patients undergoing cardiac rehabilitation. Methods: A total of 41 patients (median age 70 years; 24 men) undergoing inpatient cardiac rehabilitation were randomly assigned to 2 groups as follows: wearing an accelerometer only (control) and using both an accelerometer and an ICT-based PA monitoring system. Patients assigned to the ICT group were instructed to gradually increase their step counts according to their conditions. Adherence to wearing the accelerometer was defined as having enough wear records for at least 2 days to allow for adequate analysis during the lending period. An analysis of covariance was performed to compare the change in average step count during hospitalization as a primary outcome and the 6-minute walking distance at discharge. Results: The median duration of wearing the accelerometer was 4 days in the ICT group and 6 days in the control group. Adherence was 100% (n=22) in the ICT group but 83% (n=20) in the control group. The ICT group was more active (mean difference=1370 steps, 95% CI 437-2303) and had longer 6-minute walking distances (mean difference=81.6 m, 95% CI 18.1-145.2) than the control group. Conclusions: Through this study, the possibility of introducing a multiperson PA monitoring system in a hospital and promoting PA during hospitalization was demonstrated. These findings support the rationale and feasibility of a future clinical trial to test the efficacy of this educational intervention in improving the PA and physical function of in-hospital patients. Trial Registration: University Hospital Medical Information Network UMIN000043312; http://tinyurl.com/m2bw8vkz UR - https://www.jmir.org/2023/1/e42235 UR - http://dx.doi.org/10.2196/42235 UR - http://www.ncbi.nlm.nih.gov/pubmed/38117552 ID - info:doi/10.2196/42235 ER - TY - JOUR AU - Louissaint, Jeremy AU - Gibbs, Jeffrey AU - Shenoy, Abhishek AU - Cohen-Mekelburg, Shirley AU - Lok, Anna AU - Tapper, Elliot PY - 2023/12/19 TI - Patient Portal Use and Risk of Readmissions in Decompensated Cirrhosis: Retrospective Study JO - JMIR Form Res SP - e47080 VL - 7 KW - cirrhosis KW - patient portal KW - readmissions KW - telehealth KW - telemedicine N2 - Background: Patient portals are a common electronic medical record tool that allow for the asynchronous exchange of health information between patients and their health care teams. Patients can leverage patient portals to perform tasks such as viewing test results, reviewing clinical notes, and messaging their health care team. The impact of patient portal use on clinical outcomes in cirrhosis is unknown. Objective: In this study, we evaluated the relationship between patient portal use patterns and readmissions in cirrhosis. Methods: We identified 131 patients with decompensated cirrhosis with an index cirrhosis-related admission between May 1, 2018, and May 1, 2019. We then examined patient portal enrollment and use data during the 6-month period preceding the study period. Portal functions evaluated included sending a message, reading a message, and reading a test result. Use was categorized as active (sending a message) and passive (reading a message or test result) and was further stratified as no, moderate, or frequent use based on the frequency of portal function use compared to the mean. The primary outcomes were 90-day and overall readmissions, adjusted for age, model for end-stage liver disease?sodium, alcohol-related cirrhosis etiology, ascites, and hepatic encephalopathy. Portal functions assessed included sending a message, reading a message, and reading a result; the total number of times a portal function was performed was divided by the number of months the patient was enrolled in the patient portal during the 6-month period. Results: The study population was 50.4% (66/131) female, with a mean age of 58 years. Enrollment in the patient portal was 63.4% (83/131), and there was no significant difference in enrollment based on clinical or demographic characteristics. For the entire cohort, 14.5% (19/131) and 22.1% (29/131) of patients were moderate and frequent active users, respectively. Of those enrolled in the patient portal, 97.6% (81/83) of patients were moderate or frequent passive users for both reading a message and reading a test result. Moderate active users had less 90-day readmissions (odds ratio 0.77, 95% CI 0.60-1.00) and overall readmissions (subdistribution hazard ratio 0.42, 95% CI 0.21-0.84), compared to nonactive users. There was no relationship between readmissions and passive use. Conclusions: Passive use of the patient portal is very high but is not associated with the risk of readmissions in people with decompensated cirrhosis. However, moderately active use of the patient portal is associated with a reduced risk of readmissions. Further work is needed to identify possible confounders and refine key use behaviors that may be protective with regard to the risk of readmission in this population. UR - https://formative.jmir.org/2023/1/e47080 UR - http://dx.doi.org/10.2196/47080 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113099 ID - info:doi/10.2196/47080 ER - TY - JOUR AU - Fothergill, Lauren AU - Holland, Carol AU - Latham, Yvonne AU - Hayes, Niall PY - 2023/12/14 TI - Understanding the Value of a Proactive Telecare System in Supporting Older Adults? Independence at Home: Qualitative Interview Study Among Key Interest Groups JO - J Med Internet Res SP - e47997 VL - 25 KW - older adults KW - telecare KW - independent living KW - health and well-being N2 - Background: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults? health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals? needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare. Objective: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are. Methods: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis. Results: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service. Conclusions: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources. UR - https://www.jmir.org/2023/1/e47997 UR - http://dx.doi.org/10.2196/47997 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096023 ID - info:doi/10.2196/47997 ER - TY - JOUR AU - Misra, Satish AU - Niazi, Karen AU - Swayampakala, Kamala AU - Blackmon, Amanda AU - Lang, Melissa AU - Davenport, Elizabeth AU - Saxonhouse, Sherry AU - Fedor, John AU - Powell, Brian AU - Thompson, Joseph AU - Holshouser, John AU - Mehta, Rohit PY - 2023/12/14 TI - Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study JO - JMIR Cardio SP - e49345 VL - 7 KW - atrial fibrillation KW - behavior modification KW - cardiac rehabilitation KW - catheter ablation KW - exercise KW - remote exercise supervision KW - weight loss N2 - Background: Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. Objective: This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. Methods: A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. Results: The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [?75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. Conclusions: An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort. UR - https://cardio.jmir.org/2023/1/e49345 UR - http://dx.doi.org/10.2196/49345 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096021 ID - info:doi/10.2196/49345 ER - TY - JOUR AU - Turvey, Carolyn AU - Fuhrmeister, Lindsey AU - Klein, Dawn AU - McCoy, Kimberly AU - Moeckli, Jane AU - Stewart Steffensmeier, R. Kenda AU - Suiter, Natalie AU - Van Tiem, Jen PY - 2023/12/8 TI - Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e51277 VL - 7 KW - depression KW - text messaging KW - medication adherence KW - medication KW - medications KW - adherence KW - antidepressant KW - antidepressants KW - depressive KW - text message KW - text messages KW - messaging KW - SMS KW - veteran KW - veterans KW - military KW - randomized controlled trial KW - RCT KW - controlled trials KW - mental health KW - psychiatry KW - mobile phone N2 - Background: There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. Objective: This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. Methods: This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. Results: The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). Conclusions: A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. Trial Registration: ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849 UR - https://formative.jmir.org/2023/1/e51277 UR - http://dx.doi.org/10.2196/51277 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064267 ID - info:doi/10.2196/51277 ER - TY - JOUR AU - Maltby, Steven AU - Garcia-Esperon, Carlos AU - Jackson, Kate AU - Butcher, Ken AU - Evans, W. James AU - O'Brien, William AU - Dixon, Courtney AU - Russell, Skye AU - Wilson, Natalie AU - Kluge, G. Murielle AU - Ryan, Annika AU - Paul, L. Christine AU - Spratt, J. Neil AU - Levi, R. Christopher AU - Walker, Rohan Frederick PY - 2023/12/7 TI - TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study JO - JMIR Serious Games SP - e43416 VL - 11 KW - virtual reality KW - technology KW - medical education KW - telehealth KW - stroke management KW - stroke workflow N2 - Background: Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. Objective: We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. Methods: The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. Results: TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site). Conclusions: TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways. UR - https://games.jmir.org/2023/1/e43416 UR - http://dx.doi.org/10.2196/43416 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060297 ID - info:doi/10.2196/43416 ER - TY - JOUR AU - Seinsche, Julia AU - de Bruin, D. Eling AU - Saibene, Enrico AU - Rizzo, Francesco AU - Carpinella, Ilaria AU - Ferrarin, Maurizio AU - Moza, Sotiria AU - Ritter, Tanja AU - Giannouli, Eleftheria PY - 2023/12/7 TI - A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study JO - JMIR Hum Factors SP - e48845 VL - 10 KW - older adults KW - motor-cognitive intervention KW - exergame KW - telerehabilitation KW - information and communications technologies KW - user-centered design KW - usability KW - technology acceptance N2 - Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). Objective: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. Methods: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants? perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire?3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. Results: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system?s usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ?=0.35, P=.02 to ?=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ?=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ?=?0.35; P=.02) and the UTAUT total score (?=?0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. Conclusions: The study?s findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system?s feasibility and effectiveness. UR - https://humanfactors.jmir.org/2023/1/e48845 UR - http://dx.doi.org/10.2196/48845 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060283 ID - info:doi/10.2196/48845 ER - TY - JOUR AU - Praha, Nattaya AU - Sriyuktasuth, Aurawamon AU - Puwarawuttipanit, Wimolrat AU - Chuengsaman, Piyatida AU - Kusakunniran, Worapan PY - 2023/12/5 TI - Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study JO - J Med Internet Res SP - e48623 VL - 25 KW - acceptance KW - cross-sectional study KW - health system and access KW - mHealth KW - mobile health KW - peritoneal dialysis KW - telehealth N2 - Background: Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further. Objective: This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD. Methods: This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses. Results: A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (?=.221; P=.002), higher perceived usefulness (?=.414; P<.001), unemployment (?=?.155; P=.03), and positive illness perception (?=?.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (?=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03). Conclusions: This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD. UR - https://www.jmir.org/2023/1/e48623 UR - http://dx.doi.org/10.2196/48623 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051557 ID - info:doi/10.2196/48623 ER - TY - JOUR AU - Khavandi, Sarah AU - Zaghloul, Fatema AU - Higham, Aisling AU - Lim, Ernest AU - de Pennington, Nick AU - Celi, Anthony Leo PY - 2023/12/5 TI - Investigating the Impact of Automation on the Health Care Workforce Through Autonomous Telemedicine in the Cataract Pathway: Protocol for a Multicenter Study JO - JMIR Res Protoc SP - e49374 VL - 12 KW - artificial intelligence KW - autonomous telemedicine KW - clinician burnout KW - clinician wellbeing KW - conversational agent KW - digital health KW - health communication KW - health information technology KW - health services KW - healthcare KW - medical informatics KW - socio-technical system approach KW - systems approach KW - technology acceptability N2 - Background: While digital health innovations are increasingly being adopted by health care organizations, implementation is often carried out without considering the impacts on frontline staff who will be using the technology and who will be affected by its introduction. The enthusiasm surrounding the use of artificial intelligence (AI)?enabled digital solutions in health care is tempered by uncertainty around how it will change the working lives and practices of health care professionals. Digital enablement can be viewed as facilitating enhanced effectiveness and efficiency by improving services and automating cognitive labor, yet the implementation of such AI technology comes with challenges related to changes in work practices brought by automation. This research explores staff experiences before and after care pathway automation with an autonomous clinical conversational assistant, Dora (Ufonia Ltd), that is able to automate routine clinical conversations. Objective: The primary objective is to examine the impact of AI-enabled automation on clinicians, allied health professionals, and administrators who provide or facilitate health care to patients in high-volume, low-complexity care pathways. In the process of transforming care pathways through automation of routine tasks, staff will increasingly ?work at the top of their license.? The impact of this fundamental change on the professional identity, well-being, and work practices of the individual is poorly understood at present. Methods: We will adopt a multiple case study approach, combining qualitative and quantitative data collection methods, over 2 distinct phases, namely phase A (preimplementation) and phase B (postimplementation). Results: The analysis is expected to reveal the interrelationship between Dora and those affected by its introduction. This will reveal how tasks and responsibilities have changed or shifted, current tensions and contradictions, ways of working, and challenges, benefits, and opportunities as perceived by those on the frontlines of the health care system. The findings will enable a better understanding of the resistance or susceptibility of different stakeholders within the health care workforce and encourage managerial awareness of differing needs, demands, and uncertainties. Conclusions: The implementation of AI in the health care sector, as well as the body of research on this topic, remain in their infancy. The project?s key contribution will be to understand the impact of AI-enabled automation on the health care workforce and their work practices. International Registered Report Identifier (IRRID): PRR1-10.2196/49374 UR - https://www.researchprotocols.org/2023/1/e49374 UR - http://dx.doi.org/10.2196/49374 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051569 ID - info:doi/10.2196/49374 ER - TY - JOUR AU - Xiang, Wu AU - Wang, Jun-Yu AU - Ji, Bing-jin AU - Li, Li-Jun AU - Xiang, Han PY - 2023/12/4 TI - Effectiveness of Different Telerehabilitation Strategies on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e40735 VL - 25 KW - telerehabilitation KW - telemedicine KW - knee osteoarthritis KW - pain KW - physical function KW - systematic review KW - meta-analysis N2 - Background: Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also brings a serious economic burden to society. However, it is difficult for patients with knee OA to access rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies for the improvement of knee OA, but the effect of different telerehabilitation strategies on knee OA is not clear. Objective: The aim of this systematic review and meta-analysis was to identify telerehabilitation strategies attributing to the improvement of pain and physical function outcomes in patients with knee OA. Methods: We reviewed and analyzed telerehabilitation strategies from randomized controlled trials (RCTs) comparing telerehabilitation with conventional treatment or usual care. For each strategy, we examined whether RCTs that applied the telerehabilitation strategy resulted in a significant improvement in pain or physical function compared with conventional treatment or usual care. Results: We included 6 RCTs (n=734) incorporating 8 different telerehabilitation strategies. The duration of the interventions ranged from 1 to 48 weeks, and sample sizes ranged from 20 to 350 patients. The results showed that RCTs that provided telerehabilitation were found to be more effective than conventional treatments for improving pain (P=.003; standardized mean difference [SMD] ?0.21, 95% CI ?0.35 to ?0.07), but not physical function (P=.24; SMD ?0.09, 95% CI ?0.25 to 0.06). Furthermore, this systematic review and meta-analysis indicated that there is no significant correlation between different telerehabilitation strategies and the pain and physical function of patients with knee OA. Conclusions: This systematic review and meta-analysis showed that telerehabilitation programs could relieve pain but not improve physical function for patients with knee OA. These results indicated that telerehabilitation is beneficial for the implementation of home rehabilitation exercises for patients with knee OA, thereby reducing the economic burden of health. However, there were limitations in terms of the number of search results and the number of studies that were eligible for this review and meta-analysis. Therefore, the results need to be interpreted with caution, and more high-quality studies with large samples are needed to focus on the long-term outcomes of telerehabilitation for patients with knee OA to address this limitation. UR - https://www.jmir.org/2023/1/e40735 UR - http://dx.doi.org/10.2196/40735 UR - http://www.ncbi.nlm.nih.gov/pubmed/37982411 ID - info:doi/10.2196/40735 ER - TY - JOUR AU - Santamaria, Amparo AU - Antón Maldonado, Cristina AU - Sánchez-Quiñones, Beatriz AU - Ibarra Vega, Nataly AU - Ayo González, Maikel AU - Gonzalez Cabezas, Pedro AU - Carrasco Moreno, Rafael PY - 2023/12/4 TI - Implementing Telemedicine in Clinical Practice in the First Digital Hematology Unit: Feasibility Study JO - JMIR Form Res SP - e48987 VL - 7 KW - telemedicine KW - digital unit KW - hybrid hematology department KW - hematology KW - hybrid KW - implementation KW - telehealth KW - monitor KW - monitoring KW - remote care KW - virtual care KW - hematological KW - hematologist KW - hematologists KW - service KW - services KW - delivery KW - holistic KW - digital health intervention KW - digital transformation N2 - Background: Currently, there are no telemedicine models that fully integrate all areas of hematology into daily practice. Objective: The objectives of this feasibility study were to assess the practicality of implementing telemedicine into our clinical practice in the first Digital Hematology Unit and propose an innovative integrative design for clinical practice. Methods: We designed the Digital Hematology Unit, which is a specific physical space dedicated to carrying out telemedicine and monitoring patients in a holistic way. Also, a satisfaction questionnaire was performed and health care indicators were measured. Results: In 2021, there were 1331 first visits and 7534 follow-up visits. Of the first visits, 12.2% (n=163) were face-to-face and 87.8% (n=1168) were telematic. For follow-up visits, 29.9% (n=2251) were face-to-face and 70.1% (n=5283) were telematic. The health care management indicators showed that we had a waiting time of less than 4 days and took less than 4 hours to answer interconsultations among specialists. Moreover, patients reported a high level of satisfaction with the services provided. Conclusions: Our Digital Hematology Unit, as a case of success, serves as an example of how innovative digital solutions can contribute to the quality of care and excellence in health care achieved through a digital transformation process led by hematologists. UR - https://formative.jmir.org/2023/1/e48987 UR - http://dx.doi.org/10.2196/48987 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048143 ID - info:doi/10.2196/48987 ER - TY - JOUR AU - Jeong, Hyunwoo AU - Choi, Yonsu AU - Kim, Heejung PY - 2023/11/28 TI - Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review JO - Interact J Med Res SP - e43572 VL - 12 KW - nonface-to-face visitation KW - visit restriction KW - infection control KW - patient KW - family N2 - Background: In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions. Objective: The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages. Methods: A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine. Results: Overall, patients? families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations. Conclusions: Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice. UR - https://www.i-jmr.org/2023/1/e43572 UR - http://dx.doi.org/10.2196/43572 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015595 ID - info:doi/10.2196/43572 ER - TY - JOUR AU - Braund, Heather AU - Dalgarno, Nancy AU - Chan-Nguyen, Sophy AU - Digby, Geneviève AU - Haji, Faizal AU - O'Riordan, Anne AU - Appireddy, Ramana PY - 2023/11/23 TI - Exploring Patient Advisors? Perceptions of Virtual Care Across Canada: Qualitative Phenomenological Study JO - J Med Internet Res SP - e45215 VL - 25 KW - virtual care KW - patient-oriented research KW - patient advisor KW - remote care KW - telehealth KW - telemedicine KW - phenomenology KW - phenomenological KW - perception KW - qualitative N2 - Background: While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care. Objective: This study aimed to understand patient advisors? perceptions related to virtual care and potential impacts on health care quality. Methods: We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen?s University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants). Results: Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery. Conclusions: Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care. UR - https://www.jmir.org/2023/1/e45215 UR - http://dx.doi.org/10.2196/45215 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995127 ID - info:doi/10.2196/45215 ER - TY - JOUR AU - Dukhanin, Vadim AU - Wolff, L. Jennifer AU - Salmi, Liz AU - Harcourt, Kendall AU - Wachenheim, Deborah AU - Byock, Ira AU - Gonzales, J. Matthew AU - Niehus, Doug AU - Parshley, Marianne AU - Reay, Caroline AU - Epstein, Sara AU - Mohile, Supriya AU - Farrell, W. Timothy AU - Supiano, A. Mark AU - Jajodia, Anushka AU - DesRoches, M. Catherine AU - PY - 2023/11/22 TI - Co-Designing an Initiative to Increase Shared Access to Older Adults? Patient Portals: Stakeholder Engagement JO - J Med Internet Res SP - e46146 VL - 25 KW - patient portal KW - electronic health record KW - care partners KW - stakeholder engagement KW - patient engagement KW - human-centered design KW - mobile phone KW - design KW - older adults KW - digital platform KW - awareness KW - development KW - engagement KW - stakeholder KW - education N2 - Background: The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends??care partners??to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. Objective: We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. Methods: In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders? inputs. Results: Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan ?People remember less than half of what their doctors say,? which was selected from 9 candidate alternatives as resonating best with the full range of the initiative?s stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. Conclusions: Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners. UR - https://www.jmir.org/2023/1/e46146 UR - http://dx.doi.org/10.2196/46146 UR - http://www.ncbi.nlm.nih.gov/pubmed/37991827 ID - info:doi/10.2196/46146 ER - TY - JOUR AU - Hu, Qiuyue AU - Hu, Wei AU - Pan, Lingling AU - Han, Wenjuan AU - Zheng, Yue PY - 2023/11/9 TI - Association Between Concerns About COVID-19 Infection and Blood Donation Intention: Cross-Sectional Survey Study Through a Mobile Communication Platform JO - J Med Internet Res SP - e46588 VL - 25 KW - COVID-19 KW - blood donation KW - worry KW - concern KW - intention KW - blood KW - blood transfusion KW - cognition KW - blood donor KW - communication KW - questionnaire KW - behavior control N2 - Background: The ongoing COVID-19 pandemic has had an unprecedented impact on blood transfusion and collection. At the beginning of the pandemic, most blood transfusion services had a tough challenge in maintaining an optimal blood inventory. Objective: This study aims to understand the public's psychological cognition and intention toward blood donation as well as the factors influencing their worries. We aimed to find a solution for increasing blood donations and provide a scientific reference for policy formulation regarding blood donation during the COVID-19 pandemic and in the future. Methods: A random survey with a 14-item scale on worries related to blood donation was conducted from December 31, 2022, to January 3, 2023, among residents aged 18-60 years in Zhejiang province via SMS text messaging. The results of 8 worry items in this study were compared with the survey results of March 2022, during which COVID-19 was not considered as an epidemic in Zhejiang province. Chi-square test and logistic regression analysis were performed to analyze the factors affecting respondents? blood donation intention and concerns. The degree of worry about blood donation was assigned from 1 (completely disagree) to 5 (completely agree), and 2-sided t tests were performed to analyze the differences in blood donation intention and worries about blood donation. Results: In total, 1254 valid questionnaire responses were obtained. Males accounted for 62.36% (782/1254) of the sample, 78.39% (983/1254) were 18-45 years old, 60.61% (760/1254) had a university education, and 69.06% (866/1254) had no previous blood donation experience. Approximately 36.52% (458/1254) of the public clearly expressed that they had blood donation worries regarding COVID-19. The main concerns of the respondents were temporary physical weakness caused by blood donation, their own physical conditions not meeting the requirements of blood donation, inconvenient location and working hours for blood donation, and family (or friends) worrying about blood donation. Compared with the results in 2022, the results in 2023 regarding the harmful effects of blood donation on health, temporary physical weakness, infection in donated blood, and family (friends) worrying increased significantly (P<.001). The factors influencing blood donation worries regarding COVID-19 were COVID-19 infection status, adverse reactions to the donated blood, family (or friends) worrying, and unsatisfactory blood donation experience. The factors influencing blood donation intention were gender, age, previous blood donation times, blood donation worries regarding COVID-19, harmful effects of blood donation on health, and blood donation anxiety. Conclusions: Blood transfusion services should make full use of the recovery phase of COVID-19 infection as an important time point, publicize the blood donation process and operation standardization, reduce the public's concerns about blood donation, correct negative evaluations, and increase perceived behavioral control and subjective norms. UR - https://www.jmir.org/2023/1/e46588 UR - http://dx.doi.org/10.2196/46588 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943597 ID - info:doi/10.2196/46588 ER - TY - JOUR AU - O'Neill, Linda AU - Brennan, Louise AU - Sheill, Grainne AU - Connolly, Deirdre AU - Guinan, Emer AU - Hussey, Juliette PY - 2023/11/9 TI - Moving Forward With Telehealth in Cancer Rehabilitation: Patient Perspectives From a Mixed Methods Study JO - JMIR Cancer SP - e46077 VL - 9 KW - telehealth KW - telemedicine KW - cancer rehabilitation KW - oncology KW - qualitative KW - mixed methods KW - mobile phone N2 - Background: The COVID-19 pandemic accelerated the use of telehealth in cancer care and highlighted the potential of telehealth as a means of delivering the much-needed rehabilitation services for patients living with the side effects of cancer and its treatments. Objective: This mixed methods study aims to explore patients? experiences of telehealth and their preferences regarding the use of telehealth for cancer rehabilitation to inform service development. Methods: The study was completed in 2 phases from October 2020 to November 2021. In phase 1, an anonymous survey (web- and paper-based) exploring the need, benefits, barriers, facilitators, and preferences for telehealth cancer rehabilitation was distributed to survivors of cancer in Ireland. In phase 2, survivors of cancer were invited to participate in semistructured interviews exploring their experiences of telehealth and its role in cancer rehabilitation. Interviews were conducted via telephone or video call following an interview guide informed by the results of the survey and transcribed verbatim, and reflexive thematic analysis was performed using a qualitative descriptive approach. Results: A total of 48 valid responses were received. The respondents were at a median of 26 (range 3-256) months after diagnosis, and 23 (48%) of the 48 participants had completed treatment. Of the 48 respondents, 31 (65%) reported using telehealth since the start of the pandemic, 15 (31%) reported having experience with web-based cancer rehabilitation, and 43 (90%) reported a willingness for web-based cancer rehabilitation. A total of 26 (54%) of the 48 respondents reported that their views on telehealth had changed positively since the start of the pandemic. Semistructured interviews were held with 18 survivors of cancer. The mean age of the participants was 58.9 (SD 8.24) years, 56% (10/18) of the participants were female, and 44% (8/18) of the participants were male. Reflexive thematic analysis identified 5 key themes: telehealth improves accessibility to cancer rehabilitation for some but is a barrier for others, lived experiences of the benefits of telehealth in survivorship, the value of in-person health care, telehealth in cancer care and COVID-19 (from novelty to normality), and the future of telehealth in cancer rehabilitation. Conclusions: Telehealth is broadly welcomed as a mode of cancer rehabilitation for patients living with and beyond cancer in Ireland. However, issues regarding accessibility and the importance of in-person care must be acknowledged. Factors of convenience, time savings, and cost savings indicate that telehealth interventions are a desirable patient-centered method of delivering care when performed in suitable clinical contexts and with appropriate populations. UR - https://cancer.jmir.org/2023/1/e46077 UR - http://dx.doi.org/10.2196/46077 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943595 ID - info:doi/10.2196/46077 ER - TY - JOUR AU - Babayan, Katherine AU - Keilty, Krista AU - Esufali, Jessica AU - Grajales III, J. Francisco AU - PY - 2023/11/8 TI - An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study JO - JMIR Pediatr Parent SP - e41393 VL - 6 KW - children with medical complexity KW - technology dependence KW - medical devices KW - family caregivers KW - virtual care KW - home and community care KW - emergency department visits KW - enteral feeding tubes KW - hospital-to-home transition KW - feasibility KW - mixed methods N2 - Background: Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. Objective: This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto?s Hospital for Sick Children (SickKids). Methods: This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids? electronic medical records (Epic) with a chief complaint of ?medical device problems,? after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. Results: A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to ?medical device problems? over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. Conclusions: Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits. UR - https://pediatrics.jmir.org/2023/1/e41393 UR - http://dx.doi.org/10.2196/41393 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938869 ID - info:doi/10.2196/41393 ER - TY - JOUR AU - Groot Bruinderink, L. Marije AU - Boyd, Anders AU - Coyer, Liza AU - Boers, Sophie AU - Blitz, Laura AU - Brand, Jean-Marie AU - Götz, M. Hannelore AU - Stip, Martijn AU - Woudstra, Joey AU - Yap, Kenneth AU - Vermey, Koenraad AU - Matser, Amy AU - Feddes, R. Allard AU - Jongen, W. Vita AU - Prins, Maria AU - Hoornenborg, Elske AU - van Harreveld, Frenk AU - Schim van der Loeff, F. Maarten AU - Davidovich, Udi PY - 2023/11/8 TI - Online-Mediated HIV Pre-exposure Prophylaxis Care and Reduced Monitoring Frequency for Men Who Have Sex With Men: Protocol for a Randomized Controlled Noninferiority Trial (EZI-PrEP Study) JO - JMIR Res Protoc SP - e51023 VL - 12 KW - pre-exposure prophylaxis KW - randomized controlled trial KW - telemedicine KW - HIV prevention KW - MSM KW - men who have sex with men KW - Netherlands KW - adherence KW - acceptability KW - usability N2 - Background: Daily and event-driven HIV pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine is highly effective to prevent HIV in men who have sex with men (MSM). PrEP care generally consists of in-clinic monitoring every 3 months that includes PrEP dispensing, counseling, and screening for HIV and sexually transmitted infections (STIs). However, the optimal frequency for monitoring remains undetermined. Attending a clinic every 3 months for monitoring may be a barrier for PrEP. Online-mediated PrEP care and reduced frequency of monitoring may lower this barrier. Objective: The primary objective of this study is to establish the noninferiority of online PrEP care (vs in-clinic care) and monitoring every 6 months (vs every 3 months). The secondary objectives are to (1) examine differences between PrEP care modalities regarding incidences of STIs, HIV infection, and hepatitis C virus infection; retention in PrEP care; intracellular tenofovir-diphosphate concentration; and satisfaction, usability, and acceptability of PrEP care modalities; and (2) evaluate associations of these study outcomes with sociodemographic, behavioral, and psychological characteristics. Methods: This study is a 2×2 factorial, 4-arm, open-label, multi-center, randomized, controlled, noninferiority trial. The 4 arms are (1) in-clinic monitoring every 3 months, (2) in-clinic monitoring every 6 months, (3) online monitoring every 3 months, and (4) online monitoring every 6 months. The primary outcome is a condomless anal sex act with a casual partner not covered or insufficiently covered by PrEP (ie, ?unprotected act?) as a proxy for HIV infection risk. Eligible individuals are MSM, and transgender and gender diverse people aged ?18 years who are eligible for PrEP care at 1 of 4 participating sexual health centers in the Netherlands. The required sample size is 442 participants, and the planned observation time is 24 months. All study participants will receive access to a smartphone app, which contains a diary. Participants are requested to complete the diary on a daily basis during the first 18 months of participation. Participants will complete questionnaires at baseline and 6, 12, 18, and 24 months. Dried blood spots will be collected at 6 and 12 months for assessment of intracellular tenofovir-diphosphate concentration. Incidence rates of unprotected acts will be compared between the online and in-clinic arms, and between the 6-month and 3-month arms. Noninferiority will be concluded if the upper limit of the 2-sided 97.5% CI of the incidence rate ratio is <1.8. Results: The results of the main analysis are expected in 2024. Conclusions: This trial will demonstrate whether online PrEP care and monitoring every 6 months is noninferior to standard PrEP care in terms of PrEP adherence. If noninferiority is established, these modalities may lower barriers for initiating and continuing PrEP use and potentially reduce the systemic burden for PrEP providers. Trial Registration: ClinicalTrials.gov NCT05093036; https://tinyurl.com/28b8ndvj International Registered Report Identifier (IRRID): DERR1-10.2196/51023 UR - https://www.researchprotocols.org/2023/1/e51023 UR - http://dx.doi.org/10.2196/51023 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938875 ID - info:doi/10.2196/51023 ER - TY - JOUR AU - Wang, Xinyi AU - Su, Anping AU - Liu, Feng AU - Gong, Yanping AU - Wei, Tao AU - Gong, Rixiang AU - Zhu, Jingqiang AU - Li, Zhihui AU - Lei, Jianyong PY - 2023/11/7 TI - Trends, Influence Factors, and Doctor-Patient Perspectives of Web-Based Visits for Thyroid Surgery Clinical Care: Cross-Sectional Study JO - J Med Internet Res SP - e47912 VL - 25 KW - internet hospital KW - outpatient KW - telemedicine KW - thyroid surgery KW - web-based visit N2 - Background: In recent years, the new generation of telecommunication technologies has profoundly changed the traditional medical industry. To alleviate the medical difficulties faced by patients with thyroid diseases, hospitals have opened web-based visits and actively combined online-to-offline outpatient services. Objective: This study aims to explore differences between office and web-based outpatient services from doctors? and patients? perspectives, illustrate the effect of the COVID-19 pandemic on outpatient services, and provide clues for improving the online-to-offline mode of care for patients with thyroid diseases. Methods: We collected the complete web-based and office outpatient records of the Thyroid Surgery Center of West China Hospital. A total of 300,884 completed patient encounters occurred (201,840 office visits and 99,044 web-based visits) from January 1, 2019, to May 31, 2022. We performed logistic regression to evaluate the association between the chosen visit type and patients? sociodemographic characteristics. Results: The number of web-based visits rapidly increased since March 2020 and reached 45.1% (4752/10,531) of all encounters in December 2021. The COVID-19 pandemic dramatically accelerated the development of web-based visits. Web-based visits were preferred by patients 18-45 years old (odds ratio [OR] 2.043, 95% CI 1.635-2.552, P<.001), patients with relatively high-paying jobs (technical staff: OR 1.278, 95% CI 1.088-1.479, P=.003; office clerk: OR 1.25, 95% CI 1.07-1.461, P=.005; national public servant: OR:1.248, 95% CI 1.042-1.494, P=.02), and patients living in Sichuan Province (excluding Chengdu; OR 1.167, 95% CI 1.107-1.23, P<.001). The medicine cost (P<.001) and examination cost (P<.001) of office visits were significantly higher than those of web-based visits. Conclusions: Web-based outpatient visits have increased rapidly in recent years, and the COVID-19 pandemic has boosted their development. The preference for web-based visits was influenced by the socioeconomic and demographic characteristics of both patients and doctors. UR - https://www.jmir.org/2023/1/e47912 UR - http://dx.doi.org/10.2196/47912 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796623 ID - info:doi/10.2196/47912 ER - TY - JOUR AU - Mazouri-Karker, Sanae AU - Lüchinger, Robin AU - Braillard, Olivia AU - Bajwa, Nadia AU - Achab, Sophia AU - Hudelson, Patricia AU - Dominicé Dao, Melissa AU - Junod Perron, Noelle PY - 2023/11/7 TI - Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians JO - JMIR Hum Factors SP - e50740 VL - 10 KW - acceptability KW - acceptance KW - adoption KW - attitude KW - cross sectional KW - e-consultation KW - eHealth KW - opinion KW - patient KW - perception KW - perspective KW - physician KW - questionnaire KW - remote consultation KW - survey KW - telehealth KW - telemedicine KW - usage KW - video consultation N2 - Background: While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. Objective: This study aims to evaluate patients? and physicians? self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. Methods: We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants? sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. Results: A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). Conclusions: Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient. UR - https://humanfactors.jmir.org/2023/1/e50740 UR - http://dx.doi.org/10.2196/50740 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934574 ID - info:doi/10.2196/50740 ER - TY - JOUR AU - Anil Kumar Vaidhyam, Sneha AU - Huang, Kuo-Ting PY - 2023/11/7 TI - Social Determinants of Health and Patients? Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey JO - JMIR Hum Factors SP - e47982 VL - 10 KW - social determinants of health KW - telehealth KW - COVID-19 KW - technology adoption N2 - Background: Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. Objective: This pilot study aimed to understand the social determinants of patients? adoption of telehealth in the context of the pandemic. Methods: A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). Results: The results showed that social determinant factors?safe neighborhood and built environment (P=.01) and economic stability (P=.05)?are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users? intention to use technology for both variables. Conclusions: This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients? digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health. UR - https://humanfactors.jmir.org/2023/1/e47982 UR - http://dx.doi.org/10.2196/47982 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934556 ID - info:doi/10.2196/47982 ER - TY - JOUR AU - Berry, Michael AU - Taylor, Lauren AU - Huang, Zhuoran AU - Chwyl, Christina AU - Kerrigan, Stephanie AU - Forman, Evan PY - 2023/11/6 TI - Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study JO - JMIR Form Res SP - e50872 VL - 7 KW - mobile health technology KW - weight loss KW - tailored messaging KW - lifestyle modification KW - mobile health KW - mHealth KW - messaging KW - intervention KW - overweight KW - obesity KW - qualitative KW - thematic analysis N2 - Background: Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users? subjective experiences while receiving automated messaging?based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. Objective: The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Methods: Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Results: Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Conclusions: Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824 UR - https://formative.jmir.org/2023/1/e50872 UR - http://dx.doi.org/10.2196/50872 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930786 ID - info:doi/10.2196/50872 ER - TY - JOUR AU - Dhaliwal, Raman AU - Yap, Sidney AU - Talarico, Fernanda AU - Al-Shamali, Huda AU - Mcweeny, Robert AU - Reeson, Matthew AU - Shalaby, Reham AU - Chen, Teresa AU - Spronk, Elena AU - Snodgrass, Rayven AU - Tu, Eileen AU - Erick, Taylor AU - Marshall, Tyler AU - Kennedy, Megan AU - Greenshaw, J. Andrew AU - Winkler, Olga AU - Burback, Lisa PY - 2023/11/3 TI - Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review JO - J Med Internet Res SP - e40710 VL - 25 KW - acceptability KW - accessibility KW - app KW - application KW - clinical KW - cognitive KW - computerized therapy KW - culture KW - database KW - diagnosis KW - Diagnostic and Statistical Manual of Mental Disorders KW - DSM KW - effectiveness KW - health quality KW - ICD KW - International Statistical Classification of Diseases KW - literature review KW - mental disorder KW - mental health KW - mental KW - Preferred Reporting Items for Systematic Reviews and Meta-Analysis KW - PRISMA KW - privacy KW - psychoeducation KW - psychotherapeutic KW - psychotherapy KW - remote delivery KW - remote psychotherapy KW - remote KW - scoping review KW - security KW - synchronous KW - therapist assisted KW - therapist delivered KW - therapist. N2 - Background: The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. Objective: This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. Methods: This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. Results: From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. Conclusions: In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy. UR - https://www.jmir.org/2023/1/e40710 UR - http://dx.doi.org/10.2196/40710 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921863 ID - info:doi/10.2196/40710 ER - TY - JOUR AU - Yokomitsu, Kengo AU - Takashina, N. Hikari AU - Takebayashi, Yoshitake AU - Muranaka, Seiji PY - 2023/11/3 TI - Cultural Adaptation of the Actionable Health App Evaluation in Japan: Protocol for a Web-Based Modified Delphi Expert Consensus Study JO - JMIR Res Protoc SP - e44469 VL - 12 KW - mobile KW - eHealth KW - mHealth apps KW - mobile health KW - modified Delphi study KW - Japan N2 - Background: With an increase in both the number of mental health disorders people are experiencing and the difficulty in accessing mental health care, the demand for accessible mental health care services has increased. The use of mobile devices has allowed people to receive care in their daily lives without restrictions on time or location. However, the majority of publicly available mobile health apps are not evidence-based, and the top-rated apps are not always safe or user-friendly and may not offer clinically beneficial results. Objective: This study aims to create a cultural adaptation of the American Psychiatric Association?s comprehensive app evaluation framework in Japan using a web-based modified Delphi expert consensus. Methods: A web-based modified Delphi study includes developing the Japanese version of the comprehensive app evaluation framework and 3 Delphi rounds. In the first round, our working group sends a questionnaire to the panelists, who then complete it. In the second and third rounds, the working group sends a questionnaire and a summary of the panelists? answers based on each of the previous rounds. The panelists answer the questionnaires based on this summary. The summarization procedure is automated to help reduce the biases that can be generated when panelists? answers are summarized and when the panelists receive them. The working group sends only the result of the summarization with the next round?s questionnaire. All interactions between the working group and the panelists will be conducted on Qualtrics (Qualtrics Japan LLC), a questionnaire platform. To culturally validate the comprehensive mental health app evaluation framework, participants from the following three categories will be recruited in Japan: (1) researchers, (2) practitioners, and (3) app developers. Results: This study received funding from a crowdfunding campaign in Japan (April 2023). The Delphi study began in January 2023 and will be completed in December 2023. We had already completed the translation of the 105 original app evaluation item questions by December 2022. Conclusions: While the need for treatment using mental health apps is increasing, no framework that can be used to develop a centralized database for health apps is available or accessible, and no consensus has been reached among stakeholders in Japan about an appropriate framework. The results of the web-based modified Delphi method presented in this paper may provide direction for the development and use of mental health apps in the future among the relevant stakeholders. Furthermore, this study will enhance recognition of the framework among researchers, clinicians, mental health app developers, and users, in addition to devising new instruments to help users or practitioners efficiently choose the right app for their situations. International Registered Report Identifier (IRRID): PRR1-10.2196/44469 UR - https://www.researchprotocols.org/2023/1/e44469 UR - http://dx.doi.org/10.2196/44469 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921839 ID - info:doi/10.2196/44469 ER - TY - JOUR AU - Marks, A. Victoria AU - Hsiang, R. Walter AU - Nie, James AU - Umer, Waez AU - Haleem, Afash AU - Galal, Bayan AU - Pak, Irene AU - Kim, Dana AU - Salazar, C. Michelle AU - Pantel, Haddon AU - Berger, R. Elizabeth AU - Boffa, J. Daniel AU - Cavallo, A. Jaime AU - Leapman, S. Michael PY - 2023/11/2 TI - Telehealth Availability for Cancer Care During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Cancer SP - e45518 VL - 9 KW - telehealth KW - colorectal cancer KW - breast cancer KW - melanoma KW - access to care KW - COVID-19 pandemic KW - telemedicine KW - national survey KW - cross-sectional KW - cancer KW - oncology N2 - Background: Telehealth was an important strategy for maintaining continuity of cancer care during the coronavirus pandemic and has continued to play a role in outpatient care; however, it is unknown whether services are equally available across cancer hospitals. Objective: This study aimed to assess telehealth availability at cancer hospitals for new and established patients with common cancers to contextualize the impact of access barriers to technology on overall access to health care. Methods: We conducted a national cross-sectional secret shopper study from June to November 2020 to assess telehealth availability at cancer hospitals for new and established patients with colorectal, breast, and skin (melanoma) cancer. We examined facility-level factors to determine predictors of telehealth availability. Results: Of the 312 investigated facilities, 97.1% (n=303) provided telehealth services for at least 1 cancer site. Telehealth was less available to new compared to established patients (n=226, 72% vs n=301, 97.1%). The surveyed cancer hospitals more commonly offered telehealth visits for breast cancer care (n=266, 85%) and provided lower access to telehealth for skin (melanoma) cancer care (n=231, 74%). Most hospitals (n=163, 52%) offered telehealth for all 3 cancer types. Telehealth availability was weakly correlated across cancer types within a given facility for new (r=0.16, 95% CI 0.09-0.23) and established (r=0.14, 95% CI 0.08-0.21) patients. Telehealth was more commonly available for new patients at National Cancer Institute?designated facilities, medical school?affiliated facilities, and major teaching sites, with high total admissions and below-average timeliness of care. Telehealth availability for established patients was highest at Academic Comprehensive Cancer Programs, nongovernment and nonprofit facilities, medical school?affiliated facilities, Accountable Care Organizations, and facilities with a high number of total admissions. Conclusions: Despite an increase in telehealth services for patients with cancer during the COVID-19 pandemic, we identified differences in access across cancer hospitals, which may relate to measures of clinical volume, affiliation, and infrastructure. UR - https://cancer.jmir.org/2023/1/e45518 UR - http://dx.doi.org/10.2196/45518 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917149 ID - info:doi/10.2196/45518 ER - TY - JOUR AU - Petrovskaya, Olga AU - Karpman, Albina AU - Schilling, Joanna AU - Singh, Simran AU - Wegren, Larissa AU - Caine, Vera AU - Kusi-Appiah, Elizabeth AU - Geen, Willow PY - 2023/10/19 TI - Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review JO - J Med Internet Res SP - e43765 VL - 25 KW - patient portal KW - web portal KW - MyChart KW - electronic health records KW - personal health records KW - patient access to records KW - laboratory tests KW - radiology reports KW - diagnostic imaging KW - laboratory test results KW - result release KW - embargo KW - the Cures Act N2 - Background: A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. Objective: This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles?20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. Results: Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients? actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers? view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. Conclusions: The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally. UR - https://www.jmir.org/2023/1/e43765 UR - http://dx.doi.org/10.2196/43765 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856174 ID - info:doi/10.2196/43765 ER - TY - JOUR AU - da Silva Lopes, Manuel André AU - Colomer-Lahiguera, Sara AU - Darnac, Célia AU - Giacomini, Stellio AU - Bugeia, Sébastien AU - Gutknecht, Garance AU - Spurrier-Bernard, Gilliosa AU - Cuendet, Michel AU - Muet, Fanny AU - Aedo-Lopez, Veronica AU - Mederos, Nuria AU - Michielin, Olivier AU - Addeo, Alfredo AU - Latifyan, Sofiya AU - Eicher, Manuela PY - 2023/10/18 TI - Testing a Model of Care for Patients on Immune Checkpoint Inhibitors Based on Electronic Patient-Reported Outcomes: Protocol for a Randomized Phase II Controlled Trial JO - JMIR Res Protoc SP - e48386 VL - 12 KW - patient-reported outcomes KW - model of care KW - immune-related adverse events KW - remote symptom management KW - self-management support KW - self-efficacy KW - health-related quality of life KW - eHealth KW - telehealth KW - support KW - self-management KW - symptom KW - monitoring KW - cancer KW - electronic health record KW - immune KW - detection KW - questionnaire KW - treatment N2 - Background: Management of severe symptomatic immune-related adverse events (IrAEs) related to immune checkpoint inhibitors (ICIs) can be facilitated by timely detection. As patients face a heterogeneous set of symptoms outside the clinical setting, remotely monitoring and assessing symptoms by using patient-reported outcomes (PROs) may result in shorter delays between symptom onset and clinician detection. Objective: We assess the effect of a model of care for remote patient monitoring and symptom management based on PRO data on the time to detection of symptomatic IrAEs from symptom onset. The secondary objectives are to assess its effects on the time between symptomatic IrAE detection and intervention, IrAE grade (severity), health-related quality of life, self-efficacy, and overall survival at 6 months. Methods: For this study, 198 patients with cancer receiving systemic treatment comprising ICIs exclusively will be recruited from 2 Swiss university hospitals. Patients are randomized (1:1) to a digital model of care (intervention) or usual care (control group). Patients are enrolled for 6 months, and they use an electronic app to complete weekly Functional Assessment of Cancer Therapy-General questionnaire and PROMIS (PROs Measurement Information System) Self-Efficacy to Manage Symptoms questionnaires. The intervention patient group completes a standard set of 37 items in a weekly PROs version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) questionnaire, and active symptoms are reassessed daily for the first 3 months by using a modified 24-hour recall period. Patients can add items from the full PRO-CTCAE item library to their questionnaire. Nurses call patients in the event of new or worsening symptoms and manage them by using a standardized triage algorithm based on the United Kingdom Oncology Nursing Society 24-hour triage tool. This algorithm provides guidance on deciding if patients should receive in-person care, if monitoring should be increased, or if self-management education should be reinforced. Results: The Institut Suisse de Recherche Expérimentale sur le Cancer Foundation and Kaiku Health Ltd funded this study. Active recruitment began since November 2021 and is projected to conclude in November 2023. Trial results are expected to be published in the first quarter of 2024 and will be disseminated through publications submitted at international scientific conferences. Conclusions: This trial is among the first trials to use PRO data to directly influence routine care of patients treated with ICIs and addresses some limitations in previous studies. This trial collects a wider spectrum of self-reported symptom data daily. There are some methodological limitations brought by changes in evolving treatment standards for patients with cancer. This trial's results could entail further academic discussions on the challenges of diagnosing and managing symptoms associated with treatment remotely by providing further insights into the burden symptoms represent to patients and highlight the complexity of care procedures involved in managing symptomatic IrAEs. Trial Registration: ClinicalTrials.gov NCT05530187; https://www.clinicaltrials.gov/study/NCT05530187 International Registered Report Identifier (IRRID): DERR1-10.2196/48386 UR - https://www.researchprotocols.org/2023/1/e48386 UR - http://dx.doi.org/10.2196/48386 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851498 ID - info:doi/10.2196/48386 ER - TY - JOUR AU - Shalev, Ligat AU - Bistre, Moises AU - Lubin, Gadi AU - Avirame, Keren AU - Raskin, Sergey AU - Linkovski, Omer AU - Eitan, Renana AU - Rose, J. Adam PY - 2023/10/17 TI - Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study JO - JMIR Res Protoc SP - e49405 VL - 12 KW - eHealth KW - telepsychiatry KW - digital health service KW - emergency department KW - mental health KW - implementation science KW - Promoting Action on Research Implementation in Health Services KW - organizational innovation N2 - Background: Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission. Objective: The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link. Methods: This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation?s viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records. Results: This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others. Conclusions: Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation. Trial Registration: ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545 International Registered Report Identifier (IRRID): DERR1-10.2196/49405 UR - https://www.researchprotocols.org/2023/1/e49405 UR - http://dx.doi.org/10.2196/49405 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847548 ID - info:doi/10.2196/49405 ER - TY - JOUR AU - Curran, Janet AU - Wozney, Lori AU - Tavender, Emma AU - Wilson, Catherine AU - Ritchie, C. Krista AU - Wong, Helen AU - Gallant, Allyson AU - Somerville, Mari AU - Archambault, M. Patrick AU - Cassidy, Christine AU - Jabbour, Mona AU - Mackay, Rebecca AU - Plint, C. Amy PY - 2023/10/11 TI - Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians JO - JMIR Hum Factors SP - e46379 VL - 10 KW - discharge communication KW - pediatric KW - emergency department KW - medical informatics KW - implementation science KW - electronic medical record KW - mobile phone N2 - Background: Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. Objective: This study aimed to survey nurse and physician readiness to adopt these tools. Methods: An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. Results: Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. Conclusions: Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort. UR - https://humanfactors.jmir.org/2023/1/e46379 UR - http://dx.doi.org/10.2196/46379 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819696 ID - info:doi/10.2196/46379 ER - TY - JOUR AU - Baratta, R. Laura AU - Harford, Derek AU - Sinsky, A. Christine AU - Kannampallil, Thomas AU - Lou, S. Sunny PY - 2023/10/6 TI - Characterizing the Patterns of Electronic Health Record?Integrated Secure Messaging Use: Cross-Sectional Study JO - J Med Internet Res SP - e48583 VL - 25 KW - clinical care KW - clinician burden KW - communication KW - electronic health record KW - EHR KW - interprofessional communication KW - medical assistant KW - messaging KW - nurses KW - observational study KW - physicians KW - secure messaging KW - users N2 - Background: Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. Objective: This study aims to characterize the use of an electronic health record?integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. Methods: We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). Results: A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). Conclusions: Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors. UR - https://www.jmir.org/2023/1/e48583 UR - http://dx.doi.org/10.2196/48583 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801359 ID - info:doi/10.2196/48583 ER - TY - JOUR AU - Derksen, Christina AU - Rinn, Robin AU - Gao, Lingling AU - Dahmen, Alina AU - Cordes, Cay AU - Kolb, Carina AU - Becker, Petra AU - Lippke, Sonia PY - 2023/10/4 TI - Longitudinal Evaluation of an Integrated Post?COVID-19/Long COVID Management Program Consisting of Digital Interventions and Personal Support: Randomized Controlled Trial JO - J Med Internet Res SP - e49342 VL - 25 KW - postacute COVID-19 syndrome KW - PACS KW - symptom reduction KW - work ability KW - social participation KW - personal pilots KW - digital interventions KW - empowerment KW - randomized controlled trial KW - propensity score matching KW - COVID-19 N2 - Background: The postacute COVID-19 syndrome (PACS) can be addressed with multidisciplinary approaches, including professional support and digital interventions. Objective: This research aimed to test whether patients who received a health care facilitation program including medical internet support from human personal pilots and digital interventions (intervention group [IG] and active control group [ACG]) would experience fewer symptoms and have higher work ability and social participation than an untreated comparison group (CompG). The second objective was to compare the impact of a diagnostic assessment and digital interventions tailored to patients? personal capacity (IG) with that of only personal support and digital interventions targeting the main symptoms (ACG). Methods: In total, 1020 patients with PACS were recruited. Using a randomized controlled trial design between the IG and the ACG, as well as propensity score matching to include the CompG, analyses were run with logistic regression and hierarchical-linear models. Results: Symptoms decreased significantly in all groups over time (?T1-T2=0.13, t549=5.67, P<.001; ?T2-T4=0.06, t549=2.83, P=.01), with a main effect of the group (?=?.15, t549=?2.65, P=.01) and a more pronounced effect in the IG and ACG compared to the CompG (between groups: ?T1-T2=0.14, t549=4.31, P<.001; ?T2-T4=0.14, t549=4.57, P<.001). Work ability and social participation were lower in the CompG, but there was no significant interaction effect. There were no group differences between the IG and the ACG. Conclusions: Empowerment through personal pilots and digital interventions reduces symptoms but does not increase work ability and social participation. More longitudinal research is needed to evaluate the effects of a diagnostic assessment. Social support and digital interventions should be incorporated to facilitate health care interventions for PACS. Trial Registration: ClinicalTrials.gov NCT05238415; https://classic.clinicaltrials.gov/ct2/show/NCT05238415. International Registered Report Identifier (IRRID): RR2-10.1186/s12879-022-07584-z UR - https://www.jmir.org/2023/1/e49342 UR - http://dx.doi.org/10.2196/49342 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792437 ID - info:doi/10.2196/49342 ER - TY - JOUR AU - Ainslie, Marcy AU - Corvini, Marguerite AU - Chadbourne, Jennifer PY - 2023/10/3 TI - Assumptions, Perceptions, and Experiences of Behavioral Health Providers Using Telemedicine: Qualitative Study JO - JMIR Form Res SP - e48232 VL - 7 KW - telemedicine KW - behavioral health KW - implementation research KW - implementation KW - adoption KW - telepsychiatry KW - mental health KW - psychiatry KW - clinicians KW - providers KW - telehealth KW - provider KW - clinician KW - integration KW - recommendations KW - recommendation KW - guidelines KW - guideline KW - perspective KW - experience N2 - Background: The urgent and reactive implementation of telemedicine during the pandemic does not represent a long-term, strategic, and proactive approach to optimizing this technology. The assumptions, perceptions, and experiences of the behavioral health providers using telemedicine can inform system-wide and institutional-level strategies to promote longitudinal maintenance of care delivery, which can reduce the use of high-cost care due to new symptom onset and symptom exacerbation related to service interruptions. Objective: We aim to identify the assumptions, perspectives, and experiences of behavioral health clinicians and providers using telemedicine to inform the development of an optimized, sustainable approach to telemedicine implementation. Methods: This qualitative study applies the domains of the Consolidated Framework for Implementation Research (CFIR) to structure data collection and analysis from behavioral health providers using telemedicine via an audiovisual connection in the New England region. In total, 12 providers across levels of care were recruited for a 60-minute interview, developed from the CFIR interview guide. Atlas Ti Qualitative Software (version 23; ATLAS.ti Scientific Software Development GmbH) was used to coordinate and facilitate coding among 3 reviewers. Deductive coding was provided from the CFIR interview guide, allowing for data to be categorized by domain and construct. Constructs were analyzed for descriptive themes and tabulated for response frequency. Uncoded data were reviewed and coded in vivo to explore variables contributing to participant perceptions of experience with telemedicine use. Descriptive themes, then analytical themes, were identified. Analytical themes and tabulated frequency of response data were summarized. Finally, a sentiment analysis was completed to derive tone and meaning from the data. Results: Results are reported within the CFIR domains: intervention characteristic, outer setting, inner setting, characteristics of individuals, and process. The findings with ?90% agreement include ?best practice standards were not known?; ?telemedicine was believed to be efficient and time-saving for the patient and provider, maximizing productivity and thus increasing access to care?; ?telemedicine provided an additional option for patients to access services, promoting sustained continuity and timeliness of care?; ?participants did not identify any clear goals related to telemedicine use?; ?demonstrated positive affective responses to telemedicine use?; ?expressed high efficacy with telemedicine utilization?; and ?strong leadership support.? Conclusions: These findings support the development of interstate compacts advancing licensure across state lines; payment parity across modalities of care to ensure the financial vitality of behavioral health services; improved dissemination of telehealth training and resources, and telehealth training in academic programs of the health professions; seamless, dynamic workflows to accommodate the changing needs of patient and care continuity; emergency response protocols; and community partnerships to provide private spaces needed for a therapeutic encounter. Future research exploring the patient?s experience with telemedicine is needed for all stakeholders to be represented in developing a sustainable, integrated system. UR - https://formative.jmir.org/2023/1/e48232 UR - http://dx.doi.org/10.2196/48232 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788059 ID - info:doi/10.2196/48232 ER - TY - JOUR AU - Bui, T. Dung AU - Barnett, Tony AU - Hoang, Ha AU - Chinthammit, Winyu PY - 2023/10/2 TI - Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study JO - JMIR Med Educ SP - e47228 VL - 9 KW - augmented reality KW - mentorship KW - patient simulation KW - patient care management KW - quasi-experimental study KW - telehealth N2 - Background: Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. Objective: This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. Methods: This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR?s usability, mentorship effectiveness, and mentees? self-confidence and skill performance. Results: A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees? confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees? individual skill performance rates ranged from 98% in the ACS scenario to 97% in the AMI, PSRA, and HE scenarios. Conclusions: This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research. UR - https://mededu.jmir.org/2023/1/e47228 UR - http://dx.doi.org/10.2196/47228 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782533 ID - info:doi/10.2196/47228 ER - TY - JOUR AU - Buis, R. Lorraine AU - Brown, K. Lindsay AU - Plegue, A. Melissa AU - Kadri, Reema AU - Laurie, R. Anna AU - Guetterman, C. Timothy AU - Vydiswaran, Vinod V. G. AU - Li, Jiazhao AU - Veinot, C. Tiffany PY - 2023/9/29 TI - Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study JO - J Med Internet Res SP - e49804 VL - 25 KW - COVID-19 KW - telemedicine KW - health equity KW - clinical encounters KW - electronic health records N2 - Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. UR - https://www.jmir.org/2023/1/e49804 UR - http://dx.doi.org/10.2196/49804 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773609 ID - info:doi/10.2196/49804 ER - TY - JOUR AU - Alqurashi, Heba AU - Mohammed, Rafiuddin AU - AlGhanmi, Shlyan Amany AU - Alanazi, Farhan PY - 2023/9/28 TI - The Perception of Health Care Practitioners Regarding Telemedicine During COVID-19 in Saudi Arabia: Mixed Methods Study JO - JMIR Form Res SP - e47065 VL - 7 KW - telemedicine KW - health care practitioners KW - COVID-19 KW - Saudi Arabia KW - mobile phone N2 - Background: Telemedicine is a rapidly evolving field that uses information and communication technology to provide remote health care services, such as diagnosis, treatment, consultation, patient monitoring, and medication delivery. With advancements in technology, telemedicine has become increasingly popular during the COVID-19 lockdown and has expanded beyond remote consultations via telephone or video to include comprehensive and reliable services. The integration of telemedicine platforms can enable patients and health care providers to communicate more efficiently and effectively. Objective: This study aims to investigate the awareness, knowledge, requirements, and perceptions of health care practitioners in Saudi Arabia during the pandemic health crisis from the end-user perspective. The findings of this study will inform policy makers regarding the sustainability of telemedicine and how it affects the process of provision of health care and improves the patients? journey. Methods: This study adopted a mixed methods design with a quantitative-based cross-sectional design and qualitative interviews to assess the perceptions of various health care professionals working in outpatient departments that have a telemedicine system that was used during the COVID-19 pandemic. For both approaches, ethics approval was obtained, and informed consent forms were signed. In total, 81 completed questionnaires were used in this study. In the second phase, general interviews were conducted with managerial staff and health care professionals to obtain their view of telemedicine services in their hospitals. Results: The study revealed that most participants (67/81, 83%) were familiar with telemedicine technology, and the study proved to be statistically significant at P<.05 with a proportion of the participants (52/81, 64%) believing that continuous training was essential for its effective use. The study also found that consultations (55/153, 35.9%) and monitoring patients (35/153, 22.9%) were the major components of telemedicine used by health care professionals, with telephones being the most commonly used mode of interaction with patients (74/117, 63.2%). In addition, 54% (44/81) of the respondents expressed concerns about patient privacy and confidentiality, highlighting this as a major issue. Furthermore, the majority of participants (58/81, 72%) reported the necessity of implementing national standards essential for telemedicine technology in Saudi Arabia. The interviews conducted as part of the study revealed 5 major themes: culture, barriers and difficulties, communication, implementation, and evaluation. These themes highlighted the importance of a culture of acceptance and flexibility, effective communication, and ongoing evaluation of telemedicine technologies in health care systems. Conclusions: This study provides a crucial message with insights into the perceptions and experiences of health care professionals with telemedicine during the COVID-19 pandemic in Saudi Arabia. UR - https://formative.jmir.org/2023/1/e47065 UR - http://dx.doi.org/10.2196/47065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768720 ID - info:doi/10.2196/47065 ER - TY - JOUR AU - Yang, Li-Tan AU - Lee, Jen-Kuang AU - Tsai, Chieh-Mei AU - Chen, Ying-Hsien AU - Huang, Ching-Chang AU - Wu, Hui-Wen AU - Su, Chin-Hua AU - Lee, Chien-Chang AU - Hung, Chi-Sheng AU - Ho, Yi-Lwun PY - 2023/9/26 TI - Effect of Telehealth Services on Mitral and Tricuspid Regurgitation Progression: Retrospective Study JO - J Med Internet Res SP - e47947 VL - 25 KW - mitral regurgitation KW - tricuspid regurgitation KW - telehealth KW - telemedicine KW - point-of-care ultrasound KW - cardiovascular health KW - heart disease KW - cardiac KW - cardiology KW - patience care KW - patient-reported outcome KW - remote monitoring KW - health management N2 - Background: Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with high mortality risks, which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, have been proven to improve the health management of chronic diseases, but the effects on MR and TR progression are unknown. Objective: This study aimed to explore whether patients receiving telehealth services have less MR and TR progression compared with a control group. We also aimed to identify the determinants of MR and TR progression. Methods: This single-center retrospective study conducted at the National Taiwan University Hospital compared MR and TR progression (defined as either progression to moderate or greater MR and TR or MR and TR progression by ?2 grades during the study period) between the telehealth and control groups. Patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR and TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who received telehealth services for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson Comorbidity Index components were obtained for all patients. Results: A total of 1081 patients (n=226 in the telehealth group and n=855 in the control group) were included in the study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (P<.001), higher Charlson Comorbidity Index (P=.02), higher prevalence of prior myocardial infarction (P=.01) and heart failure (P<.001), higher beta-blocker (P=.03) and diuretic (P=.04) use, and lower nitrate use (P=.04). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio 1.10, 95% CI 0.80-1.52; P=.52) and TR (hazard ratio 1.27, 95% CI 0.92-1.74; P=.14) progression. Determinants for moderate or greater MR progression included older age, female sex, diuretic use, larger left atrial dimension, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction. Determinants of moderate or greater TR progression included older age, female sex, diuretic use, presence of atrial fibrillation, LA dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction; statin use was found to be protective. Conclusions: This is the first study to assess the association between telehealth services and the progression of MR and TR. Telehealth patients, who had more comorbidities, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and atrial fibrillation, which can be incorporated into a telehealth platform and advanced alert system, improving patient outcomes through personalized care. UR - https://www.jmir.org/2023/1/e47947 UR - http://dx.doi.org/10.2196/47947 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751276 ID - info:doi/10.2196/47947 ER - TY - JOUR AU - Jo, Eunkyung AU - Kouaho, Whitney-Jocelyn AU - Schueller, M. Stephen AU - Epstein, A. Daniel PY - 2023/9/22 TI - Exploring User Perspectives of and Ethical Experiences With Teletherapy Apps: Qualitative Analysis of User Reviews JO - JMIR Ment Health SP - e49684 VL - 10 KW - teletherapy KW - therapy KW - ethical guidelines KW - ethics KW - qualitative research KW - digital mental health KW - mobile phone N2 - Background: Teletherapy apps have emerged as a promising alternative to traditional in-person therapy, especially after the COVID-19 pandemic, as they help overcome a range of geographical and emotional barriers to accessing care. However, the rapid proliferation of teletherapy apps has occurred in an environment in which development has outpaced the various regulatory and ethical considerations of this space. Thus, researchers have raised concerns about the ethical implications and potential risks of teletherapy apps given the lack of regulation and oversight. Teletherapy apps have distinct aims to more directly replicate practices of traditional care, as opposed to mental health apps, which primarily provide supplemental support, suggesting a need to examine the ethical considerations of teletherapy apps from the lens of existing ethical guidelines for providing therapy. Objective: In this study, we examined user reviews of commercial teletherapy apps to understand user perceptions of whether and how ethical principles are followed and incorporated. Methods: We identified 8 mobile apps that (1) provided teletherapy on 2 dominant mobile app stores (Google Play and Apple App Store) and (2) had received >5000 app reviews on both app stores. We wrote Python scripts (Python Software Foundation) to scrape user reviews from the 8 apps, collecting 3268 user reviews combined across 2 app stores. We used thematic analysis to qualitatively analyze user reviews, developing a codebook drawing from the ethical codes of conduct for psychologists, psychiatrists, and social workers. Results: The qualitative analysis of user reviews revealed the ethical concerns and opportunities of teletherapy app users. Users frequently perceived unprofessionalism in their teletherapists, mentioning that their therapists did not listen to them, were distracted during therapy sessions, and did not keep their appointments. Users also noted technical glitches and therapist unavailability on teletherapy apps that might affect their ability to provide continuity of care. Users held varied opinions on the affordability of those apps, with some perceiving them as affordable and others not. Users further brought up that the subscription model resulted in unfair pricing and expressed concerns about the lack of cost transparency. Users perceived that these apps could help promote access to care by overcoming geographical and social constraints. Conclusions: Our study suggests that users perceive commercial teletherapy apps as adhering to many ethical principles pertaining to therapy but falling short in key areas regarding professionalism, continuity of care, cost fairness, and cost transparency. Our findings suggest that, to provide high-quality care, teletherapy apps should prioritize fair compensation for therapists, develop more flexible and transparent payment models, and invest in measures to ensure app stability and therapist availability. Future work is needed to develop standards for teletherapy and improve the quality and accessibility of those services. UR - https://mental.jmir.org/2023/1/e49684 UR - http://dx.doi.org/10.2196/49684 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738085 ID - info:doi/10.2196/49684 ER - TY - JOUR AU - Werkmeister, Benjamin AU - Haase, M. Anne AU - Fleming, Theresa AU - Officer, N. Tara PY - 2023/9/22 TI - Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e50486 VL - 7 KW - telehealth KW - mental health services KW - Aotearoa New Zealand KW - mixed methods research KW - clinician KW - COVID-19 N2 - Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians? use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians? flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. UR - https://formative.jmir.org/2023/1/e50486 UR - http://dx.doi.org/10.2196/50486 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738075 ID - info:doi/10.2196/50486 ER - TY - JOUR AU - Haque, Saira AU - DeStefano, Sydney AU - Banger, Alison AU - Rutledge, Regina AU - Romaire, Melissa PY - 2023/9/20 TI - Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation JO - JMIR Form Res SP - e49591 VL - 7 KW - telehealth KW - virtual care KW - rural health KW - critical access hospital KW - access KW - telehealth impact KW - methods evaluation KW - mixed methods KW - thematic analysis KW - cost efficiency KW - telehealth cost KW - qualitative analysis KW - claims analysis N2 - Background: Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. Objective: We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. Methods: We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. Results: CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. Conclusions: The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability. UR - https://formative.jmir.org/2023/1/e49591 UR - http://dx.doi.org/10.2196/49591 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728991 ID - info:doi/10.2196/49591 ER - TY - JOUR AU - Ward, M. Marcia AU - Ullrich, Fred AU - Bhagianadh, Divya AU - Nelson, Eve-Lynn AU - Marcin, P. James AU - Carter, D. Knute AU - Law, Beth Kari AU - McCord, Carly AU - Neufeld, Jonathan AU - Merchant, S. Kimberly A. PY - 2023/9/18 TI - Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study JO - JMIR Ment Health SP - e47047 VL - 10 KW - anxiety KW - behavior KW - behavioral health KW - COVID-19 KW - depression KW - digital health KW - eHealth KW - mental health KW - mHealth KW - pandemic KW - rural health services KW - rural KW - telehealth KW - telemedicine N2 - Background: The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. Objective: This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. Methods: We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. Results: The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30% (698/2352) in the pre-PHE period to 35% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11% (468/4249) in the pre-PHE period to 18% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1% (22/2352) in the pre-PHE period to 11% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0% (0/4249) in the pre-PHE period to 16% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8% (190/2352) to 14% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12% (502/4249) to 4% (739/17,047; P<.001). Conclusions: The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic. UR - https://mental.jmir.org/2023/1/e47047 UR - http://dx.doi.org/10.2196/47047 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721793 ID - info:doi/10.2196/47047 ER - TY - JOUR AU - Harrison, Conrad AU - Trickett, Ryan AU - Wormald, Justin AU - Dobbs, Thomas AU - Lis, Przemys?aw AU - Popov, Vesselin AU - Beard, J. David AU - Rodrigues, Jeremy PY - 2023/9/14 TI - Remote Symptom Monitoring With Ecological Momentary Computerized Adaptive Testing: Pilot Cohort Study of a Platform for Frequent, Low-Burden, and Personalized Patient-Reported Outcome Measures JO - J Med Internet Res SP - e47179 VL - 25 KW - patient-reported outcome measures KW - ecological momentary assessment KW - computerized adaptive testing KW - EMCAT KW - symptom monitoring KW - monitoring KW - assessment KW - smartphone app KW - trauma KW - arthritis KW - usability KW - mobile phone N2 - Background: Remote patient-reported outcome measure (PROM) data capture can provide useful insights into research and clinical practice and deeper insights can be gained by administering assessments more frequently, for example, in ecological momentary assessment. However, frequent data collection can be limited by the burden of multiple, lengthy questionnaires. This burden can be reduced with computerized adaptive testing (CAT) algorithms that select only the most relevant items from a PROM for an individual respondent. In this paper, we propose ?ecological momentary computerized adaptive testing? (EMCAT): the use of CAT algorithms to reduce PROM response burden and facilitate high-frequency data capture via a smartphone app. We develop and pilot a smartphone app for performing EMCAT using a popular hand surgery PROM. Objective: The aim of this study is to determine the feasibility of EMCAT as a system for remote PROM administration. Methods: We built the EMCAT web app using Concerto, an open-source CAT platform maintained by the Psychometrics Centre, University of Cambridge, and hosted it on an Amazon Web Service cloud server. The platform is compatible with any questionnaire that has been parameterized with item response theory or Rasch measurement theory. For this study, the PROM we chose was the patient evaluation measure, which is commonly used in hand surgery. CAT algorithms were built using item response theory models derived from UK Hand Registry data. In the pilot study, we enrolled 40 patients with hand trauma or thumb-base arthritis, across 2 sites, between July 13, 2022, and September 14, 2022. We monitored their symptoms with the patient evaluation measure, via EMCAT, over a 12-week period. Patients were assessed thrice weekly, once daily, or thrice daily. We additionally administered full-length PROM assessments at 0, 6, and 12 weeks, and the User Engagement Scale at 12 weeks. Results: The use of EMCAT significantly reduced the length of the PROM (median 2 vs 11 items) and the time taken to complete it (median 8.8 seconds vs 1 minute 14 seconds). Very similar scores were obtained when EMCAT was administered concurrently with the full-length PROM, with a mean error of <0.01 on a logit (z score) scale. The median response rate in the daily assessment group was 93%. The median perceived usability score of the User Engagement Scale was 4.0 (maximum possible score 5.0). Conclusions: EMCAT reduces the burden of PROM assessments, enabling acceptable high-frequency, remote PROM data capture. This has potential applications in both research and clinical practice. In research, EMCAT could be used to study temporal variations in symptom severity, for example, recovery trajectories after surgery. In clinical practice, EMCAT could be used to monitor patients remotely, prompting early intervention if a patient?s symptom trajectory causes clinical concern. Trial Registration: ISRCTN 19841416; https://www.isrctn.com/ISRCTN19841416 UR - https://www.jmir.org/2023/1/e47179 UR - http://dx.doi.org/10.2196/47179 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707947 ID - info:doi/10.2196/47179 ER - TY - JOUR AU - Loebenberg, Gemma AU - Oldham, Melissa AU - Brown, Jamie AU - Dinu, Larisa AU - Michie, Susan AU - Field, Matt AU - Greaves, Felix AU - Garnett, Claire PY - 2023/9/14 TI - Bot or Not? Detecting and Managing Participant Deception When Conducting Digital Research Remotely: Case Study of a Randomized Controlled Trial JO - J Med Internet Res SP - e46523 VL - 25 KW - artificial intelligence KW - false information KW - mHealth applications KW - participant deception KW - participant KW - recruit KW - research subject KW - web-based studies N2 - Background: Evaluating digital interventions using remote methods enables the recruitment of large numbers of participants relatively conveniently and cheaply compared with in-person methods. However, conducting research remotely based on participant self-report with little verification is open to automated ?bots? and participant deception. Objective: This paper uses a case study of a remotely conducted trial of an alcohol reduction app to highlight and discuss (1) the issues with participant deception affecting remote research trials with financial compensation; and (2) the importance of rigorous data management to detect and address these issues. Methods: We recruited participants on the internet from July 2020 to March 2022 for a randomized controlled trial (n=5602) evaluating the effectiveness of an alcohol reduction app, Drink Less. Follow-up occurred at 3 time points, with financial compensation offered (up to £36 [US $39.23]). Address authentication and telephone verification were used to detect 2 kinds of deception: ?bots,? that is, automated responses generated in clusters; and manual participant deception, that is, participants providing false information. Results: Of the 1142 participants who enrolled in the first 2 months of recruitment, 75.6% (n=863) of them were identified as bots during data screening. As a result, a CAPTCHA (Completely Automated Public Turing Test to Tell Computers and Humans Apart) was added, and after this, no more bots were identified. Manual participant deception occurred throughout the study. Of the 5956 participants (excluding bots) who enrolled in the study, 298 (5%) were identified as false participants. The extent of this decreased from 110 in November 2020, to a negligible level by February 2022 including a number of months with 0. The decline occurred after we added further screening questions such as attention checks, removed the prominence of financial compensation from social media advertising, and added an additional requirement to provide a mobile phone number for identity verification. Conclusions: Data management protocols are necessary to detect automated bots and manual participant deception in remotely conducted trials. Bots and manual deception can be minimized by adding a CAPTCHA, attention checks, a requirement to provide a phone number for identity verification, and not prominently advertising financial compensation on social media. Trial Registration: ISRCTN Number ISRCTN64052601; https://doi.org/10.1186/ISRCTN64052601 UR - https://www.jmir.org/2023/1/e46523 UR - http://dx.doi.org/10.2196/46523 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707943 ID - info:doi/10.2196/46523 ER - TY - JOUR AU - Rush, L. Kathy AU - Burton, Lindsay AU - Seaton, L. Cherisse AU - Loewen, Peter AU - O'Connor, P. Brian AU - Moroz, Lana AU - Corman, Kendra AU - Smith, A. Mindy AU - Andrade, G. Jason PY - 2023/9/14 TI - Telehealth Satisfaction in Patients Receiving Virtual Atrial Fibrillation Care: Quantitative Exploratory Study JO - JMIR Hum Factors SP - e50232 VL - 10 KW - atrial fibrillation KW - telehealth KW - telehealth satisfaction KW - self-efficacy KW - attitudes toward technology KW - attitude KW - attitudes KW - satisfaction KW - telemedicine KW - cardiology KW - heart KW - adoption KW - eHealth KW - perception KW - perceptions N2 - Background: Telehealth can optimize access to specialty care for patients with atrial fibrillation (AF). Virtual AF care, however, may not fit with the complex needs of patients with AF. Objective: This study aims to explore the correlation among attitudes toward health care technologies, self-efficacy, and telehealth satisfaction as part of the future planning of virtual AF clinic care. Methods: Patients with AF older than 18 years from an urban-based, highly specialized AF clinic who had an upcoming telehealth visit were invited to participate in a web-based survey. The survey asked about demographic characteristics; use of technology; general, computer, and health care technology self-efficacy (HTSE) and health care technology attitudes, using a validated 30-item tool; and telehealth satisfaction questionnaire using a validated 14-item questionnaire. Data were analyzed with descriptive statistics, correlational analyses, and linear regression modeling. Results: Participants (n=195 of 579 invited, for a 34% response rate) were primarily older, male, and White, had postsecondary schooling or more, and had high self-reported overall and mental health ratings. A variety of technologies were used in their daily lives and for health care, with the majority of technologies comprising desktop and laptop computers, smartphones, and tablets. Self-efficacy and telehealth satisfaction questionnaire scores were high overall, with male participants having higher general self-efficacy, computer self-efficacy, HTSE, and technology attitude scores. After controlling for age and sex, only HTSE was significantly related to individuals? attitudes toward health care technology. Both general self-efficacy and attitude toward health care technology were positively related to telehealth satisfaction. Conclusions: Consistent with a previous study, only HTSE significantly influenced attitudes toward health care technology. This finding confirms that, in this regard, self-efficacy is not a general perception but is domain specific. Considering participants? predominant use of the telephone for virtual care, it follows that general self-efficacy and attitude toward health care technology were significant contributors to telehealth satisfaction. Given our patients? frequent use of technology and high computer self-efficacy and HTSE scores, the use of video for telehealth appointments could be supported. UR - https://humanfactors.jmir.org/2023/1/e50232 UR - http://dx.doi.org/10.2196/50232 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707881 ID - info:doi/10.2196/50232 ER - TY - JOUR AU - Sang, Ling AU - Song, Li PY - 2023/9/11 TI - The Current Status of the Use of Internet Hospitals for Outpatients With Pain: Retrospective Study JO - J Med Internet Res SP - e44759 VL - 25 KW - internet hospital KW - internet + KW - pain management KW - online visit KW - outpatient KW - pain N2 - Background: The national ?Internet +? policies and the emergence of internet hospitals have created a new direction for the management of pain outside of the hospital. Nevertheless, there are no consolidated studies conducted by pain physicians on the current state of internet hospital?based online medical services used by patients with pain outside of a hospital setting. Objective: In this retrospective study, we aimed to examine the status of the use of internet hospitals by patients who experience pain. Moreover, we identified the factors that influenced patients' decisions to make an online visit through the internet hospital. Methods: Detailed information was collected online and offline from outpatients with pain at the information technology center of West China Hospital of Sichuan University from February 2020 to April 2022. Binary logistic regression analysis was conducted to identify the determinants that influenced patients' decisions to make an online visit to the internet hospital. Results: Over a 2-year period, 85,266 pain-related clinic visits were recorded. Ultimately, 39,260 patients were enrolled for the analysis, with 12.9% (5088/39,260) having online visits. Both online and offline clinics had a greater number of visits by women than men. The average age of patients attending the online clinic was 46.85 (SD 16.56) years, whereas the average age of patients attending the offline clinic was 51.48 (SD 16.12) years. The majority of online clinic visitors (3059/5088, 60.1%) were employed, and one of the most common occupations was farming (721/5088, 14.2%). In addition, 51.8% (2635/5088) of patients who participated in the online clinics lived outside the hospital vicinity. Young (odds ratio [OR] 1.35, 95% CI 1.01-1.81; P=.045) and middle-aged (OR 1.98, 95% CI 1.81-2.16; P<.001) patients, employed patients (OR 1.11, 95% CI 1.04-1.18; P=.002), nonlocal patients (OR 1.57, 95% CI 1.48-1.67; P<.001), and the ordinary staff (OR 1.19, 95%CI 1.01-1.39; P=.03) were more likely to have the intention to choose online visits through the internet hospitals. Conclusions: Internet hospitals are flourishing as a more efficient and promising method of pain management and follow-up for patients with pain outside the hospital. People with pain who are young, working, and not in the vicinity of hospitals are more likely to visit internet hospitals. UR - https://www.jmir.org/2023/1/e44759 UR - http://dx.doi.org/10.2196/44759 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695652 ID - info:doi/10.2196/44759 ER - TY - JOUR AU - Noda, Masao AU - Kuroda, Tatsuaki AU - Nomura, Akihiro AU - Ito, Makoto AU - Yoshizaki, Tomokazu AU - Fushiki, Hiroaki PY - 2023/9/11 TI - Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review JO - JMIR Mhealth Uhealth SP - e48638 VL - 11 KW - dizziness KW - vertigo KW - telemedicine KW - smartphone KW - digital therapy KW - telehealth KW - COVID-19 KW - information technology KW - scoping review KW - health device KW - remote diagnosis KW - medical care N2 - Background: Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases. Objective: The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients. Methods: A scoping review was conducted with the methodological framework of Arksey and O?Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data. Results: This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation. Conclusions: With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients. UR - https://mhealth.jmir.org/2023/1/e48638 UR - http://dx.doi.org/10.2196/48638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695671 ID - info:doi/10.2196/48638 ER - TY - JOUR AU - Yang, Wenwen AU - Du, Yifei AU - Chen, Mengran AU - Li, Sufang AU - Zhang, Fan AU - Yu, Peiyang AU - Xu, Xiaoxia PY - 2023/9/8 TI - Effectiveness of Home-Based Telerehabilitation Interventions for Dysphagia in Patients With Head and Neck Cancer: Systematic Review JO - J Med Internet Res SP - e47324 VL - 25 KW - head and neck cancer KW - home-based rehabilitation KW - remote intervention KW - swallowing exercise KW - systematic review N2 - Background: Multimodal treatment?induced dysphagia has serious negative effects on survivors of head and neck cancer. Owing to advances in communication technologies, several studies have applied telecommunication-based interventions that incorporate swallowing exercises, education, monitoring, feedback, self-management, and communication. It is especially urgent to implement home-based remote rehabilitation in the context of the COVID-19 pandemic. However, the optimal strategy and effectiveness of remote interventions are unclear. Objective: This systematic review aimed to examine the evidence regarding the efficacy of telerehabilitation for reducing physiological and functional impairments related to swallowing and for improving adherence and related influencing factors among head and neck cancer survivors. Methods: The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Library databases were systematically searched up to July 2023 to identify relevant articles. In total, 2 investigators independently extracted the data and assessed the methodological quality of the included studies using the quality assessment tool of the Joanna Briggs Institute. Results: A total of 1465 articles were initially identified; ultimately, 13 (0.89%) were included in the systematic review. The quality assessment indicated that the included studies were of moderate to good quality. The results showed that home-based telerehabilitation improved the safety of swallowing and oral feeding, nutritional status, and swallowing-related quality of life; reduced negative emotions; improved swallowing rehabilitation adherence; was rated by participants as highly satisfactory and supportive; and was cost-effective. In addition, this review investigated factors that influenced the efficacy of telerehabilitation, which included striking a balance among swallowing training strategy, intensity, frequency, duration, and individual motor ability; treating side effects of radiotherapy; providing access to medical, motivational, and educational information; providing feedback on training; providing communication and support from speech pathologists, families, and other survivors; and addressing technical problems. Conclusions: Home-based telerehabilitation has shown great potential in reducing the safety risks of swallowing and oral feeding, improving quality of life and adherence, and meeting information needs for dysphagia among survivors of head and neck cancer. However, this review highlights limitations in the current literature, and the current research is in its infancy. In addition, owing to the diversity of patient sociodemographic, medical, physiological and functional swallowing, and behavioral factors, we recommend the development of tailored telemedicine interventions to achieve the best rehabilitation effects with the fewest and most precise interventions. UR - https://www.jmir.org/2023/1/e47324 UR - http://dx.doi.org/10.2196/47324 UR - http://www.ncbi.nlm.nih.gov/pubmed/37682589 ID - info:doi/10.2196/47324 ER - TY - JOUR AU - Shoemaker, E. Holly AU - Thorpe, Alistair AU - Stevens, Vanessa AU - Butler, M. Jorie AU - Drews, A. Frank AU - Burpo, Nicole AU - Scherer, D. Laura AU - Fagerlin, Angela PY - 2023/9/8 TI - Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study JO - JMIR Form Res SP - e42217 VL - 7 KW - telehealth KW - telemedicine KW - veterans KW - COVID-19 KW - health care KW - nationwide web-based survey KW - underserved population KW - accessible health care KW - health inequality KW - health care disparity N2 - Background: In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. Objective: This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. Methods: A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. Results: There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). Conclusions: Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all. UR - https://formative.jmir.org/2023/1/e42217 UR - http://dx.doi.org/10.2196/42217 UR - http://www.ncbi.nlm.nih.gov/pubmed/37527547 ID - info:doi/10.2196/42217 ER - TY - JOUR AU - Altabtabaei, Rabab AU - Alhuwail, Dari PY - 2023/9/7 TI - Exploring the Challenges and Opportunities of Adopting and Using Telemedicine for Diabetes Care and Management: Qualitative Semistructured Interview Study Among Health Care Providers and Patients With Diabetes JO - JMIR Hum Factors SP - e46324 VL - 10 KW - health KW - telemedicine KW - diabetes KW - challenges KW - Kuwait KW - technology KW - informatics KW - diabetes care KW - management KW - obstacle KW - health care provider KW - qualitative study KW - mobile phone N2 - Background: Around the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait. Objective: The purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait?s health care system for diabetes care and management. Methods: The research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The ?diffusion of innovation? model was used as a perspective to interpret the findings. Results: A total of 20 participants were included in this study?10 HCPs and 10 patients with diabetes?all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety. Conclusions: The results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment. UR - https://humanfactors.jmir.org/2023/1/e46324 UR - http://dx.doi.org/10.2196/46324 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676711 ID - info:doi/10.2196/46324 ER - TY - JOUR AU - Torres-Robles, Andrea AU - Allison, Karen AU - Poon, K. Simon AU - Shaw, Miranda AU - Hutchings, Owen AU - Britton, J. Warwick AU - Wilson, Andrew AU - Baysari, Melissa PY - 2023/9/5 TI - Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study JO - J Med Internet Res SP - e44540 VL - 25 KW - remote monitoring KW - patient experience KW - user experience KW - COVID-19 KW - pulse oximetry KW - usability KW - acceptability KW - oximetry KW - wearable device N2 - Background: As a response to the COVID-19 pandemic, the Sydney Local Health District in New South Wales, Australia, launched the rpavirtual program, the first full-scale virtual hospital in Australia, to remotely monitor and follow up stable patients with COVID-19. As part of the intervention, a pulse oximeter wearable device was delivered to patients to monitor their oxygen saturation levels, a critical indicator of COVID-19 patient deterioration. Understanding users? perceptions toward the device is fundamental to assessing its usability and acceptability and contributing to the effectiveness of the intervention, but no research to date has explored the user experience of the pulse oximeter for remote monitoring in this setting. Objective: This study aimed to explore the use, performance, and acceptability of the pulse oximeter by clinicians and patients in rpavirtual during COVID-19. Methods: Semistructured interviews and usability testing were conducted. Stable adult patients with COVID-19 (aged ?18 years) who used the pulse oximeter and were monitored by rpavirtual, and rpavirtual clinicians monitoring these patients were interviewed. Clinicians could be nurses, doctors, or staff who were part of the team that assisted patients with the use of the pulse oximeter. Usability testing was conducted with patients who had the pulse oximeter when they were contacted. Interviews were coded using the Theoretical Framework of Acceptability. Usability testing was conducted using a think-aloud protocol. Data were collected until saturation was reached. Results: Twenty-one patients (average age 51, SD 13 years) and 15 clinicians (average age 41, SD 11 years) completed the interview. Eight patients (average age 51, SD 13 years) completed the usability testing. All participants liked the device and thought it was easy to use. They also had a good understanding of how to use the device and the device?s purpose. Patients? age and device use?related characteristics (eg, the warmth of hands and hand steadiness) were identified by users as factors negatively impacting the accurate use of the pulse oximeter. Conclusions: Patients and clinicians had very positive perceptions of the pulse oximeter for COVID-19 remote monitoring, indicating high acceptability and usability of the device. However, factors that may impact the accuracy of the device should be considered when delivering interventions using the pulse oximeter for remote monitoring. Targeted instructions about the use of the device may be necessary for specific populations (eg, older people and patients unfamiliar with technology). Further research should focus on the integration of the pulse oximeter data into electronic medical records for real-time and secure patient monitoring. UR - https://www.jmir.org/2023/1/e44540 UR - http://dx.doi.org/10.2196/44540 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535831 ID - info:doi/10.2196/44540 ER - TY - JOUR AU - Baffert, Sandrine AU - Hadouiri, Nawale AU - Fabron, Cécile AU - Burgy, Floriane AU - Cassany, Aurelia AU - Kemoun, Gilles PY - 2023/9/5 TI - Economic Evaluation of Telerehabilitation: Systematic Literature Review of Cost-Utility Studies JO - JMIR Rehabil Assist Technol SP - e47172 VL - 10 KW - telerehabilitation KW - cost-effectiveness KW - quality-adjusted life year KW - economic evaluation KW - cost KW - rehabilitation KW - systematic review N2 - Background: Telerehabilitation could benefit a large population by increasing adherence to rehabilitation protocols. Objective: Our objective was to review and discuss the use of cost-utility approaches in economic evaluations of telerehabilitation interventions. Methods: A review of the literature on PubMed, Scopus, Centres for Review and Dissemination databases (including the HTA database, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database), Cochrane Library, and ClinicalTrials.gov (last search on February 8, 2021) was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were defined in accordance with the PICOS (population, intervention, comparison, outcomes, and study design) system: the included studies had to evaluate patients in rehabilitation therapy for all diseases and disorders (population) through exercise-based telerehabilitation (intervention) and had to have a control group that received face-to-face rehabilitation (comparison), and these studies had to evaluate effectiveness through gain in quality of life (outcome) and used the design of randomized and controlled clinical studies (study). Results: We included 11 economic evaluations, of which 6 concerned cardiovascular diseases. Several types of interventions were assessed as telerehabilitation, consisting in monitoring of rehabilitation at home (monitored by physicians) or a rehabilitation program with exercise and an educational intervention at home alone. All studies were based on randomized clinical trials and used a validated health-related quality of life instrument to describe patients? health states. Four evaluations used the EQ-5D, 1 used the EQ-5D-5L, 2 used the EQ-5D-3L, 3 used the Short-Form Six-Dimension questionnaire, and 1 used the 36-item Short Form survey. The mean quality-adjusted life years gained using telerehabilitation services varied from ?0.09 to 0.89. These results were reported in terms of the probability that the intervention was cost-effective at different thresholds for willingness-to-pay values. Most studies showed results about telerehabilitation as dominant (ie, more effective and less costly) together with superiority or noninferiority in outcomes. Conclusions: There is evidence to support telerehabilitation as a cost-effective intervention for a large population among different disease areas. There is a need for conducting cost-effectiveness studies in countries because the available evidence has limited generalizability in such countries. Trial Registration: PROSPERO CRD42021248785; https://tinyurl.com/4xurdvwf UR - https://rehab.jmir.org/2023/1/e47172 UR - http://dx.doi.org/10.2196/47172 UR - http://www.ncbi.nlm.nih.gov/pubmed/37669089 ID - info:doi/10.2196/47172 ER - TY - JOUR AU - Spiess, T. Saskia AU - Gardner, Elena AU - Turner, Cindy AU - Galt, Annie AU - Fortenberry, Katherine AU - Ho, Tiffany AU - Knox, Jordan AU - Ose, Dominik PY - 2023/8/31 TI - We Cannot Put This Genie Back in the Bottle: Qualitative Interview Study Among Family Medicine Providers About Their Experiences With Virtual Visits During the COVID-19 Pandemic JO - J Med Internet Res SP - e43877 VL - 25 KW - family medicine KW - primary care KW - virtual visits KW - telemedicine KW - COVID-19 N2 - Background: When a genie is freed from its bottle, things cannot be restored to the way they were before. At the beginning of the global COVID-19 pandemic, health care systems adjusted how they delivered care overnight. Primary care practices switched from seeing patients in person to virtual care applications, including video and phone visits, e-visits, e-consults, and messaging with clinicians. Prior to the pandemic, these applications were not as widely used, but discussions around their advantages and disadvantages in some settings were being explored. Emergency regulatory changes spurred by the pandemic freed this virtual care ?genie? from its bottle. Wide-scale adoption of virtual care in family medicine has much potential, as primary care services are often a patient?s first point of contact with the health care system. Objective: This study aims to analyze family medicine providers? experiences using virtual visits during the pandemic, perceived outcomes of the shift to virtual visits, and discusses its implications for the future of family medicine. Methods: This qualitative study took place at 3 academic primary care clinics between June and December 2020. Data were collected through one-on-one Zoom (version 5.2.1) interviews with family medicine clinical faculty who experienced the rapid transition of in-person visits to mostly ?virtual? visits. The interviews were recorded, deidentified, and transcribed. We adopted a constructivist approach to qualitative content analysis to evaluate the results. Results: In total, 25 participants were eligible, and 20 individuals participated in this study (80% participation rate). The mean age was 43.4 years, and 85% (17/20) of the participants were female. We identified 3 main themes: the care process, patient engagement, and team-based care. Conclusions: This study highlights the transition from in-person to virtual visits during the pandemic from the perspective of family medicine providers. Generally, family medicine providers? perceptions of the shift to virtual visits were positive, especially regarding team-based care. Challenges involved virtual inhibition, particularly for providers. Providers described ways they integrated virtual care with aspects of in-person care, creating a hybrid environment. The genie is out of the bottle?things will not be the same?but family medicine now has the opportunity to evolve. UR - https://www.jmir.org/2023/1/e43877 UR - http://dx.doi.org/10.2196/43877 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651162 ID - info:doi/10.2196/43877 ER - TY - JOUR AU - Vanderhout, Shelley AU - Goldbloom, B. Ellen AU - Li, Amy AU - Newhook, Dennis AU - Garcia, Meghan AU - Dulude, Catherine PY - 2023/8/30 TI - Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study JO - J Med Internet Res SP - e45287 VL - 25 KW - environmental scan KW - experience KW - interviews KW - pediatrics KW - telemedicine KW - virtual care N2 - Background: Virtual care was rapidly integrated into pediatric health services during the COVID-19 pandemic. While virtual care offers many benefits, it is necessary to better understand the experiences of those who receive, deliver, and coordinate virtual care in order to support sustainable, high-quality, and patient-centered health care. To date, methods implemented to evaluate users? experiences of virtual care have been highly variable, making comparison and data synthesis difficult. Objective: This study aims to describe evaluation strategies currently used to understand personal experiences with pediatric virtual care in Canada. Methods: In this mixed methods environmental scan, we first distributed a web-based questionnaire to clinical, research, and operational leaders delivering and evaluating pediatric virtual care in Canada. The questionnaire collected information about how experiences with virtual care have been or are currently being evaluated and whether these evaluations included the perspectives of children or youth, families, providers, or support staff. Second, respondents were asked to share the questions they used in their evaluations, and a content analysis was performed to identify common question categories. Third, we conducted semistructured interviews to further explore our respondents? evaluation experiences across 4 domains?evaluation approaches, distribution methods, response rates, and lessons learned?and interest in a core set of questions for future evaluations. Results: There were 72 respondents to the web-based questionnaire; among those who had conducted an evaluation, we identified 15 unique evaluations, and 14 of those provided a copy of the tools used to evaluate virtual care. These evaluations measured the virtual care experiences of parents or caregivers (n=15, 100%), children or youth (n=11, 73%), health care providers (n=11, 73%), and support staff (n=4, 27%). The most common data collection method used was electronic questionnaires distributed by email. Two respondents used validated tools; the remainder modified existing tools or developed new tools. Content analysis of the 14 submitted questionnaires revealed that the most common questions were about overall participant satisfaction, the comparison of virtual care to in-person care, and whether participants would choose virtual care options in the future. Interview findings indicate respondents frequently relied on methods used by peers and that a standardized, core set of questions to evaluate experiences with virtual care would be helpful to improve evaluation practices and support pediatric health care delivery. Conclusions: At our institution and elsewhere in Canada, experiences with pediatric virtual care have been evaluated using a variety of methods. A more consistent evaluation approach using standardized tools may enable more regular comparisons of experiences with virtual care and the synthesis of findings across health care settings. In turn, this may better inform our approach to virtual care, improve its integration into health systems, and facilitate sustainable, high-quality, patient-centered care. UR - https://www.jmir.org/2023/1/e45287 UR - http://dx.doi.org/10.2196/45287 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647120 ID - info:doi/10.2196/45287 ER - TY - JOUR AU - Campbell, Kate AU - Greenfield, Geva AU - Li, Edmond AU - O'Brien, Niki AU - Hayhoe, Benedict AU - Beaney, Thomas AU - Majeed, Azeem AU - Neves, Luísa Ana PY - 2023/8/30 TI - The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review JO - J Med Internet Res SP - e48920 VL - 25 KW - remote consultations KW - primary care KW - telemedicine KW - systematic review KW - teleconsult KW - quality care KW - efficiency KW - socioeconomic status N2 - Background: The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. Objective: This study aims to evaluate the impact of virtual consultations on the quality of primary care. Methods: A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. Results: In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients? perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. Conclusions: Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies. UR - https://www.jmir.org/2023/1/e48920 UR - http://dx.doi.org/10.2196/48920 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647117 ID - info:doi/10.2196/48920 ER - TY - JOUR AU - Flynn, Nichols Anne AU - Koelper, C. Nathanael AU - Sonalkar, Sarita PY - 2023/8/28 TI - Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study JO - J Med Internet Res SP - e42559 VL - 25 KW - contraception KW - electronic medical record KW - family planning KW - pregnancy intendedness KW - pregnancy of unknown location KW - pre-post study KW - telephone-based intervention N2 - Background: Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed. Objective: This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention. Methods: This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception. Results: Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort. Conclusions: We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care. UR - https://www.jmir.org/2023/1/e42559 UR - http://dx.doi.org/10.2196/42559 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639302 ID - info:doi/10.2196/42559 ER - TY - JOUR AU - Wu, Chenguang Doris AU - Zhao, Xianduo AU - Wu, Ji PY - 2023/8/24 TI - Online Physician-Patient Interaction and Patient Satisfaction: Empirical Study of the Internet Hospital Service JO - J Med Internet Res SP - e39089 VL - 25 KW - internet hospital KW - online health service KW - online physician-patient interaction KW - patient satisfaction KW - COVID-19 N2 - Background: In China, a form of online health service called the internet hospital became a prominent means of patient care when face-to-face visits were not possible during the COVID-19 pandemic to minimize transmission of the SARS-CoV-2 virus. Patients? internet hospital experiences largely depend on online physician-patient interaction. Yet, little is known about how physicians can improve patient satisfaction by using specific communication strategies online. Objective: This study aimed to identify specific communication strategies to help physicians deliver better quality internet hospital services. We also outline recommendations for hospitals to operate internet hospital platforms more effectively. Methods: A longitudinal data set was collected from an internet hospital platform operated by a top hospital in China. By extracting communication patterns from approximately 20,000 records of online health care services and by controlling the features of service requests, we tested the impacts of response load, more detailed style, and emotional comfort on patient satisfaction. We further explored the effects of these communication patterns in different service contexts. Results: Physicians with a low response load, a more detailed style, and expressions of emotional comfort received more positive patient feedback. Response load did not affect patient satisfaction with free online health service, whereas a more detailed style and emotional comfort enhanced satisfaction with free service. Response load significantly reduced patient satisfaction with paid online health service, while a more detailed style had no effect. Compared with free service, emotional comfort more strongly promoted patient satisfaction with paid service. Conclusions: The communication strategies identified can help physicians provide patients with a better internet hospital experience. These strategies require hospitals to schedule each physician?s online service period more appropriately. In addition, tailoring the strategies to service situations can facilitate more targeted and effective internet hospital service for patients. UR - https://www.jmir.org/2023/1/e39089 UR - http://dx.doi.org/10.2196/39089 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616031 ID - info:doi/10.2196/39089 ER - TY - JOUR AU - Brown-Johnson, G. Cati AU - Lessios, Sophia Anna AU - Thomas, Samuel AU - Kim, Mirini AU - Fukaya, Eri AU - Wu, Siqi AU - Kling, R. Samantha M. AU - Brown, Gretchen AU - Winget, Marcy PY - 2023/8/23 TI - A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study JO - JMIR Form Res SP - e43258 VL - 7 KW - nursing KW - telehealth KW - telemedicine KW - follow-up KW - wound care KW - capacity building KW - mobile phone N2 - Background: Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective: This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods: Patients and part-time or per-diem, wound care?certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results: This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care?specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions: This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients? technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care. UR - https://formative.jmir.org/2023/1/e43258 UR - http://dx.doi.org/10.2196/43258 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610798 ID - info:doi/10.2196/43258 ER - TY - JOUR AU - Lehmann, Jens AU - de Ligt, M. Kelly AU - Tipelius, Stefanie AU - Giesinger, M. Johannes AU - Sztankay, Monika AU - Voigt, Sandra AU - van de Poll-Franse, V. Lonneke AU - Rumpold, Gerhard AU - Weger, Roman AU - Willenbacher, Ella AU - Willenbacher, Wolfgang AU - Holzner, Bernhard PY - 2023/8/22 TI - Adherence to Patient-Reported Symptom Monitoring and Subsequent Clinical Interventions for Patients With Multiple Myeloma in Outpatient Care: Longitudinal Observational Study JO - J Med Internet Res SP - e46017 VL - 25 KW - neoplasms KW - patient-reported outcome measures KW - quality of life KW - ambulatory care KW - multiple myeloma KW - symptom monitoring KW - symptoms KW - monitoring KW - myeloma KW - cancer patient KW - therapy KW - application KW - treatment KW - web-based assessment KW - clinical care N2 - Background: The use of software to monitor patient-reported outcome measures (PROMs) can improve outcomes for patients with cancer receiving anticancer therapy; however, evidence from applications used in routine clinical practice is lacking. Objective: We aimed to investigate adherence to and patient perceptions of a weekly, web-based PROM symptom monitoring program in routine clinical practice for patients with Multiple Myeloma. Moreover, we aimed to capture how clinical alerts prompted by the system influenced clinical care. Methods: We conducted a single-center longitudinal observational study to evaluate patient adherence to and perceptions of the PROM monitoring software in routine practice. Patients with Multiple Myeloma remotely completed weekly treatment-specific PROMs to monitor key symptoms via a dedicated web-based platform. Alarming symptoms triggered clinical alerts in the application for the treatment team, which could initiate clinical interventions. The primary outcomes were the web-based assessment completion rate and patients? perceptions of the monitoring program, as assessed by an evaluation questionnaire. Moreover, clinical alerts prompted by the system and consequential clinical interventions were analyzed. Results: Between July 2021 and June 2022, a total of 55 patients were approached for participation; 39 patients participated (24, 61% male, mean age 63.2, SD 9.2 years). The median assessment completion rate out of all weekly scheduled assessments was 70.3% (IQR 41.2%-89.6%). Most patients (77%) felt that the health care team was better informed about their health status due to the web-based assessments. Clinical alerts were triggered for 1758 of 14,639 (12%) reported symptoms. For 548 of 1758 (31.2%) alerts, the symptom had been registered before and no further action was required; for 348 of 1758 (19.9%) alerts, telephone consultation and self-management advice sufficed. Higher-level interventions were seldom needed in response to alerts: referral to a doctor or specialist (88/1758, 5% alerts), medication changes (22/1758, 1.3%), scheduling additional diagnostics (9/1758, 0.5%), or unplanned emergency visits (7/1758, 0.4%). Most patients (55%) reported the calls in response to alerts gave them ?quite a bit? or ?very much? of an added feeling of security during therapy. Conclusions: Our study shows that high adherence to regular and tailored PROM monitoring can be achieved in routine clinical care. The findings provide valuable insight into how the PROM monitoring program and the clinical alerts and resulting interventions shaped clinical practice. Trial Registration: ClinicalTrials.gov NCT05036863; https://clinicaltrials.gov/study/NCT05036863 UR - https://www.jmir.org/2023/1/e46017 UR - http://dx.doi.org/10.2196/46017 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606979 ID - info:doi/10.2196/46017 ER - TY - JOUR AU - Calabrò, Salvatore Rocco AU - Bonanno, Mirjam AU - Torregrossa, William AU - Cacciante, Luisa AU - Celesti, Antonio AU - Rifici, Carmela AU - Tonin, Paolo AU - De Luca, Rosaria AU - Quartarone, Angelo PY - 2023/8/21 TI - Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality JO - J Med Internet Res SP - e45458 VL - 25 KW - telerehabilitation KW - teleneuro-VRRS KW - virtual reality rehabilitation system KW - SABI KW - severe acquired brain injury KW - acquired brain injury KW - virtual reality KW - rehabilitation KW - neurorehabilitation KW - brain injury KW - neurology N2 - Background: In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). Objective: The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. Methods: In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. Results: The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Conclusions: Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers? burden distress management, mitigating distress and promoting positive aspects of caring. Trial Registration: ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875 UR - https://www.jmir.org/2023/1/e45458 UR - http://dx.doi.org/10.2196/45458 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490017 ID - info:doi/10.2196/45458 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Bokermann, Josephine AU - Hajek, André PY - 2023/8/18 TI - Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review JO - JMIR Ment Health SP - e46148 VL - 10 KW - telemedicine KW - digital health KW - teletherapy KW - mental health KW - use KW - satisfaction N2 - Background: Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. Objective: The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. Methods: This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. Results: Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). Conclusions: The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. Trial Registration: PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5 UR - https://mental.jmir.org/2023/1/e46148 UR - http://dx.doi.org/10.2196/46148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594785 ID - info:doi/10.2196/46148 ER - TY - JOUR AU - Thomas, Elizabeth AU - Lee, Ying Crystal Man AU - Norman, Richard AU - Wells, Leanne AU - Shaw, Tim AU - Nesbitt, Julia AU - Frean, Isobel AU - Baxby, Luke AU - Bennett, Sabine AU - Robinson, Suzanne PY - 2023/8/17 TI - Patient Use, Experience, and Satisfaction With Telehealth in an Australian Population (Reimagining Health Care): Web-Based Survey Study JO - J Med Internet Res SP - e45016 VL - 25 KW - telehealth KW - consumer experience KW - demographic influence KW - population survey KW - health care survey KW - telemedicine KW - Australia KW - participant recruitment N2 - Background: The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. Objective: The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. Methods: A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. Results: Of the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor?s degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. Conclusions: There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor?s degree. UR - https://www.jmir.org/2023/1/e45016 UR - http://dx.doi.org/10.2196/45016 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590037 ID - info:doi/10.2196/45016 ER - TY - JOUR AU - Lear, Rachael AU - Ellis, Sophia AU - Ollivierre-Harris, Tiffany AU - Long, Susannah AU - Mayer, K. Erik PY - 2023/8/16 TI - Video Recording Patients for Direct Care Purposes: Systematic Review and Narrative Synthesis of International Empirical Studies and UK Professional Guidance JO - J Med Internet Res SP - e46478 VL - 25 KW - video recording KW - audio-visual media KW - digital health KW - electronic health records KW - mobile phone N2 - Background: Video recordings of patients may offer advantages to supplement patient assessment and clinical decision-making. However, little is known about the practice of video recording patients for direct care purposes. Objective: We aimed to synthesize empirical studies published internationally to explore the extent to which video recording patients is acceptable and effective in supporting direct care and, for the United Kingdom, to summarize the relevant guidance of professional and regulatory bodies. Methods: Five electronic databases (MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC) were searched from 2012 to 2022. Eligible studies evaluated an intervention involving video recording of adult patients (?18 years) to support diagnosis, care, or treatment. All study designs and countries of publication were included. Websites of UK professional and regulatory bodies were searched to identify relevant guidance. The acceptability of video recording patients was evaluated using study recruitment and retention rates and a framework synthesis of patients? and clinical staff?s perspectives based on the Theoretical Framework of Acceptability by Sekhon. Clinically relevant measures of impact were extracted and tabulated according to the study design. The framework approach was used to synthesize the reported ethico-legal considerations, and recommendations of professional and regulatory bodies were extracted and tabulated. Results: Of the 14,221 abstracts screened, 27 studies met the inclusion criteria. Overall, 13 guidance documents were retrieved, of which 7 were retained for review. The views of patients and clinical staff (16 studies) were predominantly positive, although concerns were expressed about privacy, technical considerations, and integrating video recording into clinical workflows; some patients were anxious about their physical appearance. The mean recruitment rate was 68.2% (SD 22.5%; range 34.2%-100%; 12 studies), and the mean retention rate was 73.3% (SD 28.6%; range 16.7%-100%; 17 studies). Regarding effectiveness (10 studies), patients and clinical staff considered video recordings to be valuable in supporting assessment, care, and treatment; in promoting patient engagement; and in enhancing communication and recall of information. Observational studies (n=5) favored video recording, but randomized controlled trials (n=5) did not demonstrate that video recording was superior to the controls. UK guidelines are consistent in their recommendations around consent, privacy, and storage of recordings but lack detailed guidance on how to operationalize these recommendations in clinical practice. Conclusions: Video recording patients for direct care purposes appears to be acceptable, despite concerns about privacy, technical considerations, and how to incorporate recording into clinical workflows. Methodological quality prevents firm conclusions from being drawn; therefore, pragmatic trials (particularly in older adult care and the movement disorders field) should evaluate the impact of video recording on diagnosis, treatment monitoring, patient-clinician communication, and patient safety. Professional and regulatory documents should signpost to practical guidance on the implementation of video recording in routine practice. Trial Registration: PROSPERO CRD42022331825: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331825 UR - https://www.jmir.org/2023/1/e46478 UR - http://dx.doi.org/10.2196/46478 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585249 ID - info:doi/10.2196/46478 ER - TY - JOUR AU - Campos-Castillo, Celeste PY - 2023/8/16 TI - Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment JO - JMIR Form Res SP - e38965 VL - 7 KW - primary care shortage KW - workforce KW - health care seeking KW - public opinion KW - consumers KW - online studies KW - COVID-19 KW - pandemic KW - primary care KW - nurse practitioners KW - nurse KW - healthcare KW - resources KW - advocacy N2 - Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. Objective: The aim of this study is to evaluate the public?s willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon?s Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed. UR - https://formative.jmir.org/2023/1/e38965 UR - http://dx.doi.org/10.2196/38965 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347928 ID - info:doi/10.2196/38965 ER - TY - JOUR AU - Maul, Valeska Lara AU - Jahn, Sophie Anna AU - Pamplona, P. Gustavo S. AU - Streit, Markus AU - Gantenbein, Lorena AU - Müller, Simon AU - Nielsen, Mia-Louise AU - Greis, Christian AU - Navarini, A. Alexander AU - Maul, Julia-Tatjana PY - 2023/8/11 TI - Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users? Perspectives: Multicenter, Cross-Sectional Study in Dermatology JO - JMIR Dermatol SP - e45384 VL - 6 KW - acceptance KW - patient KW - physician KW - satisfaction KW - teledermatology N2 - Background: Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. Objective: The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. Methods: This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. Results: Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). Conclusions: This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. Trial Registration: ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036 UR - https://derma.jmir.org/2023/1/e45384 UR - http://dx.doi.org/10.2196/45384 UR - http://www.ncbi.nlm.nih.gov/pubmed/37582265 ID - info:doi/10.2196/45384 ER - TY - JOUR AU - Sapanel, Yoann AU - Tadeo, Xavier AU - Brenna, A. Connor T. AU - Remus, Alexandria AU - Koerber, Florian AU - Cloutier, Martin L. AU - Tremblay, Gabriel AU - Blasiak, Agata AU - Hardesty, L. Chris AU - Yoong, Joanne AU - Ho, Dean PY - 2023/8/1 TI - Economic Evaluation Associated With Clinical-Grade Mobile App?Based Digital Therapeutic Interventions: Systematic Review JO - J Med Internet Res SP - e47094 VL - 25 KW - digital health KW - digital therapeutics KW - economic evaluation KW - cost-effectiveness KW - mobile phone KW - systematic review N2 - Background: Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of medical disorders and diseases as well as deliver unprecedented portability for patients and scalability for health care providers. Their adoption and implementation were accelerated by the need for remote care during the COVID-19 pandemic, and awareness about their utility has rapidly grown among providers, payers, and regulators. Despite this, relatively little is known about the capacity of DTx to provide economic value in care. Objective: This study aimed to systematically review and summarize the published evidence regarding the cost-effectiveness of clinical-grade mobile app?based DTx and explore the factors affecting such evaluations. Methods: A systematic review of economic evaluations of clinical-grade mobile app?based DTx was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Major electronic databases, including PubMed, Cochrane Library, and Web of Science, were searched for eligible studies published from inception to October 28, 2022. Two independent reviewers evaluated the eligibility of all the retrieved articles for inclusion in the review. Methodological quality and risk of bias were assessed for each included study. Results: A total of 18 studies were included in this review. Of the 18 studies, 7 (39%) were nonrandomized study?based economic evaluations, 6 (33%) were model-based evaluations, and 5 (28%) were randomized clinical trial?based evaluations. The DTx intervention subject to assessment was found to be cost-effective in 12 (67%) studies, cost saving in 5 (28%) studies, and cost-effective in 1 (6%) study in only 1 of the 3 countries where it was being deployed in the final study. Qualitative deficiencies in methodology and substantial potential for bias, including risks of performance bias and selection bias in participant recruitment, were identified in several included studies. Conclusions: This systematic review supports the thesis that DTx interventions offer potential economic benefits. However, DTx economic analyses conducted to date exhibit important methodological shortcomings that must be addressed in future evaluations to reduce the uncertainty surrounding the widespread adoption of DTx interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022358616; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022358616 UR - https://www.jmir.org/2023/1/e47094 UR - http://dx.doi.org/10.2196/47094 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526973 ID - info:doi/10.2196/47094 ER - TY - JOUR AU - Rettinger, Lena AU - Kuhn, Sebastian PY - 2023/8/1 TI - Barriers to Video Call?Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process JO - J Med Internet Res SP - e46715 VL - 25 KW - telehealth KW - telemedicine KW - eHealth KW - barriers KW - allied health professions KW - nursing KW - video call KW - videoconferencing KW - web-based consultation KW - remote consultation KW - mobile phone N2 - Background: Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses. Objective: This review aimed to identify and map the perceived barriers to the use of video call?based telehealth interventions among allied health professionals and nurses. Methods: A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call?based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups. Results: A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication. Conclusions: This review identified key barriers to video call?based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers. UR - https://www.jmir.org/2023/1/e46715 UR - http://dx.doi.org/10.2196/46715 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526957 ID - info:doi/10.2196/46715 ER - TY - JOUR AU - Zhong, Wen AU - Liu, Rui AU - Cheng, Hongxin AU - Xu, Lin AU - Wang, Lu AU - He, Chengqi AU - Wei, Quan PY - 2023/7/28 TI - Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e46359 VL - 11 KW - cardiac telerehabilitation KW - coronary artery disease KW - CAD KW - cardiac rehabilitation KW - CR KW - long-term effect KW - meta-analysis N2 - Background: Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. Objective: This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. Methods: We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. Results: In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. Conclusions: Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients. UR - https://mhealth.jmir.org/2023/1/e46359 UR - http://dx.doi.org/10.2196/46359 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505803 ID - info:doi/10.2196/46359 ER - TY - JOUR AU - Claessens, Janneau AU - Mueller-Schotte, Sigrid AU - van Weerden, Jeannette AU - Kort, Helianthe AU - Imhof, Saskia AU - Wisse, Robert PY - 2023/7/28 TI - The TeleTriageTeam, Offering Continuity of Personalized Care Through Telemedicine: Development and Evaluation JO - JMIR Hum Factors SP - e46145 VL - 10 KW - triaging KW - telehealth KW - telemedicine KW - remote care KW - ophthalmology KW - eye care KW - mobile phone KW - COVID-19 N2 - Background: The COVID-19 pandemic taught us how to rethink care delivery. It catalyzed creative solutions to amplify the potential of personnel and facilities. This paper presents and evaluates a promptly introduced triaging solution that evolved into a tool to tackle the ever-growing waiting lists at an academic ophthalmology department, the TeleTriageTeam (TTT). A team of undergraduate optometry students, tutor optometrists, and ophthalmologists collaborate to maintain continuity of eye care. In this ongoing project, we combine innovative interprofessional task allocation, teaching, and remote care delivery. Objective: In this paper, we described a novel approach, the TTT; reported its clinical effectiveness and impact on waiting lists; and discussed its transformation to a sustainable method for delivering remote eye care. Methods: Real-world clinical data of all patients assessed by the TTT between April 16, 2020, and December 31, 2021, are covered in this paper. Business data on waiting lists and patient portal access were collected from the capacity management team and IT department of our hospital. Interim analyses were performed at different time points during the project, and this study presents a synthesis of these analyses. Results: A total of 3658 cases were assessed by the TTT. For approximately half (1789/3658, 48.91%) of the assessed cases, an alternative to a conventional face-to-face consultation was found. The waiting lists that had built up during the first months of the pandemic diminished and have been stable since the end of 2020, even during periods of imposed lockdown restrictions and reduced capacity. Patient portal access decreased with age, and patients who were invited to perform a remote, web-based eye test at home were on average younger than patients who were not invited. Conclusions: Our promptly introduced approach to remotely review cases and prioritize urgency has been successful in maintaining continuity of care and education throughout the pandemic and has evolved into a telemedicine service that is of great interest for future purposes, especially in the routine follow-up of patients with chronic diseases. TTT appears to be a potentially preferred practice in other clinics and medical specialties. The paradox is that judicious clinical decision-making based on remotely collected data is possible, only if we as caregivers are willing to change our routines and cognitions regarding face-to-face care delivery. UR - https://humanfactors.jmir.org/2023/1/e46145 UR - http://dx.doi.org/10.2196/46145 UR - http://www.ncbi.nlm.nih.gov/pubmed/37311121 ID - info:doi/10.2196/46145 ER - TY - JOUR AU - Baradwan, Saeed AU - Al-Hanawi, Mohammed PY - 2023/7/27 TI - Perceived Knowledge, Attitudes, and Barriers Toward the Adoption of Telemedicine Services in the Kingdom of Saudi Arabia: Cross-Sectional Study JO - JMIR Form Res SP - e46446 VL - 7 KW - telemedicine KW - telehealth KW - attitude KW - knowledge KW - barrier KW - Saudi Arabia KW - mobile phone N2 - Background: The adoption of telemedicine has facilitated the opportunity to offer the best health care services. Nevertheless, there is a mismatch between the presence of telemedicine programs in the Kingdom of Saudi Arabia and poor acceptance by the end-user patients. Objective: This study aimed to gain a holistic understanding of the knowledge, attitudes, and barriers of the end-user patients (ie, research participants) toward the utility of telemedicine services in the Kingdom of Saudi Arabia. Methods: A cross-sectional, survey-based study was conducted from June 1 to July 31, 2022, in the Kingdom of Saudi Arabia. The questionnaire was developed based on a literature review and was examined for validity and reliability. Knowledge questions used a yes-or-no format, whereas attitude and barrier questions used a 5-point Likert-scale format. Data were reported descriptively and analyzed using SPSS (IBM Corp) software. To evaluate the differences in mean scores and identify sociodemographic factors associated with knowledge and attitudes toward the adoption of telemedicine, the data were analyzed using univariate and multivariable regression analyses, respectively. Results: Overall, 1024 participants participated in the survey. The percentages of participants who attended a telemedicine service before, during, and after COVID-19 were 49.61% (508/1024), 61.91% (634/1024), and 50.1% (513/1024), respectively. The mean score for knowledge was 3.52 (SD 1.486; range 0-5), reflecting a high level of knowledge. The mean score for attitudes was 37.08 (SD 8.526; range 11-55), reflecting optimistic (positive) attitudes. Regarding barriers, the participants voiced some concerns regarding patient and physician resistance and attributed some cultural and technology-related limitations as potential hindrances to the full adoption of telemedicine services. The place of residence (rural vs nonrural) had a significant impact on the scores of knowledge, attitudes, and barriers, whereas gender had no significant impact. The multivariable regression analysis showed that several sociodemographic factors significantly correlated with knowledge and attitudes toward the adoption of telemedicine services. Conclusions: The participants showed good knowledge and positive attitudes toward telemedicine services. The perceived barriers were in line with the published literature. This research calls for the need to strengthen the positive attitudes and rectify the barriers, so that the utility of telemedicine services can be maximized in the community. UR - https://formative.jmir.org/2023/1/e46446 UR - http://dx.doi.org/10.2196/46446 UR - http://www.ncbi.nlm.nih.gov/pubmed/37315177 ID - info:doi/10.2196/46446 ER - TY - JOUR AU - Rome, Danielle AU - Sales, Alyssa AU - Cornelius, Talea AU - Malhotra, Sujata AU - Singer, Jessica AU - Ye, Siqin AU - Moise, Nathalie PY - 2023/7/26 TI - Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science?Informed Retrospective Cohort Study JO - J Med Internet Res SP - e47670 VL - 25 KW - telemedicine KW - telehealth KW - implementation science KW - quality metrics KW - screening KW - adoption KW - diverse KW - socioeconomic KW - audio based KW - video based KW - video consultation N2 - Background: Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics. Objective: The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens. Methods: Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation. Results: We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population. Conclusions: Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered. UR - https://www.jmir.org/2023/1/e47670 UR - http://dx.doi.org/10.2196/47670 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494087 ID - info:doi/10.2196/47670 ER - TY - JOUR AU - Xu, Jianing AU - Qu, Mingyu AU - Dong, Xuejie AU - Chen, Yihe AU - Yin, Hongfan AU - Qu, Fangge AU - Zhang, Lin PY - 2023/7/26 TI - Tele-Instruction Tool for Multiple Lay Responders Providing Cardiopulmonary Resuscitation in Telehealth Emergency Dispatch Services: Mixed Methods Study JO - J Med Internet Res SP - e46092 VL - 25 KW - cardiac arrest KW - lay responder KW - teamwork KW - telehealth KW - telephone-assisted cardiopulmonary resuscitation N2 - Background: Telephone-assisted cardiopulmonary resuscitation (T-CPR) has proven to be a crucial intervention in enhancing the ability of lay responders to perform cardiopulmonary resuscitation (CPR) during telehealth emergency services. While the majority of established T-CPR protocols primarily focus on guiding individual rescuers, there is a lack of emphasis on instructing and coordinating multiple lay responders to perform resuscitation collaboratively. Objective: This study aimed to develop an innovative team-based tele-instruction tool to efficiently organize and instruct multiple lay responders on the CPR process and to evaluate the effectiveness and feasibility of the tool. Methods: We used a mixed methods design in this study. We conducted a randomized controlled simulation trial to conduct the quantitative analysis. The intervention groups used the team-based tele-instruction tool for team resuscitation, while the control groups did not have access to the tool. Baseline resuscitation was performed during the initial phase (phase I test). Subsequently, all teams watched a team-based CPR education training video and finished a 3-person practice session with teaching followed by a posttraining test (phase II test). In the qualitative analysis, we randomly selected an individual from each team and 4 experts in emergency medical services to conduct semistructured interviews. The purpose of these interviews was to evaluate the effectiveness and feasibility of this tool. Results: The team-based tele-instruction tool significantly improved the quality of chest compression in both phase I and phase II tests. The average compression rates were more appropriate in the intervention groups compared to the control groups (median 104.5, IQR 98.8-111.8 min?1 vs median 112, IQR 106-120.8 min?1; P=.04 in phase I and median 117.5, IQR 112.3-125 min?1 vs median 111, IQR 105.3-119 min?1; P=.03 in phase II). In the intervention group, there was a delay in the emergency response time compared to that in the control group (time to first chest compression: median 20, IQR 15-24.8 seconds vs median 25, IQR 20.5-40.3 seconds; P=.03; time to open the airway: median 48, IQR 36.3-62 seconds vs median 73.5, IQR 54.5-227.8 seconds; P=.01). However, this delay was partially mitigated after the phase II test. The qualitative results confirmed the compatibility and generalizability of the team-based tele-instruction tool, demonstrating its ability to effectively guide multiple lay responders through teamwork and effective communication with telecommunicators. Conclusions: The use of the team-based tele-instruction tool offers an effective solution to enhance the quality of chest compression among multiple lay responders. This tool facilitated the organization of resuscitation teams by dispatchers and enabled efficient cooperation. Further assessment of the widespread adoption and practical application of the team-based tele-instruction tools in real-life rescue scenarios within the telehealth emergency services system is warranted. UR - https://www.jmir.org/2023/1/e46092 UR - http://dx.doi.org/10.2196/46092 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494107 ID - info:doi/10.2196/46092 ER - TY - JOUR AU - Gijsbers, Harm AU - Nurmohamed, Azam AU - van de Belt, H. Tom AU - Schijven, Marlies AU - PY - 2023/7/26 TI - The National Coordinated Citrien eHealth Program to Scale Up Telemonitoring: Protocol for a Before-and-After Evaluation Study JO - JMIR Res Protoc SP - e45201 VL - 12 KW - study protocol KW - implementation KW - upscaling KW - telemonitoring KW - telemedicine KW - e-health KW - eHealth KW - healthcare KW - health care N2 - Background: Sustainable implementation of telemonitoring in health care is challenging, especially if one aims to scale up telemonitoring initiatives nationwide. The National collaborative eHealth program in the Netherlands is supporting the nationwide upscaling of telemonitoring in 3 clinical domains by implementing telemonitoring in all Dutch university medical centers (UMCs). The chosen telemonitoring concepts are (1) telemonitoring solutions in the domain of cardiology, (2) telemonitoring solutions providing care from a distance in obstetrics, and (3) telemonitoring solutions monitoring vital functions in hospital wards. Objective: The aim of this study is to evaluate the upscaling of telemonitoring in Dutch university hospitals in order to gain a better knowledge of the process, methods, and outcomes of nationwide upscaling strategies. Our hypothesis is that by the completion of the Citrien program?s scale-up, telemonitoring will be operational in all UMCs but not normalized in routine care. Methods: A before-and-after study will be conducted to assess upscaling. The theoretical frameworks used are the framework for nonadoption, abandonment, scale-up, spread, and sustainability; the Normalization Process Theory; and a project management tool Project Canvas. The primary outcome of the study is the degree of normalization to which health care providers at UMCs consider telemonitoring a part of their routine practice, measured using the Normalization MeAsurement Development tool (NoMAD). Our secondary outcome is the uptake of telemonitoring at the Dutch UMCs, using management data from UMCs? business intelligence systems query. Results: Data will be collected between May 2020 and December 2022. Results were retrieved in June 2023. UMCs? business intelligence systems are queried for data for the secondary outcome measures. There is a risk that the UMCs will not be able to provide this management information. The laws and regulations governing telemonitoring in the Netherlands are changing, with the Electronic Data Exchange in Health Care Act (Wet elektronische gegevensuitwisseling in de zorg) and the European Health Data Space Act expected to positively influence implementation and upscaling. Conclusions: The Citrien program is a nationally coordinated change management program that is scaling up telemonitoring across contexts and settings. This study will produce original data on the uptake and upscaling of telemonitoring at Dutch UMCs. Future initiatives to implement eHealth in the health care sector may be guided by the wide range of success factors, obstacles, and experiences collected through this program. The network itself may be of great value impacting future acceleration of eHealth initiatives. International Registered Report Identifier (IRRID): DERR1-10.2196/45201 UR - https://www.researchprotocols.org/2023/1/e45201 UR - http://dx.doi.org/10.2196/45201 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494085 ID - info:doi/10.2196/45201 ER - TY - JOUR AU - Kötting, Lukas AU - Derksen, Christina AU - Keller, Maria Franziska AU - Lippke, Sonia PY - 2023/7/24 TI - Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e44701 VL - 6 KW - Health Action Process Approach KW - HAPA KW - intention KW - safe communication behavior KW - patient safety KW - obstetric patients KW - digital intervention KW - web-based app N2 - Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women?s safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ?p2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ?p2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women?s communication and patient safety in obstetrics. Trial Registration: ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 UR - https://pediatrics.jmir.org/2023/1/e44701 UR - http://dx.doi.org/10.2196/44701 UR - http://www.ncbi.nlm.nih.gov/pubmed/37486755 ID - info:doi/10.2196/44701 ER - TY - JOUR AU - Haegens, L. Lex AU - Huiskes, B. Victor J. AU - van der Ven, Jeffrey AU - van den Bemt, F. Bart J. AU - Bekker, L. Charlotte PY - 2023/7/20 TI - Factors Influencing Preferences of Patients With Rheumatic Diseases Regarding Telehealth Channels for Support With Medication Use: Qualitative Study JO - JMIR Form Res SP - e45086 VL - 7 KW - digital human KW - drug-related problems KW - frequently asked questions KW - interviews KW - qualitative KW - rheumatology KW - support KW - telehealth KW - telemedicine N2 - Background: Patients with rheumatic diseases are known to experience drug-related problems at various times during their treatment. As these problems can negatively influence patients? health, they should be prevented or resolved as soon as possible, for which patients might benefit from additional support. Telehealth has the potential to continuously provide information and offers the possibility to easily contact a health care provider in order to support patients with medication use. Knowledge of factors influencing the patient?s preference for telehealth channels can improve the actual use of telehealth channels. Objective: This study aims to identify factors that influence the preferences of patients with rheumatic diseases regarding telehealth channels for support with medication use. Methods: A qualitative study with face-to-face interviews was performed among patients with an inflammatory rheumatic disease in the Netherlands. A total of 4 telehealth channels were used: a frequently asked questions page, a digital human, an app for SMS text messaging with health care providers, and an app for video-calling with health care providers. Using a semistructured interview guide based on domains of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, participants were questioned about (1) their general opinion on the 4 telehealth channels, (2) factors influencing preference for individual telehealth channels, and (3) factors influencing preference for individual telehealth channels in relation to the other available channels. Interviews were recorded, transcribed, and categorically analyzed. Results: A total of 15 patients were interviewed (female: n=8, 53%; male: n=7, 47%; mean age 55, SD 16.8 years; median treatment duration of 41, IQR 12-106 months). The following 3 categories of factors influencing patient preference regarding telehealth channels were identified: (1) problem-related factors included problems needing a visual check, problems specifically related to the patient, and urgency of the problem; (2) patient-related factors included personal communication preference and patient characteristics; and (3) channel-related factors included familiarity with the telehealth channel, direct communication with a health care provider, methods of searching, and conversation history. Conclusions: Preference for telehealth channels is influenced by factors related to the problem experienced, the patient experiencing the problem, and telehealth channel characteristics. As the preference for telehealth channels varies between these categories, multiple telehealth channels should be offered to enable patients to tailor the support with their medication use to their needs. UR - https://formative.jmir.org/2023/1/e45086 UR - http://dx.doi.org/10.2196/45086 UR - http://www.ncbi.nlm.nih.gov/pubmed/37471137 ID - info:doi/10.2196/45086 ER - TY - JOUR AU - Pol, Margriet AU - Qadeer, Amarzish AU - van Hartingsveldt, Margo AU - Choukou, Mohamed-Amine PY - 2023/7/18 TI - Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study JO - JMIR Rehabil Assist Technol SP - e44498 VL - 10 KW - aging in place KW - aging well KW - digital technology KW - remote monitoring KW - activity KW - sensor KW - mobile phone N2 - Background: Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identi?ed as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. Objective: The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. Methods: We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers? perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. Results: The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Conclusions: Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults? rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals. UR - https://rehab.jmir.org/2023/1/e44498 UR - http://dx.doi.org/10.2196/44498 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463040 ID - info:doi/10.2196/44498 ER - TY - JOUR AU - Braga Ferreira, Letícia AU - Lanna de Almeida, Rodrigo AU - Arantes, Alair AU - Abdulazeem, Hebatullah AU - Weerasekara, Ishanka AU - Ferreira, Norberto Leticia Santos Dias AU - Fonseca de Almeida Messias, Luana AU - Siuves Ferreira Couto, Luciana AU - Parreiras Martins, Auxiliadora Maria AU - Suelen Antunes, Núbia AU - Fonseca Cândido, Carolina Raissa AU - Rosa Ferreira, Samuel AU - Guerra Pezzini Assis, Tati AU - Marques Pedroso, Thais AU - Boersma, Eric AU - Ribeiro, Antonio AU - Marcolino, Soriano Milena PY - 2023/7/10 TI - Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e45922 VL - 25 KW - anticoagulation KW - telemedicine KW - eHealth KW - warfarin KW - DOACs KW - atrial fibrillation N2 - Background: Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. Objective: The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. Methods: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. Results: In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). Conclusions: Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208 UR - https://www.jmir.org/2023/1/e45922 UR - http://dx.doi.org/10.2196/45922 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428532 ID - info:doi/10.2196/45922 ER - TY - JOUR AU - Cunha, Soraia Ana AU - Pedro, Rita Ana AU - Cordeiro, V. João PY - 2023/7/10 TI - Facilitators of and Barriers to Accessing Hospital Medical Specialty Telemedicine Consultations During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e44188 VL - 25 KW - health services accessibility KW - COVID-19 KW - hospitals KW - barriers KW - facilitators KW - telemedicine N2 - Background: The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in health care access, especially for the most susceptible populations. Objective: We aimed to characterize the determinant factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic and to identify the main opportunities and challenges (technological, ethical, legal, and social) generated by the use of telemedicine in the context of the COVID-19 pandemic. Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases (Scopus, Web of Science, PubMed, and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3, 2020, and December 31, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and the results were integrated into a thematic synthesis. The identification of the main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. Results: Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States. The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and the need for complementary diagnostic tests or the delivery of test results. Conclusions: The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of a technological nature (access to technological devices and internet services and level of digital literacy), a sociocultural and demographic nature (ethnic and racial disparities, geographic disparities, language barriers, and age), a socioeconomic nature (income level and health insurance coverage), and an ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most susceptible communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. UR - https://www.jmir.org/2023/1/e44188 UR - http://dx.doi.org/10.2196/44188 UR - http://www.ncbi.nlm.nih.gov/pubmed/37262124 ID - info:doi/10.2196/44188 ER - TY - JOUR AU - Potts, Courtney AU - Lindström, Frida AU - Bond, Raymond AU - Mulvenna, Maurice AU - Booth, Frederick AU - Ennis, Edel AU - Parding, Karolina AU - Kostenius, Catrine AU - Broderick, Thomas AU - Boyd, Kyle AU - Vartiainen, Anna-Kaisa AU - Nieminen, Heidi AU - Burns, Con AU - Bickerdike, Andrea AU - Kuosmanen, Lauri AU - Dhanapala, Indika AU - Vakaloudis, Alex AU - Cahill, Brian AU - MacInnes, Marion AU - Malcolm, Martin AU - O'Neill, Siobhan PY - 2023/7/6 TI - A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study JO - J Med Internet Res SP - e43051 VL - 25 KW - conversational user interfaces KW - digital interventions KW - Warwick-Edinburgh Mental Well-Being Scale KW - Satisfaction With Life Scale KW - World Health Organization-Five Well-Being Index Scale KW - mental health KW - apps KW - health care KW - mixed methods KW - conversation agent KW - mental well-being KW - digital health intervention N2 - Background: In recent years, advances in technology have led to an influx of mental health apps, in particular the development of mental health and well-being chatbots, which have already shown promise in terms of their efficacy, availability, and accessibility. The ChatPal chatbot was developed to promote positive mental well-being among citizens living in rural areas. ChatPal is a multilingual chatbot, available in English, Scottish Gaelic, Swedish, and Finnish, containing psychoeducational content and exercises such as mindfulness and breathing, mood logging, gratitude, and thought diaries. Objective: The primary objective of this study is to evaluate a multilingual mental health and well-being chatbot (ChatPal) to establish if it has an effect on mental well-being. Secondary objectives include investigating the characteristics of individuals that showed improvements in well-being along with those with worsening well-being and applying thematic analysis to user feedback. Methods: A pre-post intervention study was conducted where participants were recruited to use the intervention (ChatPal) for a 12-week period. Recruitment took place across 5 regions: Northern Ireland, Scotland, the Republic of Ireland, Sweden, and Finland. Outcome measures included the Short Warwick-Edinburgh Mental Well-Being Scale, the World Health Organization-Five Well-Being Index, and the Satisfaction with Life Scale, which were evaluated at baseline, midpoint, and end point. Written feedback was collected from participants and subjected to qualitative analysis to identify themes. Results: A total of 348 people were recruited to the study (n=254, 73% female; n=94, 27% male) aged between 18 and 73 (mean 30) years. The well-being scores of participants improved from baseline to midpoint and from baseline to end point; however, improvement in scores was not statistically significant on the Short Warwick-Edinburgh Mental Well-Being Scale (P=.42), the World Health Organization-Five Well-Being Index (P=.52), or the Satisfaction With Life Scale (P=.81). Individuals that had improved well-being scores (n=16) interacted more with the chatbot and were significantly younger compared to those whose well-being declined over the study (P=.03). Three themes were identified from user feedback, including ?positive experiences,? ?mixed or neutral experiences,? and ?negative experiences.? Positive experiences included enjoying exercises provided by the chatbot, while most of the mixed, neutral, or negative experiences mentioned liking the chatbot overall, but there were some barriers, such as technical or performance errors, that needed to be overcome. Conclusions: Marginal improvements in mental well-being were seen in those who used ChatPal, albeit nonsignificant. We propose that the chatbot could be used along with other service offerings to complement different digital or face-to-face services, although further research should be carried out to confirm the effectiveness of this approach. Nonetheless, this paper highlights the need for blended service offerings in mental health care. UR - https://www.jmir.org/2023/1/e43051 UR - http://dx.doi.org/10.2196/43051 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410537 ID - info:doi/10.2196/43051 ER - TY - JOUR AU - Sim, Wilson AU - Choi, Ellie AU - Chandran, Suyien Nisha PY - 2023/7/6 TI - Where Are We With Teledermatology? Two Years in the Wake of COVID-19 JO - JMIR Dermatol SP - e47168 VL - 6 KW - teledermatology KW - telehealth KW - teleconsultation KW - COVID-19 KW - dermatology KW - trends KW - sustainability KW - uptake KW - telemedicine KW - global trend KW - low quality of care KW - technological barrier KW - virtual care UR - https://derma.jmir.org/2023/1/e47168 UR - http://dx.doi.org/10.2196/47168 UR - http://www.ncbi.nlm.nih.gov/pubmed/21127633 ID - info:doi/10.2196/47168 ER - TY - JOUR AU - Shaker, Abbas Ali AU - Austin, F. Stephen AU - Storebø, Jakob Ole AU - Schaug, Perrine Julie AU - Ayad, Alaa AU - Sørensen, Aasted John AU - Tarp, Kristine AU - Bechmann, Henrik AU - Simonsen, Erik PY - 2023/7/5 TI - Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e44790 VL - 10 KW - telemedicine KW - telepsychiatry KW - video consultation KW - mobile health KW - mHealth KW - eHealth KW - COVID-19 KW - synchronous technology KW - anxiety KW - psychiatry KW - patient satisfaction KW - depression KW - posttraumatic stress disorder KW - PTSD N2 - Background: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. Objective: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. Methods: A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. Results: A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference ?0.01, 95% CI ?0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (?0.66, 95% CI ?1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI ?0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). Conclusions: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357 UR - https://mental.jmir.org/2023/1/e44790 UR - http://dx.doi.org/10.2196/44790 UR - http://www.ncbi.nlm.nih.gov/pubmed/37277113 ID - info:doi/10.2196/44790 ER - TY - JOUR AU - Wiwatkunupakarn, Nutchar AU - Aramrat, Chanchanok AU - Pliannuom, Suphawita AU - Buawangpong, Nida AU - Pinyopornpanish, Kanokporn AU - Nantsupawat, Nopakoon AU - Mallinson, Carson Poppy Alice AU - Kinra, Sanjay AU - Angkurawaranon, Chaisiri PY - 2023/6/28 TI - The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review JO - J Med Internet Res SP - e45944 VL - 25 KW - telemedicine KW - clinical decision support system KW - CDSS KW - primary care KW - multimorbidity KW - polypharmacy KW - chronic disease KW - pharmacy KW - pharmaceutic KW - telehealth KW - decision support KW - scoping KW - search strategy KW - review N2 - Background: Multimorbidity, the presence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies that have been used to reduce the complexity of patient management. However, each element of telemedicine and CDSSs is often examined separately and with great variability. Telemedicine has been used for simple patient education as well as more complex consultations and case management. For CDSSs, there is variability in data inputs, intended users, and outputs. Thus, there are several gaps in knowledge about how to integrate CDSSs into telemedicine and to what extent these integrated technological interventions can help improve patient outcomes for those with multimorbidity. Objective: Our aims were to (1) broadly review system designs for CDSSs that have been integrated into each function of telemedicine for multimorbid patients in primary care, (2) summarize the effectiveness of the interventions, and (3) identify gaps in the literature. Methods: An online search for literature was conducted up to November 2021 on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference lists was done to find additional potential studies. The eligibility criterion was that the study focused on the use of CDSSs in telemedicine for patients with multimorbidity in primary care. The system design for the CDSS was extracted based on its software and hardware, source of input, input, tasks, output, and users. Each component was grouped by telemedicine functions: telemonitoring, teleconsultation, tele?case management, and tele-education. Results: Seven experimental studies were included in this review: 3 randomized controlled trials (RCTs) and 4 non-RCTs. The interventions were designed to manage patients with diabetes mellitus, hypertension, polypharmacy, and gestational diabetes mellitus. CDSSs can be used for various telemedicine functions: telemonitoring (eg, feedback), teleconsultation (eg, guideline suggestions, advisory material provisions, and responses to simple queries), tele?case management (eg, sharing information across facilities and teams), and tele-education (eg, patient self-management). However, the structure of CDSSs, such as data input, tasks, output, and intended users or decision-makers, varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions. Conclusions: Telemedicine and CDSSs have a role in supporting patients with multimorbidity. CDSSs can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined; examining tasks of CDSSs, particularly for screening and diagnosis of multiple conditions; and exploring the role of the patient as the direct user of the CDSS. UR - https://www.jmir.org/2023/1/e45944 UR - http://dx.doi.org/10.2196/45944 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379066 ID - info:doi/10.2196/45944 ER - TY - JOUR AU - Boyle, Tehnaz AU - Boggs, Krislyn AU - Gao, Jingya AU - McMahon, Maureen AU - Bedenbaugh, Rachel AU - Schmidt, Lauren AU - Zachrison, Sauser Kori AU - Goralnick, Eric AU - Biddinger, Paul AU - Camargo Jr, A. Carlos PY - 2023/6/27 TI - Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e44164 VL - 9 KW - disaster medicine KW - disaster KW - telemedicine KW - telehealth KW - eHealth KW - teleconsultation KW - remote consultation KW - health care delivery KW - e-consult KW - notification KW - alert KW - emergency KW - health system KW - hospital management N2 - Background: The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. Objective: To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response. Methods: We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability. Results: Overall, 164 (87%) hospitals and EDs responded?126 (77%) completed telephone surveys. Most (n=148, 90%) receive emergency notifications from state-based systems. Forty (24%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18%); radiation specialists, 25 (15%); and trauma specialists, 20 (12%). Among critical access hospitals (CAHs) or EDs with <10,000 annual visits (n=36), 92% received routine nondisaster telehealth services but lacked toxicologist (25%), burn (22%), and radiation (17%) specialist access. Most hospitals and EDs (n=115, 70%) require disaster credentialing of teleconsultants before system use. Among 113 hospitals and EDs with written disaster credentialing procedures, 28% expected completing disaster credentialing within 24 hours, and 55% within 25-72 hours, which varied by state. Most (n=154, 94%) reported adequate internet or cellular service for video-streaming; 81% maintained cellular service despite internet disruption. Fewer rural hospitals and EDs reported reliable internet or cellular service (19/22, 86% vs 135/142, 95%) and ability to maintain cellular service with internet disruption (11/19, 58% vs 113/135, 84%) than urban hospitals and EDs. Overall, 133 (81%) were somewhat or very likely to use a regional disaster teleconsultation system. Large-volume EDs (annual visits ?40,000) were less likely to use the service than smaller ones; all CAHs and nearly all rural hospitals or freestanding EDs were likely to use disaster consultation services. Among hospitals and EDs somewhat or very unlikely to use the system (n=26), sufficient consultant access (69%) and reluctance to use new technology or systems (27%) were common barriers. Potential delays (19%), liability (19%), privacy (15%), and hospital information system security restrictions (15%) were infrequent concerns. Conclusions: Most New England hospitals and EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. System developers should focus on ways to improve telecommunication redundancy in rural areas and use low-bandwidth technology to maintain service availability to CAHs and rural hospitals and EDs. Policies and procedures to accelerate and standardize disaster credentialing are needed for implementation across jurisdictions. UR - https://publichealth.jmir.org/2023/1/e44164 UR - http://dx.doi.org/10.2196/44164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368481 ID - info:doi/10.2196/44164 ER - TY - JOUR AU - Patel, Milan AU - Berlin, Hanna AU - Rajkumar, Abishek AU - Krein, L. Sarah AU - Miller, Rebecca AU - DeVito, Jessie AU - Roy, Jake AU - Punch, Margaret AU - Ellimootti, Chad AU - Peahl, F. Alex PY - 2023/6/26 TI - Barriers to Telemedicine Use: Qualitative Analysis of Provider Perspectives During the COVID-19 Pandemic JO - JMIR Hum Factors SP - e39249 VL - 10 KW - telehealth KW - virtual visits KW - public health crisis KW - barriers and facilitators KW - provider perspectives KW - implementation KW - access KW - health care KW - patient care N2 - Background: Though telemedicine is a promising approach for removing barriers to care and improving access for patients, telemedicine use for many medical specialties has decreased from its peak during the acute COVID-19 public health crisis. Understanding the barriers and facilitators to the maintenance of web-based visits?one key component of telemedicine?is critical for ensuring the continuous availability of this service for patients. Objective: The purpose of this study is to describe medical providers? perceived barriers and facilitators to the continued use of web-based visits to inform quality improvement efforts and promote sustainability. Methods: We performed a qualitative content analysis of free-text responses from a survey of medical providers administered from February 5-14, 2021, at a large, midwestern academic institution, including all providers from medical professions that offered telemedicine (eg, physicians, residents or fellows, nurse practitioners, physicians assistants, or nurses) who completed at least 1 web-based visit from March 20, 2020, to February 14, 2021. The primary outcome was the experience of providing web-based visits, including barriers and facilitators to continued usage of web-based visits. Survey questions included 3 major domains: quality of care, technology, and satisfaction. Responses were coded using qualitative content analysis and further analyzed through a matrix analysis to understand the providers? perspectives and elucidate key barriers and facilitators of web-based visit usage. Results: Of 2692 eligible providers, 1040 (38.6%) completed the survey, of whom 702 were providers from medical professions that offered telemedicine. These providers spanned 7 health care professions and 47 clinical departments. The most common professions represented were physicians (486/702, 46.7%), residents or fellows (85/702, 8.2%), and nurse practitioners (81/702, 7.8%), while the most common clinical departments were internal medicine (69/702, 6.6%), psychiatry (69/702, 6.6%), and physical medicine and rehabilitation (67/702, 6.4%). The following 4 overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. Though many providers saw web-based visits as a tool for improving care access, quality, and equity, others shared how appropriate selection of web-based visits, support (eg, patient training, home devices, and broadband access), and institutional and nationwide optimization (eg, relaxation of licensing requirements across state borders and reimbursement for phone-only modalities) were needed to sustain web-based visits. Conclusions: Our findings demonstrate key barriers to the maintenance of telemedicine services following the acute public health crisis. These findings can help prioritize the most impactful methods of sustaining and expanding telemedicine availability for patients who prefer this method of care delivery. UR - https://humanfactors.jmir.org/2023/1/e39249 UR - http://dx.doi.org/10.2196/39249 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358887 ID - info:doi/10.2196/39249 ER - TY - JOUR AU - Duffy, V. Lisa AU - Evans, Rebecka AU - Bennett, Veronica AU - Hady, Marie Joan AU - Palaniappan, Priya PY - 2023/6/22 TI - Therapeutic Relational Connection in Telehealth: Concept Analysis JO - J Med Internet Res SP - e43303 VL - 25 KW - therapeutic relational connection KW - telehealth KW - telemedicine KW - eHealth KW - concept analysis KW - provider-patient relationship KW - therapeutic relationship KW - relationship KW - connection KW - patient-provider KW - patient-physician N2 - Background:  Therapeutic relational connection (TRC) in telehealth is a new concept that refers to the intentional use of relationship connection between health care providers and their patients as both parties work toward a therapeutic aim. It has been demonstrated that TRC positively affects patient-centered outcomes including adherence, self-management, and satisfaction with care. What is not known are best practices for establishing TRC during telehealth visits. The rapid emergence of telehealth during the COVID-19 pandemic has identified a number of challenges. These challenges include lack of human contact, distance creating mistrust, the inability to rely on nonverbal communication, and a sense of depersonalization. Training for health care providers in these interpersonal communication skills needed to establish TRC during telehealth visits is needed. Objective:  This paper aims to explore the evolutionary concept of TRC in telehealth. The purpose of this paper is to provide a concept analysis of TRC during telehealth interactions between providers and patients through a comprehensive review of the existing published literature. Methods:  Rodgers? evolutionary concept analysis method was used to guide this study. PubMed, Embase, PsycINFO, and CINAHL were used to search for relevant publications. An integrative review strategy aided by Rayyan software was used to identify a final sample of 13 papers for analysis. Results:  The proposed definition of TRC in telehealth is the experience of a mutually responsive patient-provider relationship that is built on mutual respect and understanding and informed by cultural humility, presence, empathy, and the ability to effectively evaluate patient concerns to work toward a therapeutic aim. The key attributes of TRC in telehealth are the provider?s ability to evaluate patient concerns, interpersonal communication, cultural humility, mutual trust and respect, presence, empathy, and building relationships. Clinical presence, proper environment, knowledge about the use of technology (both patient and provider), use of verbal and nonverbal communication, and knowledge about community and culture are important antecedents of TRC. Consequences of TRC include improved communication resulting in mutual respect and caring, adherence to follow-up recommendations, increased coping, collaborative decision-making, and satisfaction with care. Conclusions:  Telehealth visits necessitate alternative approaches to establishing TRC as compared to in-person clinic visits. With the rapid expansion of telehealth platforms and a heightened acceptance of the technology, there is a need to integrate knowledge and provide a clear conceptualization of TRC in telehealth as TRC has been demonstrated to result in positive patient-centered outcomes. Identifying the attributes and antecedents of TRC in telehealth allows us the opportunity to develop guidelines and educational interventions aimed at training health care providers in the skills needed to establish TRC during telehealth visits. UR - https://www.jmir.org/2023/1/e43303 UR - http://dx.doi.org/10.2196/43303 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347526 ID - info:doi/10.2196/43303 ER - TY - JOUR AU - Touzani, Rajae AU - Dembele, Elodie AU - Schultz, Emilien AU - Rouquette, Alexandra AU - Seguin, Lorène AU - Dufour, Jean-Charles AU - Bannier, Marie AU - Mancini, Julien PY - 2023/6/16 TI - The French General Population?s Perception of New Information and Communication Technologies for Medical Consultations: National Survey JO - J Med Internet Res SP - e45822 VL - 25 KW - new ICT KW - video recording KW - mHealth apps KW - video broadcasting KW - health literacy KW - telehealth KW - teleconsultation KW - HLS19 KW - COVID-19 KW - France N2 - Background: The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples? current experience of health care. Objective: This study aimed to determine the French general population?s perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. Methods: Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. Results: The majority (1239/2003, 62%) of respondents considered the use of mHealth apps useful, while only 27.6% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (? 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95% CI 1.31-2.17; mHealth apps: aOR 1.88, 95% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. Conclusions: There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all. UR - https://www.jmir.org/2023/1/e45822 UR - http://dx.doi.org/10.2196/45822 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327032 ID - info:doi/10.2196/45822 ER - TY - JOUR AU - Trivedi, Ranak AU - Hirayama, Kawena Sierra AU - Risbud, Rashmi AU - Suresh, Madhuvanthi AU - Humber, Blair Marika AU - Butler, Kevin AU - Razze, Alex AU - Timko, Christine AU - Nelson, Karin AU - Zulman, M. Donna AU - Asch, M. Steven AU - Humphreys, Keith AU - Piette, D. John PY - 2023/6/16 TI - Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing JO - JMIR Form Res SP - e43903 VL - 7 KW - dyadic KW - eHealth KW - behavioral interventions KW - self-management KW - caregiver KW - web-based KW - interventions KW - stress management KW - self-care N2 - Background: The COVID-19 pandemic has amplified the need for web-based behavioral interventions to support individuals who are diagnosed with chronic conditions and their informal caregivers. However, most interventions focus on patient outcomes. Dyadic technology?enabled interventions that simultaneously improve outcomes for patients and caregivers are needed. Objective: This study aimed to describe the methodology used to adapt a telephone-based, facilitated, and dyadic self-management program called Self-care Using Collaborative Coping Enhancement in Diseases (SUCCEED) into a self-guided, web-based version (web-SUCCEED) and to conduct usability testing for web-SUCCEED. Methods: We developed web-SUCCEED in 6 steps: ideation?determine the intervention content areas; prototyping?develop the wireframes, illustrating the look and feel of the website; prototype refinement via feedback from focus groups; finalizing the module content; programming web-SUCCEED; and usability testing. A diverse team of stakeholders including content experts, web designers, patients, and caregivers provided input at various stages of development. Costs, including full-time equivalent employee, were summarized. Results: At the ideation stage, we determined the content of web-SUCCEED based on feedback from the program?s original pilot study. At the prototyping stage, the principal investigator and web designers iteratively developed prototypes that included inclusive design elements (eg, large font size). Feedback about these prototypes was elicited through 2 focus groups of veterans with chronic conditions (n=13). Rapid thematic analysis identified two themes: (1) web-based interventions can be useful for many but should include ways to connect with other users and (2) prototypes were sufficient to elicit feedback about the esthetics, but a live website allowing for continual feedback and updating would be better. Focus group feedback was incorporated into building a functional website. In parallel, the content experts worked in small groups to adapt SUCCEED?s content, so that it could be delivered in a didactic, self-guided format. Usability testing was completed by veterans (8/16, 50%) and caregivers (8/16, 50%). Veterans and caregivers gave web-SUCCEED high usability scores, noting that it was easy to understand, easy to use, and not overly burdensome. Notable negative feedback included ?slightly agreeing? that the site was confusing and awkward. All veterans (8/8, 100%) agreed that they would choose this type of program in the future to access an intervention that aims to improve their health. Developing and maintaining the software and hosting together cost approximately US $100,000, excluding salary and fringe benefits for project personnel (steps 1-3: US $25,000; steps 4-6: US $75,000). Conclusions: Adapting an existing, facilitated self-management support program for delivery via the web is feasible, and such programs can remotely deliver content. Input from a multidisciplinary team of experts and stakeholders can ensure the program?s success. Those interested in adapting programs should have a realistic estimate of the budget and staffing requirements. UR - https://formative.jmir.org/2023/1/e43903 UR - http://dx.doi.org/10.2196/43903 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327057 ID - info:doi/10.2196/43903 ER - TY - JOUR AU - Auton, Alice AU - Zaman, Sameer AU - Padayachee, Yorissa AU - Samways, W. Jack AU - Quaife, M. Nicholas AU - Sweeney, Mark AU - Tenorio, Indira AU - Linton, F. Nick W. AU - Cole, D. Graham AU - Peters, S. Nicholas AU - Mayet, Jamil AU - Barton, Carys AU - Plymen, Carla PY - 2023/6/6 TI - Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives JO - JMIR Nursing SP - e44630 VL - 6 KW - heart failure KW - health-related quality of life KW - mHealth KW - nurse specialist KW - patient engagement KW - self-management KW - self-care N2 - Background: Community-based management by heart failure specialist nurses (HFSNs) is key to improving self-care in heart failure with reduced ejection fraction. Remote monitoring (RM) can aid nurse-led management, but in the literature, user feedback evaluation is skewed in favor of the patient rather than nursing user experience. Furthermore, the ways in which different groups use the same RM platform at the same time are rarely directly compared in the literature. We present a balanced semantic analysis of user feedback from patient and nurse perspectives of Luscii, a smartphone-based RM strategy combining self-measurement of vital signs, instant messaging, and e-learning. Objective: This study aims to (1) evaluate how patients and nurses use this type of RM (usage type), (2) evaluate patients? and nurses? user feedback on this type of RM (user experience), and (3) directly compare the usage type and user experience of patients and nurses using the same type of RM platform at the same time. Methods: We performed a retrospective usage type and user experience evaluation of the RM platform from the perspective of both patients with heart failure with reduced ejection fraction and the HFSNs using the platform to manage them. We conducted semantic analysis of written patient feedback provided via the platform and a focus group of 6 HFSNs. Additionally, as an indirect measure of tablet adherence, self-measured vital signs (blood pressure, heart rate, and body mass) were extracted from the RM platform at onboarding and 3 months later. Paired 2-tailed t tests were used to evaluate differences between mean scores across the 2 timepoints. Results: A total of 79 patients (mean age 62 years; 35%, 28/79 female) were included. Semantic analysis of usage type revealed extensive, bidirectional information exchange between patients and HFSNs using the platform. Semantic analysis of user experience demonstrates a range of positive and negative perspectives. Positive impacts included increased patient engagement, convenience for both user groups, and continuity of care. Negative impacts included information overload for patients and increased workload for nurses. After the patients used the platform for 3 months, they showed significant reductions in heart rate (P=.004) and blood pressure (P=.008) but not body mass (P=.97) compared with onboarding. Conclusions: Smartphone-based RM with messaging and e-learning facilitates bilateral information sharing between patients and nurses on a range of topics. Patient and nurse user experience is largely positive and symmetrical, but there are possible negative impacts on patient attention and nurse workload. We recommend RM providers involve patient and nurse users in platform development, including recognition of RM usage in nursing job plans. UR - https://nursing.jmir.org/2023/1/e44630 UR - http://dx.doi.org/10.2196/44630 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279054 ID - info:doi/10.2196/44630 ER - TY - JOUR AU - Nogueira-Leite, Diogo AU - Diniz, Miguel José AU - Cruz-Correia, Ricardo PY - 2023/6/2 TI - Mental Health Professionals? Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Mixed Methods Study JO - JMIR Hum Factors SP - e45949 VL - 10 KW - mobile health KW - mHealth KW - health policy KW - mental health KW - digital health KW - apps KW - psychiatrists KW - psychologists KW - technology acceptance KW - adoption KW - government regulation N2 - Background: Digital health apps are among the most visible facets of the ongoing digital transition in health care, with mental health?focused apps as one of the main therapeutic areas. However, concerns regarding their scientific robustness drove regulators to establish evaluation procedures, with Germany?s Digitale Gesundheitsanwendungen program pioneering in app prescription with costs covered by statutory health insurance. Portugal gathers a set of conditions and requirements that position it as an excellent test bed for digital health apps. Its daunting mental health landscape reinforces the potential interest in new interventions. To understand if they would be acceptable, we need to understand the supply side?s attitudes and perceptions toward them, that is, those of psychiatrists and psychologists. Objective: This study aims to understand the attitudes and expectations of psychiatrists and psychologists toward digital mental health apps (DMHAs) in the Portuguese context, as well as perceived benefits, barriers, and actions to support their adoption. Methods: We conducted a 2-stage sequential mixed methods study. Stage 1 consisted of a cross-sectional web survey adapted to the Portuguese context that was delivered to mental health professionals and psychologists. Stage 2 complemented the insights of the web survey results with a key opinion leader analysis. Results: A total of 160 complete survey responses were recorded, most of which were from psychologists. This is the most extensive study on mental health professionals? attitudes and perceptions of DMHAs in Portugal. A total of 87.2% (136/156) of the respondents supported the opportunity to prescribe DMHAs. Increased health literacy (139/160, 86.9%), wider adherence to treatment (137/160, 85.6%), and proper disease management (127/160, 79.4%) were the most frequently agreed upon benefits of DMHAs. However, only less than half (68/156, 43.6%) of the respondents planned to prescribe or recommend DMHAs, with psychologists being more favorable than psychiatrists. Professionals faced substantial barriers, such as a lack of information on DMHAs (154/160, 96.3%), the level of initial training effort (115/160, 71.9%), and the need for adjustments of clinical processes and records (113/160, 70.6%). Professionals reported that having more information on the available apps and their suitability for health objectives (151/160, 94.4%), more scientific evidence of the validity of the apps as a health intervention (147/160, 91.9%), and established recommendations of apps by specific clinical guidelines or professional societies (145/160, 90.6%) would be essential to foster adoption. Conclusions: More information about DMHAs regarding their clinical validity and how they work is necessary so that such an intervention can be adopted in Portugal. Recommendations from professional and scientific societies, as well as from governmental bodies, are strongly encouraged. Although the benefits of and the barriers to using these apps are consensual, more evidence, along with further promotion of mental health professionals? digital literacy, is needed. International Registered Report Identifier (IRRID): RR2-10.2196/41040 UR - https://humanfactors.jmir.org/2023/1/e45949 UR - http://dx.doi.org/10.2196/45949 UR - http://www.ncbi.nlm.nih.gov/pubmed/37266977 ID - info:doi/10.2196/45949 ER - TY - JOUR AU - Officer, N. Tara AU - Tait, Marika AU - McBride-Henry, Karen AU - Burnet, Laura AU - Werkmeister, J. Benjamin PY - 2023/5/26 TI - Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications JO - JMIR Form Res SP - e47008 VL - 7 KW - telehealth KW - mental health service delivery KW - COVID-19 KW - Aotearoa New Zealand KW - clients KW - patient-centered care KW - telemedicine KW - mental health KW - experience KW - satisfaction KW - perception KW - perspective KW - attitude N2 - Background: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. Objective: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Methods: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. Results: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Conclusions: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes. UR - https://formative.jmir.org/2023/1/e47008 UR - http://dx.doi.org/10.2196/47008 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234041 ID - info:doi/10.2196/47008 ER - TY - JOUR AU - Liang, Jiaming AU - Aranda, P. Maria PY - 2023/5/25 TI - The Use of Telehealth Among People Living With Dementia-Caregiver Dyads During the COVID-19 Pandemic: Scoping Review JO - J Med Internet Res SP - e45045 VL - 25 KW - scoping review KW - COVID-19 KW - telehealth KW - people living with dementia KW - family caregiver KW - mobile phone N2 - Background: Telehealth has gained substantial attention during the COVID-19 pandemic, and reimbursement policies in health care settings have increased access to remote modes of care delivery. Telehealth has the potential to mitigate care concerns for people living with dementia and their family caregivers. There is a paucity of knowledge on the performance of telehealth services and user experiences, especially among caregiving dyads during the pandemic. Objective: This study aims to describe the implementation, effectiveness, user experience, and barriers to accessing and using telehealth services for people living with dementia and their caregivers during the COVID-19 pandemic. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, we searched 7 databases (PubMed, PsycINFO, AgeLine, CINAHL, Social Services Abstracts, Web of Science, and Scopus) and a web-based search engine (Google Scholar). The inclusion criteria for peer-reviewed English publications from March 2020 to August 2022 consisted of studies related to telehealth services for people living with dementia and their family caregivers and studies conducted during the COVID-19 pandemic. Results: A total of 24 articles (10 quantitative and 14 qualitative studies) from 10 different countries were included. The major findings of the reviewed articles were extracted and organized into the following 4 themes: study design characteristics?strategies were adopted to improve the accessibility and experience of people living with dementia-caregiver dyads; efficacy outcomes of telehealth services?robust evidence is lacking on the comparative effectiveness of in-person services; perceived experiences of people living with dementia and caregivers?most reviewed studies reported positive experiences of using telehealth services and perceived personal and social benefits from their participants; and barriers to accessing and using telehealth services?several barriers related to individuals, infrastructure, and telehealth environments were identified. Conclusions: Although evidence of its effectiveness is still limited, telehealth is widely accepted as a viable alternative to in-person care for high-risk groups, such as people living with dementia and their caregivers. Future research should include expanding digital access for those with limited resources and low technology literacy, adopting randomized controlled trial designs to establish the comparative effectiveness of different modes of service delivery, and increasing the sample diversity. UR - https://www.jmir.org/2023/1/e45045 UR - http://dx.doi.org/10.2196/45045 UR - http://www.ncbi.nlm.nih.gov/pubmed/37227755 ID - info:doi/10.2196/45045 ER - TY - JOUR AU - Kling, R. Samantha M. AU - Aleshin, A. Maria AU - Saliba-Gustafsson, A. Erika AU - Garvert, W. Donn AU - Brown-Johnson, G. Cati AU - Amano, Alexis AU - Kwong, Y. Bernice AU - Calugar, Ana AU - Shaw, G. Jonathan AU - Ko, M. Justin AU - Winget, Marcy PY - 2023/5/25 TI - Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation JO - JMIR Dermatol SP - e43389 VL - 6 KW - care transition KW - discharge planning KW - inpatient KW - outpatient KW - follow-up KW - teledermatology KW - dermatology KW - consultative dermatology N2 - Background: In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex. Objective: In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology. Methods: Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews?with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)?identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021). Results: Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation. Conclusions: Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload. UR - https://derma.jmir.org/2023/1/e43389 UR - http://dx.doi.org/10.2196/43389 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632927 ID - info:doi/10.2196/43389 ER - TY - JOUR AU - Fridman, Ilona AU - Smalls, Ahmaya AU - Fleming, Patrice AU - Elston Lafata, Jennifer PY - 2023/5/24 TI - Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey JO - JMIR Form Res SP - e40709 VL - 7 KW - electronic communication KW - patient preferences KW - digital health KW - patient portals KW - physician-patient communication KW - communication KW - text KW - phone KW - test KW - treatment KW - clinical KW - vaccination KW - survey KW - intervention KW - screening KW - social media KW - information N2 - Background: Health information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors? offices. Objective: We explored stated preferences by communication modes through the lens of social determinants of health (SDOH) to gauge acceptability and equity implications for future interventions. Methods: A cross-sectional survey was mailed to primary care patients aged 45-75 years, in 2020-2021, which assessed respondents' use of telephones, computers, or tablets in daily life and their preferred modes of communication for different types of health information, including educational materials about cancer screening, tips for taking prescription medication, and protection from respiratory diseases from their doctors? offices. Respondents indicated their willingness to receive messages from their doctors? offices via each of the provided modes of communication, including telephone, text, email, patient portals, websites, and social media, on a 5-point Likert scale ranging from ?unwilling? to ?willing.? We present the percentage of respondents who indicated that they were ?willing? to receive information via specific electronic mode. Chi-square tests were used to compare participants? willingness by social characteristics. Results: In total, 133 people completed the survey (response rate 27%). The average respondent age was 64 years, 82 (63%) respondents were female, 106 (83%) were White, 20 (16%) were Black, and 1 (1%) was Asian. In total, 75 (58%) respondents had a bachelor?s degree or higher; 26 (20%) resided in rural areas, 37 (29%) in suburban areas, 50 (39%) in a town, and 15 (12%) in a city. The majority, 73 (57%), reported being comfortable with their income. Preferences of respondents for electronic communication about cancer screening were distributed as follows: 100 (75%) respondents were willing to receive information from their doctor?s office via their patient portal, 98 (74%) via email, 75 (56%) via text, 60 (45%) via the hospital website, 50 (38%) via telephone, and 14 (11%) via social media. About 6 (5%) respondents were unwilling to receive any communication via electronic modes. Preferences were distributed similarly for other types of information. Respondents reporting lesser income and education consistently preferred receiving telephone calls relative to other communication modes. Conclusions: To optimize health communication and reach a socioeconomically diverse population, telephone calls should be added to electronic communication, especially for people with less income and education. Further research needs to identify the underlying reasons for the observed differences and how best to ensure that socioeconomically diverse groups of older adults can access reliable health information and health care services. UR - https://formative.jmir.org/2023/1/e40709 UR - http://dx.doi.org/10.2196/40709 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223979 ID - info:doi/10.2196/40709 ER - TY - JOUR AU - Kim, Jiyeong AU - Linos, Eleni AU - Fishman, A. Debra AU - Dove, S. Melanie AU - Hoch, S. Jeffrey AU - Keegan, H. Theresa PY - 2023/5/22 TI - Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study JO - JMIR Cancer SP - e44339 VL - 9 KW - online patient-provider communication KW - cancer survivor KW - COVID-19 KW - telehealth KW - eHealth activities KW - telemedicine KW - eHealth KW - e-health KW - patient provider KW - online communication KW - patient-physician KW - national survey KW - sociodemographic KW - oncology KW - cancer N2 - Background: Online patient-provider communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS-CoV-2/COVID-19, yet investigations in vulnerable subgroups have been limited. Objective: This study aims to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID-19 versus pre?COVID-19. Methods: Nationally representative cross-sectional survey data (Health Information National Trends Survey 5, 2017-2020) were used among cancer survivors (N=1900) and adults without a history of cancer (N=13,292). COVID-19 data included data from February to June 2020. We calculated the prevalence of 3 types of OPPC, defined as using the email/internet, tablet/smartphone, or electronic health record (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (ORs) and 95% CIs. Results: The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs 49.7%, email/internet; 32.2% vs 37.9%, tablet/smartphone; 19.0% vs 30.0%, EHR). Cancer survivors (OR 1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID-19. Among cancer survivors, the email/internet (OR 1.61, 95% CI 1.08-2.40) and EHRs (OR 1.92, 95% CI 1.22-3.02) were more likely to be used during COVID-19 than pre?COVID-19. During COVID-19, subgroups of cancer survivors, including Hispanics (OR 0.26, 95% CI 0.09-0.71 vs non-Hispanic Whites) or those with the lowest income (US $50,000-1000 patients per quarter were positively associated with TM use. In addition, being aged 51 to 60 years, thinking that TM is not important for current and future work, and not currently using TM were negatively associated with TM willingness, whereas owning a smart device and working in an urban area were positively associated with TM willingness. Conclusions: The results point to the close connection between health care professionals? knowledge of TM and actual TM use. These results lend support to the integration of digital competencies into medical education as well as hands-on training for health care professionals. Incentive programs for physicians aged >50 years and practicing in rural areas could further encourage TM willingness. UR - https://www.jmir.org/2022/11/e40304 UR - http://dx.doi.org/10.2196/40304 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449333 ID - info:doi/10.2196/40304 ER - TY - JOUR AU - Ward, Kanesha AU - Vagholkar, Sanjyot AU - Sakur, Fareeya AU - Khatri, Nafees Neha AU - Lau, S. Annie Y. PY - 2022/11/28 TI - Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review JO - JMIR Med Inform SP - e40469 VL - 10 IS - 11 KW - primary care KW - general practitioners KW - telehealth KW - telemedicine KW - COVID-19 KW - remote consultation KW - video consultation KW - eHealth N2 - Background: Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. Objective: The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. Methods: This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. Results: A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post?test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. Conclusions: Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. Trial Registration: PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4 UR - https://medinform.jmir.org/2022/11/e40469 UR - http://dx.doi.org/10.2196/40469 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265039 ID - info:doi/10.2196/40469 ER - TY - JOUR AU - Strachna, Olga AU - Asan, Onur AU - Stetson, D. Peter PY - 2022/11/3 TI - Managing Critical Patient-Reported Outcome Measures in Oncology Settings: System Development and Retrospective Study JO - JMIR Med Inform SP - e38483 VL - 10 IS - 11 KW - patient-reported outcome measures KW - delivery of health care KW - self-report KW - quality of care KW - neoplasms KW - surveys and questionnaires KW - clinical decision support systems N2 - Background: Remote monitoring programs based on the collection of patient-reported outcome (PRO) data are being increasingly adopted in oncology practices. Although PROs are a great source of patient data, the management of critical PRO data is not discussed in detail in the literature. Objective: This first-of-its-kind study aimed to design, describe, and evaluate a closed-loop alerting and communication system focused on managing PRO-related alerts in cancer care. Methods: We designed and developed a novel solution using an agile software development methodology by incrementally building new capabilities. We evaluated these new features using participatory design and the Fit between Individuals, Task, and Technology framework. Results: A total of 8 questionnaires were implemented using alerting features, resulting in an alert rate of 7.82% (36,838/470,841) with 13.28% (10,965/82,544) of the patients triggering at least one alert. Alerts were reviewed by 501 staff members spanning across 191 care teams. All the alerts were reviewed with a median response time of 1 hour (SD 185 hours) during standard business hours. The most severe (red) alerts were documented 56.83% (2592/4561) of the time, whereas unlabeled alerts were documented 27.68% (1298/4689) of the time, signaling clinician concordance with the alert thresholds. Conclusions: A PRO-based alert and communication system has some initial benefits in reviewing clinically meaningful PRO data in a reasonable amount of time. We have discussed key system design considerations, workflow integration, and the mitigation of potential impact on the burden of care teams. The introduction of a PRO-based alert and communication system provides a reliable mechanism for care teams to review and respond to patient symptoms quickly. The system was standardized across many different oncology settings, demonstrating system flexibility. Future studies should focus on formally evaluating system usability through qualitative methods. UR - https://medinform.jmir.org/2022/11/e38483 UR - http://dx.doi.org/10.2196/38483 UR - http://www.ncbi.nlm.nih.gov/pubmed/36326801 ID - info:doi/10.2196/38483 ER - TY - JOUR AU - Preclaro, Caballero Ivan Arni AU - Gulmatico-Flores, Zharlah AU - Tianco, Velasco Elizabeth Amelia PY - 2022/10/31 TI - Concordance and Accuracy of Teledermatology Using Mobile Phones in the Outpatient Clinic of Jose R Reyes Memorial Medical Center: Cross-sectional Study JO - JMIR Dermatol SP - e32546 VL - 5 IS - 4 KW - teledermatology KW - telemedicine KW - store-and-forward approach KW - dermatology KW - virtual consultation KW - histopathological diagnosis KW - skin KW - telehealth KW - mobile phones KW - cross-sectional study KW - dermatologists KW - dermatologic care KW - mucosal N2 - Background: Dermatologists rely on visual findings; thus, teledermatology is uniquely compatible to providing dermatologic care. The use of mobile phones in a store-and-forward approach, where gathered data are sent to a distant health provider for later review, may be a potential bridge in seeking dermatologic care. Objective: This study aimed to determine the agreement between face-to-face consultations and teledermatologic consultations through the store-and-forward approach using mobile phones and its accuracy compared to a histopathologic diagnosis. Methods: The study design was a cross-sectional study of participants consecutively recruited from dermatology patients who presented with skin or mucosal complaint and without prior dermatologist consultation. Photographs were taken using a standard smartphone (iPhone 6s Plus), and a 4-mm skin punch biopsy was taken on each patient?the gold standard to which the study result was compared to. The photographs were sent to 3 consultant dermatologists using a store-and-forward approach, for independent diagnosis and treatment plan. Results: A total of 60 patients were included, with a median age of 41 years. There was moderate-to?almost perfect agreement in terms of final diagnosis between the face-to-face dermatologic diagnosis and teledermatologic diagnoses. The third teledermatologist had the highest agreement with the clinical dermatologist in terms of final diagnosis (?=0.84; P<.001). Among the 3 dermatologists, there was moderate-to?almost perfect agreement as well. Agreement between pairs of teledermatologists ranged from 0.45 to 0.84. The 3 teledermatologists had moderate-to-substantial agreement with the biopsy results, with the third teledermatologist having the highest accuracy (?=0.77; P<.001). Overall, there was a moderate agreement in the diagnosis of patients across raters. Conclusions: Teledermatology is a viable alternative to face-to-face consultations. Our results show moderate-to-substantial agreement in diagnoses from a face-to-face consultation and store-and-forward teledermatology. UR - https://derma.jmir.org/2022/4/e32546 UR - http://dx.doi.org/10.2196/32546 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632883 ID - info:doi/10.2196/32546 ER - TY - JOUR AU - Darley, Sarah AU - Coulson, Tessa AU - Peek, Niels AU - Moschogianis, Susan AU - van der Veer, N. Sabine AU - Wong, C. David AU - Brown, C. Benjamin PY - 2022/10/24 TI - Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers JO - J Med Internet Res SP - e37436 VL - 24 IS - 10 KW - general practice KW - systematic review KW - remote consultation KW - OC KW - triage KW - primary health care KW - care provider KW - health care professional KW - workforce KW - telemedicine KW - COVID-19 KW - pandemic KW - primary care KW - health outcome KW - patient care N2 - Background: Online consultations (OCs) allow patients to contact their care providers on the web. Worldwide, OCs have been rolled out in primary care rapidly owing to policy initiatives and COVID-19. There is a lack of evidence regarding how OC design and implementation influence care quality. Objective: We aimed to synthesize research on the impacts of OCs on primary care quality, and how these are influenced by system design and implementation. Methods: We searched databases from January 2010 to February 2022. We included quantitative and qualitative studies of real-world OC use in primary care. Quantitative data were transformed into qualitative themes. We used thematic synthesis informed by the Institute of Medicine domains of health care quality, and framework analysis informed by the nonadoption, abandonment, scale-up, spread, and sustainability framework. Strength of evidence was judged using the GRADE-CERQual approach. Results: We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients? queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. Conclusions: This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). Trial Registration: PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy UR - https://www.jmir.org/2022/10/e37436 UR - http://dx.doi.org/10.2196/37436 UR - http://www.ncbi.nlm.nih.gov/pubmed/36279172 ID - info:doi/10.2196/37436 ER - TY - JOUR AU - Imai, Chisato AU - Amin, Janaki AU - Prgomet, Mirela AU - Pearce, Christopher AU - Georgiou, Andrew PY - 2022/10/18 TI - An Increase in Antibiotic Prescribing for Respiratory Tract Infections Through Telehealth Consultations: Retrospective Study in Australian General Practice JO - J Med Internet Res SP - e40876 VL - 24 IS - 10 KW - general practice KW - anti-infective agents KW - antibiotics KW - medication KW - prescriptions KW - respiratory tract infections KW - infection KW - telehealth KW - telemedicine KW - Australia UR - https://www.jmir.org/2022/10/e40876 UR - http://dx.doi.org/10.2196/40876 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256826 ID - info:doi/10.2196/40876 ER - TY - JOUR AU - Kala?ska-?ukasik, Barbara AU - G?ady?, Aleksandra AU - Jadczyk, Tomasz AU - Gruz-Kwapisz, Monika AU - Wojakowski, Wojciech AU - Kowalska, Malgorzata PY - 2022/10/18 TI - Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study JO - JMIR Form Res SP - e33769 VL - 6 IS - 10 KW - telemedicine KW - readiness KW - patient-cardiologist contact KW - telehealth KW - acceptance N2 - Background: Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients? readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users? expectations. Objective: This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases. Methods: We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants. Results: Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication. Conclusions: During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions. UR - https://formative.jmir.org/2022/10/e33769 UR - http://dx.doi.org/10.2196/33769 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256834 ID - info:doi/10.2196/33769 ER - TY - JOUR AU - Savoy, April AU - Patel, Himalaya AU - Shahid, Umber AU - Offner, D. Alexis AU - Singh, Hardeep AU - Giardina, D. Traber AU - Meyer, D. Ashley N. PY - 2022/9/22 TI - Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach JO - JMIR Hum Factors SP - e37313 VL - 9 IS - 3 KW - clinicians KW - community-based participatory research KW - web-based design KW - delivery of health care KW - health intervention KW - physicians KW - primary health care KW - videoconferencing N2 - Background: Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians? commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. Objective: The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. Methods: We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. Results: A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. Conclusions: ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions. UR - https://humanfactors.jmir.org/2022/3/e37313 UR - http://dx.doi.org/10.2196/37313 UR - http://www.ncbi.nlm.nih.gov/pubmed/36136374 ID - info:doi/10.2196/37313 ER - TY - JOUR AU - Meskó, Bertalan PY - 2022/9/19 TI - COVID-19?s Impact on Digital Health Adoption: The Growing Gap Between a Technological and a Cultural Transformation JO - JMIR Hum Factors SP - e38926 VL - 9 IS - 3 KW - COVID-19 KW - digital health KW - future KW - cultural transformation KW - medical information KW - technology adoption KW - health care KW - physician burnout KW - burnout UR - https://humanfactors.jmir.org/2022/3/e38926 UR - http://dx.doi.org/10.2196/38926 UR - http://www.ncbi.nlm.nih.gov/pubmed/36121692 ID - info:doi/10.2196/38926 ER - TY - JOUR AU - Turner, Jane AU - Clarke, Malcolm AU - George, Grizelda AU - Jones, Wynn Russell AU - Pullinger, Rick AU - Kharbanda, Rajesh AU - Kennedy, James AU - Hands, Linda PY - 2022/9/15 TI - An Assessment of the Potential Benefits of Video Consultation in the Emergency Department: Mixed Methods Study JO - Interact J Med Res SP - e36081 VL - 11 IS - 2 KW - emergency medicine KW - telemedicine KW - health service research KW - eHealth KW - emergency KW - video consultation KW - remote KW - specialist KW - video conferencing KW - videoconferencing KW - video conference KW - telehealth KW - benefit KW - patient management N2 - Background: District general hospital emergency departments may refer patients to a tertiary center depending on the information available to a generalist clinician in discussion with a specialist team. If there is uncertainty, the lowest-risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient and local clinician while still in the emergency department could improve decision-making for patient transfer. Objective: The aim of this study is to assess the potential benefit of real-time video consultation between remote specialists and emergency department patients and clinicians across all specialties. Methods: Detailed patient data were collected prospectively for 6 months (between January 16, 2012, and July 15, 2012) on all patients presenting to a district general hospital emergency department who required input from a specialist team at the nearest tertiary care center. These patients were discussed retrospectively with the specialist teams to determine whether videoconferencing could have benefited their management. The logistics for the use of videoconferencing were explored. Results: A total of 18,799 patients were seen in the emergency department during the study period. Among the 18,799 patients, 413 referrals (2.2%) were made to the tertiary center specialist teams. A review of the patients transferred indicated that 193 (46.7%) of the 413 patients who were referred might have benefited from video consultation (193/18,799, 1% of all patients). If the specialist team could be accessed via videoconferencing only while a senior member was available in the hospital (8:00 AM-10:00 PM), then a maximum of 5 patients per week across all specialties would use the equipment. If 24-hour specialist access was available, this would increase to 7 patients per week. Conclusions: In regions where there is direct transportation of patients by ambulance to specialist centers and there is a regional picture archiving and communication system in place, video consultation between emergency department patients and specialists has limited potential to improve patient management. UR - https://www.i-jmr.org/2022/2/e36081 UR - http://dx.doi.org/10.2196/36081 UR - http://www.ncbi.nlm.nih.gov/pubmed/36107488 ID - info:doi/10.2196/36081 ER - TY - JOUR AU - Liu, W. Andrew AU - Odisho, Y. Anobel AU - Brown III, William AU - Gonzales, Ralph AU - Neinstein, B. Aaron AU - Judson, J. Timothy PY - 2022/9/13 TI - Patient Experience and Feedback After Using an Electronic Health Record?Integrated COVID-19 Symptom Checker: Survey Study JO - JMIR Hum Factors SP - e40064 VL - 9 IS - 3 KW - COVID-19 KW - patient portals KW - digital health KW - diagnostic self evaluation KW - medical informatics KW - internet KW - telemedicine KW - triage KW - feedback KW - medical records systems KW - San Francisco KW - user experience KW - user satisfaction KW - self-triage KW - symptom checker KW - health system KW - workflow KW - integration KW - electronic health record N2 - Background: Symptom checkers have been widely used during the COVID-19 pandemic to alleviate strain on health systems and offer patients a 24-7 self-service triage option. Although studies suggest that users may positively perceive web-based symptom checkers, no studies have quantified user feedback after use of an electronic health record?integrated COVID-19 symptom checker with self-scheduling functionality. Objective: In this paper, we aimed to understand user experience, user satisfaction, and user-reported alternatives to the use of a COVID-19 symptom checker with self-triage and self-scheduling functionality. Methods: We launched a patient-portal?based self-triage and self-scheduling tool in March 2020 for patients with COVID-19 symptoms, exposures, or questions. We made an optional, anonymous Qualtrics survey available to patients immediately after they completed the symptom checker. Results: Between December 16, 2021, and March 28, 2022, there were 395 unique responses to the survey. Overall, the respondents reported high satisfaction across all demographics, with a median rating of 8 out of 10 and 288/395 (47.6%) of the respondents giving a rating of 9 or 10 out of 10. User satisfaction scores were not associated with any demographic factors. The most common user-reported alternatives had the web-based tool not been available were calling the COVID-19 telephone hotline and sending a patient-portal message to their physician for advice. The ability to schedule a test online was the most important symptom checker feature for the respondents. The most common categories of user feedback were regarding other COVID-19 services (eg, telephone hotline), policies, or procedures, and requesting additional features or functionality. Conclusions: This analysis suggests that COVID-19 symptom checkers with self-triage and self-scheduling functionality may have high overall user satisfaction, regardless of user demographics. By allowing users to self-triage and self-schedule tests and visits, tools such as this may prevent unnecessary calls and messages to clinicians. Individual feedback suggested that the user experience for this type of tool is highly dependent on the organization's operational workflows for COVID-19 testing and care. This study provides insight for the implementation and improvement of COVID-19 symptom checkers to ensure high user satisfaction. UR - https://humanfactors.jmir.org/2022/3/e40064 UR - http://dx.doi.org/10.2196/40064 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960593 ID - info:doi/10.2196/40064 ER - TY - JOUR AU - Ehrler, Frederic AU - Rochat, Jessica AU - Siebert, N. Johan AU - Guessous, Idris AU - Lovis, Christian AU - Spechbach, Hervé PY - 2022/9/6 TI - Use of a Semiautomatic Text Message System to Improve Satisfaction With Wait Time in the Adult Emergency Department: Cross-sectional Survey Study JO - JMIR Med Inform SP - e34488 VL - 10 IS - 9 KW - emergency KW - patient satisfaction KW - service-oriented health care KW - quality of care KW - health service KW - emergency department N2 - Background: Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time. Objective: We aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician. Methods: We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs. Results: A total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use. Conclusions: Although not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use. UR - https://medinform.jmir.org/2022/9/e34488 UR - http://dx.doi.org/10.2196/34488 UR - http://www.ncbi.nlm.nih.gov/pubmed/36066921 ID - info:doi/10.2196/34488 ER - TY - JOUR AU - Gray, Caroline AU - Wray, Charlie AU - Tisdale, Rebecca AU - Chaudary, Camila AU - Slightam, Cindie AU - Zulman, Donna PY - 2022/8/24 TI - Factors Influencing How Providers Assess the Appropriateness of Video Visits: Interview Study With Primary and Specialty Health Care Providers JO - J Med Internet Res SP - e38826 VL - 24 IS - 8 KW - virtual care KW - decision-making KW - qualitative KW - virtual visits KW - web-based KW - carer KW - video KW - telephone KW - telemedicine KW - appointments KW - caregiver N2 - Background: The rapid implementation of virtual care (ie, telephone or video-based clinic appointments) during the COVID-19 pandemic resulted in many providers offering virtual care with little or no formal training and without clinical guidelines and tools to assist with decision-making. As new guidelines for virtual care provision take shape, it is critical that they are informed by an in-depth understanding of how providers make decisions about virtual care in their clinical practices. Objective: In this paper, we sought to identify the most salient factors that influence how providers decide when to offer patients video appointments instead of or in conjunction with in-person care. Methods: We conducted semistructured interviews with 28 purposefully selected primary and specialty health care providers from the US Department of Veteran?s Affairs health care system. We used an inductive approach to identify factors that impact provider decision-making. Results: Qualitative analysis revealed distinct clinical, patient, and provider factors that influence provider decisions to initiate or continue with virtual visits. Clinical factors include patient acuity, the need for additional tests or labs, changes in patients? health status, and whether the patient is new or has no recent visit. Patient factors include patients? ability to articulate symptoms or needs, availability and accessibility of technology, preferences for or against virtual visits, and access to caregiver assistance. Provider factors include provider comfort with and acceptance of virtual technology as well as virtual physical exam skills and training. Conclusions: Providers within the US Department of Veterans Affairs health administration system consider a complex set of factors when deciding whether to offer or continue a video or telephone visit. These factors can inform the development and further refinement of decision tools, guides, and other policies to ensure that virtual care expands access to high-quality care. UR - https://www.jmir.org/2022/8/e38826 UR - http://dx.doi.org/10.2196/38826 UR - http://www.ncbi.nlm.nih.gov/pubmed/36001364 ID - info:doi/10.2196/38826 ER - TY - JOUR AU - Selick, Avra AU - Durbin, Janet AU - Hamdani, Yani AU - Rayner, Jennifer AU - Lunsky, Yona PY - 2022/8/22 TI - Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study JO - JMIR Form Res SP - e38916 VL - 6 IS - 8 KW - COVID-19 KW - intellectual disability KW - developmental disability KW - qualitative KW - telemedicine KW - virtual care KW - primary care N2 - Background: The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective: The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods: We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results: We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that ?one size does not fit all,? and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients? abilities to access necessary health care. Conclusions: This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models. UR - https://formative.jmir.org/2022/8/e38916 UR - http://dx.doi.org/10.2196/38916 UR - http://www.ncbi.nlm.nih.gov/pubmed/35951444 ID - info:doi/10.2196/38916 ER - TY - JOUR AU - Haverinen, Jari AU - Keränen, Niina AU - Tuovinen, Timo AU - Ruotanen, Ronja AU - Reponen, Jarmo PY - 2022/8/12 TI - National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study JO - JMIR Med Inform SP - e35612 VL - 10 IS - 8 KW - eHealth KW - electronic health records KW - picture archiving and communication systems KW - health information exchange KW - electronic prescribing KW - referral and consultation KW - videoconferencing KW - clinical decision support systems KW - health informatics KW - clinical informatics N2 - Background: eHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities. Objective: The first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020. Methods: Data for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable. Results: All the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations. Conclusions: eHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies. UR - https://medinform.jmir.org/2022/8/e35612 UR - http://dx.doi.org/10.2196/35612 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969462 ID - info:doi/10.2196/35612 ER - TY - JOUR AU - Chen, Wenwen AU - Flanagan, Ashley AU - Nippak, MD Pria AU - Nicin, Michael AU - Sinha, K. Samir PY - 2022/8/10 TI - Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Aging SP - e34952 VL - 5 IS - 3 KW - telemedicine KW - virtual care visit KW - geriatric care professionals KW - aging population KW - Consolidated Framework for Implementation Research KW - geriatric care KW - older adults KW - elderly care KW - telehealth KW - digital health KW - COVID-19 KW - pandemic KW - technology usability N2 - Background: Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective: This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods: This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions: This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families. UR - https://aging.jmir.org/2022/3/e34952 UR - http://dx.doi.org/10.2196/34952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830331 ID - info:doi/10.2196/34952 ER - TY - JOUR AU - Abbasgholizadeh Rahimi, Samira AU - Cwintal, Michelle AU - Huang, Yuhui AU - Ghadiri, Pooria AU - Grad, Roland AU - Poenaru, Dan AU - Gore, Genevieve AU - Zomahoun, Vignon Hervé Tchala AU - Légaré, France AU - Pluye, Pierre PY - 2022/8/9 TI - Application of Artificial Intelligence in Shared Decision Making: Scoping Review JO - JMIR Med Inform SP - e36199 VL - 10 IS - 8 KW - artificial intelligence KW - machine learning KW - shared decision making KW - patient-centered care KW - scoping review N2 - Background: Artificial intelligence (AI) has shown promising results in various fields of medicine. It has the potential to facilitate shared decision making (SDM). However, there is no comprehensive mapping of how AI may be used for SDM. Objective: We aimed to identify and evaluate published studies that have tested or implemented AI to facilitate SDM. Methods: We performed a scoping review informed by the methodological framework proposed by Levac et al, modifications to the original Arksey and O'Malley framework of a scoping review, and the Joanna Briggs Institute scoping review framework. We reported our results based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guideline. At the identification stage, an information specialist performed a comprehensive search of 6 electronic databases from their inception to May 2021. The inclusion criteria were: all populations; all AI interventions that were used to facilitate SDM, and if the AI intervention was not used for the decision-making point in SDM, it was excluded; any outcome related to patients, health care providers, or health care systems; studies in any health care setting, only studies published in the English language, and all study types. Overall, 2 reviewers independently performed the study selection process and extracted data. Any disagreements were resolved by a third reviewer. A descriptive analysis was performed. Results: The search process yielded 1445 records. After removing duplicates, 894 documents were screened, and 6 peer-reviewed publications met our inclusion criteria. Overall, 2 of them were conducted in North America, 2 in Europe, 1 in Australia, and 1 in Asia. Most articles were published after 2017. Overall, 3 articles focused on primary care, and 3 articles focused on secondary care. All studies used machine learning methods. Moreover, 3 articles included health care providers in the validation stage of the AI intervention, and 1 article included both health care providers and patients in clinical validation, but none of the articles included health care providers or patients in the design and development of the AI intervention. All used AI to support SDM by providing clinical recommendations or predictions. Conclusions: Evidence of the use of AI in SDM is in its infancy. We found AI supporting SDM in similar ways across the included articles. We observed a lack of emphasis on patients? values and preferences, as well as poor reporting of AI interventions, resulting in a lack of clarity about different aspects. Little effort was made to address the topics of explainability of AI interventions and to include end-users in the design and development of the interventions. Further efforts are required to strengthen and standardize the use of AI in different steps of SDM and to evaluate its impact on various decisions, populations, and settings. UR - https://medinform.jmir.org/2022/8/e36199 UR - http://dx.doi.org/10.2196/36199 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943793 ID - info:doi/10.2196/36199 ER - TY - JOUR AU - Kling, R. Samantha M. AU - Saliba-Gustafsson, A. Erika AU - Winget, Marcy AU - Aleshin, A. Maria AU - Garvert, W. Donn AU - Amano, Alexis AU - Brown-Johnson, G. Cati AU - Kwong, Y. Bernice AU - Calugar, Ana AU - El-Banna, Ghida AU - Shaw, G. Jonathan AU - Asch, M. Steven AU - Ko, M. Justin PY - 2022/8/3 TI - Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation JO - J Med Internet Res SP - e38792 VL - 24 IS - 8 KW - teledermatology KW - telemedicine KW - telehealth KW - video visits KW - care transitions KW - care coordination KW - discharge planning KW - follow-up KW - inpatient KW - outpatient KW - mixed methods KW - dermatology KW - mobile phone KW - smartphone N2 - Background: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination?dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic?s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19?related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient?s own. Conclusions: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers? preferences. UR - https://www.jmir.org/2022/8/e38792 UR - http://dx.doi.org/10.2196/38792 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921146 ID - info:doi/10.2196/38792 ER - TY - JOUR AU - Tso, Sze Lai PY - 2022/7/29 TI - Use of Social Media for Implementing Diagnoses, Consultation, Training, and Case Reporting Among Medical Professionals to Improve Patient Care: Case Study of WeChat Groups Across Health Care Settings JO - JMIR Med Educ SP - e26419 VL - 8 IS - 3 KW - mHealth KW - WeChat KW - implementation research KW - low-resource settings KW - innovative medical technologies KW - digital health KW - medical education KW - social media KW - mobile health technologies KW - bottom-up approach N2 - Background: Health professionals in low- and middle-resource settings have limited access to up-to-date resources for diagnosing and treating illnesses, training medical staff, reviewing newly disseminated guidelines and publications, and preparing data for international disease reporting. A concomitant difficulty in high-resource settings is the need for continuing education and skills up-training in innovative procedures on unfamiliar social media platforms. These challenges can delay both patient care and epidemiological surveillance efforts. To overcome these challenges, health professionals have adapted WeChat Groups to implement timely, low-cost, and high-quality patient care. Objective: The primary study aim was to describe the processes taken by medical professionals across their diverse physical and virtual networks in adapting a bottom-up approach to collectively overcome resource shortages. The secondary study aim was to delineate the pathways, procedures, and resource/information sharing implemented by medical professionals using an international publicly available popular social media app (WeChat) to enhance performance of facility-based procedures and protocols for improved patient care. Methods: In-depth interviews, observations, and digital ethnography of WeChat Groups communications were collected from medical professionals in interconnected networks of health care facilities. Participants? WeChat Groups usage and observations of their professional functions in interconnected networks were collected from November 2018 to 2019. Qualitative analysis and thematic coding were used to develop constructs and themes in NVivo. Constructs incorporated descriptions for the implementation and uses of WeChat Groups for professional connections, health care procedures, and patient care. Themes supporting the constructs focused on the pathways and venues used by medical professionals to build trust, to establish and solidify online networks, and to identify requests and resource sharing within WeChat Groups. Results: There were 58 participants (males 36 and females 22) distributed across 24 health care settings spanning geographical networks in south China. Analysis yielded 4 constructs and 11 themes delineating the bottom-up usage of WeChat Groups among clinicians, technicians, nurses, pharmacists, and public health administrators. Participants used WeChat Groups for collectively training hospital staff in complex new procedures, processing timely diagnoses of biological specimens, staying abreast of latest trends and clinical procedures and symptoms, and contributing to case reporting for emergent illnesses and international surveillance reporting. An unexpected strength of implementing clinical, training, and research support on a popular app with international coverage is the added ability to overcome administrative and geographic barriers in resource distribution. This advantage increased a network?s access to WeChat Groups members both working within China and abroad, greatly expanding the scope of shared resources. Conclusions: The organic, bottom-up approach of repurposing extant social media apps is low cost and efficient for timely implementation to improve patient care. WeChat?s international user base enables medical staff to access widespread professional networks across geographic, administrative, and economic barriers, with potential to reduce health disparities in low-resource settings. UR - https://mededu.jmir.org/2022/3/e26419 UR - http://dx.doi.org/10.2196/26419 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904858 ID - info:doi/10.2196/26419 ER - TY - JOUR AU - Zahradka, Nicole AU - Pugmire, Juliana AU - Lever Taylor, Jessie AU - Wolfberg, Adam AU - Wilkes, Matt PY - 2022/7/29 TI - Deployment of an End-to-End Remote, Digitalized Clinical Study Protocol in COVID-19: Process Evaluation JO - JMIR Form Res SP - e37832 VL - 6 IS - 7 KW - evaluation study KW - telemedicine KW - remote consultation KW - digital divide KW - research design KW - virtual clinical trial KW - decentralized KW - COVID-19 KW - primary recruitment KW - social media KW - virtual care KW - heart rate KW - wearable KW - health care cost KW - health technology N2 - Background: The SARS-CoV-2 (COVID-19) pandemic may accelerate the adoption of digital, decentralized clinical trials. Conceptual recommendations for digitalized and remote clinical studies and technology are available to enable digitalization. Fully remote studies may break down some of the participation barriers in traditional trials. However, they add logistical complexity and offer fewer opportunities to intervene following a technical failure or adverse event. Objective: Our group designed an end-to-end digitalized clinical study protocol, using the Food and Drug Administration (FDA)?cleared Current Health (CH) remote monitoring platform to collect symptoms and continuous physiological data of individuals recently infected with COVID-19 in the community. The purpose of this work is to provide a detailed example of an end-to-end digitalized protocol implementation based on conceptual recommendations by describing the study setup in detail, evaluating its performance, and identifying points of success and failure. Methods: Primary recruitment was via social media and word of mouth. Informed consent was obtained during a virtual appointment, and the CH-monitoring kit was shipped directly to the participants. The wearable continuously recorded pulse rate (PR), respiratory rate (RR), oxygen saturation (SpO2), skin temperature, and step count, while a tablet administered symptom surveys. Data were transmitted in real time to the CH cloud-based platform and displayed in the web-based dashboard, with alerts to the study team if the wearable was not charged or worn. The study duration was up to 30 days. The time to recruit, screen, consent, set up equipment, and collect data was quantified, and advertising engagement was tracked with a web analytics service. Results: Of 13 different study advertisements, 5 (38.5%) were live on social media at any one time. In total, 38 eligibility forms were completed, and 19 (50%) respondents met the eligibility criteria. Of these, 9 (47.4%) were contactable and 8 (88.9%) provided informed consent. Deployment times ranged from 22 to 110 hours, and participants set up the equipment and started transmitting vital signs within 7.6 (IQR 6.3-10) hours of delivery. The mean wearable adherence was 70% (SD 19%), and the mean daily survey adherence was 88% (SD 21%) for the 8 participants. Vital signs were in normal ranges during study participation, and symptoms decreased over time. Conclusions: Evaluation of clinical study implementation is important to capture what works and what might need to be modified. A well-calibrated approach to online advertising and enrollment can remove barriers to recruitment and lower costs but remains the most challenging part of research. Equipment was effectively and promptly shipped to participants and removed the risk of illness transmission associated with in-person encounters during a pandemic. Wearable technology incorporating continuous, clinical-grade monitoring offered an unprecedented level of detail and ecological validity. However, study planning, relationship building, and troubleshooting are more complex in the remote setting. The relevance of a study to potential participants remains key to its success. UR - https://formative.jmir.org/2022/7/e37832 UR - http://dx.doi.org/10.2196/37832 UR - http://www.ncbi.nlm.nih.gov/pubmed/35852933 ID - info:doi/10.2196/37832 ER - TY - JOUR AU - Lawrence, Katharine AU - Nov, Oded AU - Mann, Devin AU - Mandal, Soumik AU - Iturrate, Eduardo AU - Wiesenfeld, Batia PY - 2022/7/28 TI - The Impact of Telemedicine on Physicians? After-hours Electronic Health Record ?Work Outside Work? During the COVID-19 Pandemic: Retrospective Cohort Study JO - JMIR Med Inform SP - e34826 VL - 10 IS - 7 KW - telemedicine KW - telehealth KW - eHealth KW - COVID-19 KW - EHR KW - electronic health record KW - clinician workload KW - impact KW - transition KW - workload KW - cohort KW - retrospective KW - physician KW - efficient KW - doctor KW - health care professional KW - pandemic N2 - Background: Telemedicine as a mode of health care work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians? after-hours electronic health record (EHR)?based clinical and administrative work is unclear. Objective: This study assesses the impact of the transition to telemedicine during the COVID-19 pandemic on physicians? EHR-based after-hours workload (ie, ?work outside work?) at a large academic medical center in New York City. Methods: We conducted an EHR-based retrospective cohort study of ambulatory care physicians providing telemedicine services before the pandemic, during the acute pandemic, and after the acute pandemic, relating EHR-based after-hours work to telemedicine intensity (ie, percentage of care provided via telemedicine) and clinical load (ie, patient load per provider). Results: A total of 2129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased for all physicians, whereas patient volume decreased. When normalized by clinical load (ie, average appointments per day by average clinical days per week), telemedicine intensity was positively associated with work outside work across time periods. This association was strongest after the acute pandemic. Conclusions: Taking physicians? clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively. This suggests that telemedicine, as currently delivered, may be less efficient than in-person?based care and may increase the after-hours work burden of physicians. UR - https://medinform.jmir.org/2022/7/e34826 UR - http://dx.doi.org/10.2196/34826 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749661 ID - info:doi/10.2196/34826 ER - TY - JOUR AU - Muschol, Jennifer AU - Heinrich, Martin AU - Heiss, Christian AU - Knapp, Gero AU - Repp, Holger AU - Schneider, Henning AU - Thormann, Ulrich AU - Uhlar, Johanna AU - Unzeitig, Kai AU - Gissel, Christian PY - 2022/7/27 TI - Assessing Telemedicine Efficiency in Follow-up Care With Video Consultations for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial JO - J Med Internet Res SP - e36996 VL - 24 IS - 7 KW - telemedicine KW - video consultations KW - follow-up KW - efficiency KW - orthopedic KW - trauma surgery KW - mobile phone N2 - Background: Telemedicine can help mitigate important health care challenges, such as demographic changes and the current COVID-19 pandemic, in high-income countries such as Germany. It gives physicians and patients the opportunity to interact via video consultations, regardless of their location, thus offering cost and time savings for both sides. Objective: We aimed to investigate whether telemedicine can be implemented efficiently in the follow-up care for patients in orthopedic and trauma surgery, with respect to patient satisfaction, physician satisfaction, and quality of care. Methods: We conducted a prospective randomized controlled trial in a German university hospital and enrolled 60 patients with different knee and shoulder conditions. For follow-up appointments, patients received either an in-person consultation in the clinic (control group) or a video consultation with their physician (telemedicine group). Patients? and physicians? subsequent evaluations of these follow-up appointments were collected and assessed using separate questionnaires. Results: On the basis of data from 52 consultations after 8 withdrawals, it was found that patients were slightly more satisfied with video consultations (mean 1.58, SD 0.643) than with in-clinic consultations (mean 1.64, SD 0.569), although the difference was not statistically significant (P=.69). After excluding video consultations marred by technical problems, no significant difference was found in physician satisfaction between the groups (mean 1.47, SD 0.516 vs mean 1.32, SD 0.557; P=.31). Further analysis indicated that telemedicine can be applied to broader groups of patients and that patients who have prior experience with telemedicine are more willing to use telemedicine for follow-up care. Conclusions: Telemedicine can be an alternative and efficient form of follow-up care for patients in orthopedic and trauma surgery in Germany, and it has no significant disadvantages compared with in-person consultations in the clinic. Trial Registration: German Clinical Trials Register DRKS00023445; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023445 UR - https://www.jmir.org/2022/7/e36996 UR - http://dx.doi.org/10.2196/36996 UR - http://www.ncbi.nlm.nih.gov/pubmed/35896015 ID - info:doi/10.2196/36996 ER - TY - JOUR AU - Schember, Oliver Cassandra AU - Scott, E. Sarah AU - Jenkins, A. Cathy AU - Rebeiro, F. Peter AU - Turner, Megan AU - Furukawa, S. Sally AU - Bofill, Carmen AU - Yan, Zhou AU - Jackson, P. Gretchen AU - Pettit, C. April PY - 2022/7/25 TI - Electronic Patient Portal Access, Retention in Care, and Viral Suppression Among People Living With HIV in Southeastern United States: Observational Study JO - JMIR Med Inform SP - e34712 VL - 10 IS - 7 KW - HIV KW - viral suppression KW - retention in care KW - patient engagement KW - patient portal KW - observational study KW - United States KW - North America KW - eHealth KW - human immunodeficiency virus N2 - Background: Approximately 1.1 million people living with HIV live in the United States, and the incidence is highest in Southeastern United States. Electronic patient portal prevalence is increasing and can improve engagement in primary medical care. Retention in care and viral suppression?measures of engagement in HIV care?are associated with decreased HIV transmission, morbidity, and mortality. Objective: We aimed to determine if patient portal access among people living with HIV was associated with retention and viral suppression. Methods: We conducted an observational cohort study among people living with HIV in care at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from 2011-2016. Individual access was defined as patient portal account registration at any point in the year prior. Retention was defined as ?2 kept appointments or HIV lab measurements ?3 months apart within a 12-month period. Viral suppression was defined as the last viral load in the calendar year <200 copies/mL. We calculated adjusted prevalence ratios (aPRs) and 95% CIs using modified Poisson regression with generalized estimating equations to estimate the association of portal access with retention and viral suppression. Results: We included 4237 people living with HIV contributing 16,951 person-years of follow-up (median 5, IQR 3-5 person-years). The median age was 43 (IQR 33-50) years. Of the 4237 people living with HIV, 78.1% (n=4237) were male, 40.8% (n=1727) were Black non-Hispanic, and 56.5% (n=2395) had access. Access was independently associated with retention (aPR 1.13, 95% CI 1.10-1.17) and viral suppression (aPR 1.18, 95% CI 1.14-1.22). Conclusions: In this population, patient portal access was associated with retention and viral suppression. Future prospective studies should assess the impact of increasing portal access among people living with HIV on these HIV outcomes. UR - https://medinform.jmir.org/2022/7/e34712 UR - http://dx.doi.org/10.2196/34712 UR - http://www.ncbi.nlm.nih.gov/pubmed/35877160 ID - info:doi/10.2196/34712 ER - TY - JOUR AU - Xuan, Yan AU - Guo, Chaojin AU - Lu, Wei PY - 2022/7/21 TI - The Effects of Information Continuity and Interpersonal Continuity on Physician Services Online: Cross-sectional Study JO - JMIR Med Inform SP - e35830 VL - 10 IS - 7 KW - continuity of care KW - web-based medical service KW - service quality KW - information continuity KW - interpersonal continuity N2 - Background: Web-based medical services have become an effective supplement to traditional services in hospitals and an essential part of medical services. Studies have shown that web-based medical services are useful for shortening the delayed admission time and for enhancing the treatment effect from the service continuity perspective. However, the specific measures that patients and physicians should take to improve service continuity remain unknown. Objective: Based on the information richness theory and continuity of care, this study investigates the dynamic effects of information continuity and interpersonal continuity on physician services online. Methods: Data of 7200 patients with 360 physicians covering complete interaction records were collected from a professional web-based platform in China. Content analysis was performed to recognize matching patients and physicians, and least square regression analysis was performed to obtain all empirical results. Results: Empirical results showed that in the short term, information continuity (including offline experience, medical records, and detailed information) influences physicians? web-based services, and their influences show heterogeneity. Moreover, if a patient?s online physician is the same physician who he/she has visited offline, we find that interpersonal continuity is important for service. In the long term, information continuity and interpersonal continuity positively improve service continuity by facilitating repeat purchases. Conclusions: Overall, our findings not only shed new light on patient behavior online and cross-channel behavior but also provide practical insights into improving the continuity of care in online health communities. UR - https://medinform.jmir.org/2022/7/e35830 UR - http://dx.doi.org/10.2196/35830 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862183 ID - info:doi/10.2196/35830 ER - TY - JOUR AU - Dainty, N. Katie AU - Seaton, Bianca M. AU - Estacio, Antonio AU - Hicks, K. Lisa AU - Jamieson, Trevor AU - Ward, Sarah AU - Yu, H. Catherine AU - Mosko, D. Jeffrey AU - Kassardjian, D. Charles PY - 2022/6/28 TI - Virtual Specialist Care During the COVID-19 Pandemic: Multimethod Patient Experience Study JO - JMIR Med Inform SP - e37196 VL - 10 IS - 6 KW - virtual care KW - specialist care KW - patient experience KW - COVID-19 KW - medical care KW - virtual health KW - care data KW - decision support KW - telehealth KW - video consultation N2 - Background: Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators. Objective: We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care. Methods: This study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). All patients who could speak and read English and attended a virtual specialist appointment in a participating clinic at St. Michael?s Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021, were eligible to participate. Results: During the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of ?virtual? visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person. Conclusions: Patient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care. UR - https://medinform.jmir.org/2022/6/e37196 UR - http://dx.doi.org/10.2196/37196 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482950 ID - info:doi/10.2196/37196 ER - TY - JOUR AU - Wozney, Lori AU - Curran, Janet AU - Archambault, Patrick AU - Cassidy, Christine AU - Jabbour, Mona AU - Mackay, Rebecca AU - Newton, Amanda AU - Plint, C. Amy AU - Somerville, Mari PY - 2022/6/24 TI - Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review JO - JMIR Pediatr Parent SP - e36878 VL - 5 IS - 2 KW - emergency department KW - medical informatics KW - pediatric KW - systematic review KW - patient discharge summaries KW - patient-centered care KW - technology KW - hospital N2 - Background: Electronic discharge communication tools (EDCTs) are increasingly common in pediatric emergency departments (EDs). These tools have been shown to improve patient-centered communication, support postdischarge care at home, and reduce unnecessary return visits to the ED. Objective: This study aimed to map and assess the evidence base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features, and outcomes. Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. A total of 7 databases (EBSCO, MEDLINE, CINAHL, PsycINFO, EMBASE Scopus, and Web of Science) were searched for studies published between 1989 and 2021. Studies evaluating discharge communication?related outcomes using electronic tools (eg, text messages, videos, and kiosks) in pediatric EDs were included. In all, 2 researchers independently assessed the eligibility. Extracted data related to study identification, methodology, settings and demographics, intervention features, outcome implementation features, and practice, policy, and research implications. The Mixed Method Appraisal Tool was used to assess methodological quality. The synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics, and heat mapping. Results: In total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. In all, 70% (26/37) of the studies met at least three of five Mixed Method Appraisal Tool criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. The time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (eg, asthma, fracture, head injury, fever, and otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service use. Unvalidated self-report measures were typically used for measurement. Health care provider satisfaction or system-level impacts were infrequently measured in studies. The directionality of primary outcomes pointed to positive effects for the primary measure (44/55, 80%) or no significant difference (10/55, 18%). Only one study reported negative findings, with an increase in return visits to the ED after receiving the intervention compared with the control group. Conclusions: This review is the first to map the broad literature of EDCTs used in pediatric EDs. The findings suggest a promising evidence base, demonstrating that EDCTs have been successfully integrated across clinical contexts and deployed via diverse technological modalities. Although caregiver and patient satisfaction with EDCTs is high, future research should use robust trials using consistent measures of communication quality, clinician experience, cost-effectiveness, and health service use to accumulate evidence regarding these outcomes. Trial Registration: PROSPERO CRD42020157500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157500 UR - https://pediatrics.jmir.org/2022/2/e36878 UR - http://dx.doi.org/10.2196/36878 UR - http://www.ncbi.nlm.nih.gov/pubmed/35608929 ID - info:doi/10.2196/36878 ER - TY - JOUR AU - Nordtug, Maja AU - Assing Hvidt, Elisabeth AU - Lüchau, Christine Elle AU - Grønning, Anette PY - 2022/6/14 TI - General Practitioners? Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study JO - JMIR Form Res SP - e36289 VL - 6 IS - 6 KW - video consultation technology KW - general practice, COVID-19, doctor-patient communication KW - uncertainties KW - general practitioners KW - video consultation KW - virtual health KW - physician KW - digital health KW - pandemic N2 - Background: Uncertainties are omnipresent in health care, but little is known about general practitioners? (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. Objective: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. Methods: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. Results: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. Conclusions: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs? working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships?not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology. UR - https://formative.jmir.org/2022/6/e36289 UR - http://dx.doi.org/10.2196/36289 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653607 ID - info:doi/10.2196/36289 ER - TY - JOUR AU - León, Alejandra Maria AU - Pannunzio, Valeria AU - Kleinsmann, Maaike PY - 2022/6/6 TI - The Impact of Perioperative Remote Patient Monitoring on Clinical Staff Workflows: Scoping Review JO - JMIR Hum Factors SP - e37204 VL - 9 IS - 2 KW - remote patient monitoring KW - telemonitoring KW - workflow KW - nurses KW - physicians KW - perioperative care KW - perioperative medicine KW - telehealth KW - mobile phone N2 - Background: Remote patient monitoring (RPM) interventions are being increasingly implemented in health care environments, given their benefits for different stakeholders. However, the effects of these interventions on the workflow of clinical staff are not always considered in RPM research and practice. Objective: This review explored how contemporary RPM interventions affect clinical staff and their workflows in perioperative settings. Methods: We conducted a scoping review of recent articles reporting the impact of RPM interventions implemented in perioperative settings on clinical staff and their workflow. The databases accessed were Embase and PubMed. A qualitative analysis was performed to identify the main problems and advantages that RPM brings to staff, in addition to the approaches taken to evaluate the impact of those interventions. Different themes were identified in terms of the challenges of RPM for clinical staff as well as in terms of benefits, risk-reduction strategies, and methods for measuring the impact of these interventions on the workflow of clinical staff. Results: A total of 1063 papers were found during the initial search, of which 21 (1.98%) met the inclusion criteria. Of the 21 included papers, 15 (71%) focused on evaluating new RPM systems, 4 (19%) focused on existing systems, and 2 (10%) were reviews. Conclusions: The reviewed literature shows that the impact on staff work experience is a crucial factor to consider when developing and implementing RPM interventions in perioperative settings. However, we noticed both underdevelopment and lack of standardization in the methods for assessing the impact of these interventions on clinical staff and their workflow. On the basis of the reviewed literature, we recommend the development of more robust methods for evaluating the impact of RPM interventions on staff experience in perioperative care; the adoption of a stronger focus on transition management when introducing these interventions in clinical practice; and the inclusion of longer periods of assessment, including the evaluation of long-term goals. UR - https://humanfactors.jmir.org/2022/2/e37204 UR - http://dx.doi.org/10.2196/37204 UR - http://www.ncbi.nlm.nih.gov/pubmed/35666574 ID - info:doi/10.2196/37204 ER - TY - JOUR AU - Ge, Fangmin AU - Qian, Huan AU - Lei, Jianbo AU - Ni, Yiqi AU - Li, Qian AU - Wang, Song AU - Ding, Kefeng PY - 2022/6/1 TI - Experiences and Challenges of Emerging Online Health Services Combating COVID-19 in China: Retrospective, Cross-Sectional Study of Internet Hospitals JO - JMIR Med Inform SP - e37042 VL - 10 IS - 6 KW - COVID-19 KW - telehealth KW - e-consultation KW - dynamics of health care topics KW - China health system N2 - Background: Internet-based online virtual health services were originally an important way for the Chinese government to resolve unmet medical service needs due to inadequate medical institutions. Its initial development was not well received. Then, the unexpected COVID-19 pandemic produced a tremendous demand for telehealth in a short time, which stimulated the explosive development of internet hospitals. The Second Affiliated Hospital of Zhejiang University (SAHZU) has taken a leading role in the construction of internet hospitals in China. The pandemic triggered the hospital to develop unique research on health service capacity under strict quarantine policies and to predict long-term trends. Objective: This study aims to provide policy enlightenment for the construction of internet-based health services to better fight against COVID-19 and to elucidate future directions through an in-depth analysis of 2 years of online health service data gleaned from SAHZU?s experiences and lessons learned. Methods: We collected data from SAHZU Internet Hospital from November 1, 2019, to September 16, 2021. Data from over 900,000 users were analyzed with respect to demographic characteristics, demands placed on departments by user needs, new registrations, and consultation behaviors. Interrupted time series (ITS) analysis was adopted to evaluate the impact of this momentous emergency event and its long-term trends. With theme analysis and a defined 2D model, 3 investigations were conducted synchronously to determine users? authentic demands on online hospitals. Results: The general profile of internet hospital users is young or middle-aged women who live in Zhejiang and surrounding provinces. The ITS model indicated that, after the intervention (the strict quarantine policies) was implemented during the outbreak, the number of internet hospital users significantly increased (?_2=105.736, P<.001). Further, long-term waves of COVID-19 led to an increasing number of users following the outbreak (?_3=0.167, P<.001). In theme analysis, we summarized 8 major demands by users of the SAHZU internet hospital during the national shutdown period and afterwards. Online consultations and information services were persistent and universal demands, followed by concerns about medical safety and quality, time, and cost. Users? medical behavior patterns changed from onsite to online as internet hospital demands increased. Conclusions: The pandemic has spawned the explosive growth of telehealth; as a public tertiary internet hospital, the SAHZU internet hospital is partially and irreversibly integrated into the traditional medical system. As we shared the practical examples of 1 public internet hospital in China, we put forward suggestions about the future direction of telehealth. Vital experience in the construction of internet hospitals was provided in the normalization of COVID-19 prevention and control, which can be demonstrated as a model of internet hospital management practice for other medical institutions. UR - https://medinform.jmir.org/2022/6/e37042 UR - http://dx.doi.org/10.2196/37042 UR - http://www.ncbi.nlm.nih.gov/pubmed/35500013 ID - info:doi/10.2196/37042 ER - TY - JOUR AU - Silva, Vieira Cícera Renata Diniz AU - Lopes, Horácio Rayssa AU - de Goes Bay Jr, Osvaldo AU - Martiniano, Santos Claudia AU - Fuentealba-Torres, Miguel AU - Arcêncio, Alexandre Ricardo AU - Lapão, Velez Luís AU - Dias, Sonia AU - Uchoa, Costa Severina Alice da PY - 2022/5/31 TI - Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review JO - JMIR Hum Factors SP - e35380 VL - 9 IS - 2 KW - digital health KW - telehealth KW - telemedicine KW - primary health care KW - quality of care KW - COVID-19 KW - pandemic KW - science database KW - gray literature N2 - Background: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service. UR - https://humanfactors.jmir.org/2022/2/e35380 UR - http://dx.doi.org/10.2196/35380 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319466 ID - info:doi/10.2196/35380 ER - TY - JOUR AU - Enam, Amia AU - Dreyer, C. Heidi AU - De Boer, Luitzen PY - 2022/5/25 TI - Individuals? Perceptions as a Substitute for Guidelines and Evidence: Interview Study Among Clinicians on How They Choose Between In-Person and Remote Consultation JO - JMIR Form Res SP - e35950 VL - 6 IS - 5 KW - video consultation KW - work routine KW - outpatient care KW - telemedicine KW - clinician KW - professional work N2 - Background: Video consultation (VC) is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and growing demand for health care worldwide. Therefore, the sustainable implementation of VC is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Studies are often criticized for not being sufficiently robust because the research settings are mostly small-scale pilot projects and are unable to reflect long-term implementation. The COVID-19 pandemic has compelled clinicians worldwide to conduct remote consultation, creating a favorable context to study large-scale remote consultation implementation. Objective: The aim of this study was to thoroughly investigate how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reasons are for their choices. We posited that a deeper understanding of clinicians? perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and sustained as a regular service. Methods: A qualitative approach was taken, in which the unit of analysis was clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which were used as the primary data source. Using the performative model of routine as the theoretical framework, data were analyzed using deductive content analysis. Results: Clinicians have mixed opinions on the merits and demerits of VC and its position between in-person and telephone consultation. Totally, 6 different planning criteria were identified, and individual clinicians used different combinations of these criteria when choosing a mode of consultation. The ideals that clinicians hold for conducting consultation can be divided into three aspects: clinical, interpersonal, and managerial. VC engenders a new ideal and endangers the existing ideals. VC causes minor changes in the tasks the clinicians perform during a consultation; thus, these changes do not play a significant role in their choice of consultation. Clinicians could not identify any changes in the outcome of consultation as a result of incorporating a remote mode of consultation. Conclusions: Clinicians feel that there is a lack of scientific evidence on the long-term effect of remote consultation on clinical efficacy and interpersonal and managerial aspects, which are crucial for consultation service. The absence of sufficient scientific evidence and a clear understanding of the merits and demerits of VC and standard practices and shared norms among clinicians regarding the use of video for consultation both create a void in the consultation practice. This void leads clinicians to use their personal judgments and preferences to justify their choices regarding the consultation mode. Thus, diverse opinions emerge, including some paradoxical ones, resulting in an uncertain future for sustainable large-scale implementation, which can reduce the quality of consultation service. UR - https://formative.jmir.org/2022/5/e35950 UR - http://dx.doi.org/10.2196/35950 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475503 ID - info:doi/10.2196/35950 ER - TY - JOUR AU - Huguet, Marius AU - Sarazin, Marianne AU - Perrier, Lionel AU - Augusto, Vincent PY - 2022/5/20 TI - How We Can Reap the Full Benefit of Teleconsultations: Economic Evaluation Combined With a Performance Evaluation Through a Discrete-Event Simulation JO - J Med Internet Res SP - e32002 VL - 24 IS - 5 KW - telemedicine KW - telehealth KW - teleconsultation KW - discrete-event simulation KW - economic evaluation KW - propensity score matching N2 - Background: In recent years, the rapid development of information and communications technology enabled by innovations in videoconferencing solutions and the emergence of connected medical devices has contributed to expanding the scope of application and expediting the development of telemedicine. Objective: This study evaluates the use of teleconsultations (TCs) for specialist consultations at hospitals in terms of costs, resource consumption, and patient travel time. The key feature of our evaluation framework is the combination of an economic evaluation through a cost analysis and a performance evaluation through a discrete-event simulation (DES) approach. Methods: Three data sets were used to obtain detailed information on the characteristics of patients, characteristics of patients? residential locations, and usage of telehealth stations. A total of 532 patients who received at least one TC and 18,559 patients who received solely physical consultations (CSs) were included in the initial sample. The TC patients were recruited during a 7-month period (ie, 2020 data) versus 19 months for the CS patients (ie, 2019 and 2020 data). A propensity score matching procedure was applied in the economic evaluation. To identify the best scenarios for reaping the full benefits of TCs, various scenarios depicting different population types and deployment strategies were explored in the DES model. Associated break-even levels were calculated. Results: The results of the cost evaluation reveal a higher cost for the TC group, mainly induced by higher volumes of (tele)consultations per patient and the substantial initial investment required for TC equipment. On average, the total cost per patient over 298 days of follow-up was ?356.37 (US $392) per TC patient and ?305.18 (US $336) per CS patient. However, the incremental cost of TCs was not statistically significant: ?356.37 ? ?305.18 = ?51.19 or US $392 ? US $336 = US $56 (95% CI ?35.99 to 114.25; P=.18). Sensitivity analysis suggested heterogeneous economic profitability levels within subpopulations and based on the intensity of use of TC solutions. In fact, the DES model results show that TCs could be a cost-saving strategy in some cases, depending on population characteristics, the amortization speed of telehealth equipment, and the locations of telehealth stations. Conclusions: The use of TCs has the potential to lead to a major organizational change in the health care system in the near future. Nevertheless, TC performance is strongly related to the context and deployment strategy involved. UR - https://www.jmir.org/2022/5/e32002 UR - http://dx.doi.org/10.2196/32002 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594065 ID - info:doi/10.2196/32002 ER - TY - JOUR AU - Falgarone, Géraldine AU - Bousquet, Guilhem AU - Wilmet, Arnaud AU - Brizio, Albert AU - Faure, Valérie AU - Guillouet, Celestin AU - Baudino, Franck AU - Roque, Isabelle AU - Mayol, Samuel AU - Pamoukdjian, Frederic PY - 2022/5/17 TI - A Teleconsultation Device, Consult Station, for Remote Primary Care: Multisite Prospective Cohort Study JO - J Med Internet Res SP - e33507 VL - 24 IS - 5 KW - telemedicine booth KW - primary care KW - cost-benefit KW - absenteeism from work KW - health care system KW - telemedicine KW - consultation KW - remote medical consultation KW - proof-of-concept KW - general practice N2 - Background: Telemedicine technology is a growing field, especially in the context of the COVID-19 pandemic. Consult Station (Health for Development) is the first telemedicine device enabling completely remote medical consultations, including the concurrent collection of clinical parameters and videos. Objective: Our aim was to collect data on the multisite urban and suburban implementation of the Consult Station for primary care and assess its contribution to health care pathways in areas with a low density of medical services. Methods: In a proof-of-concept multisite prospective cohort study, 2134 consecutive patients had teleconsultations. Consultation characteristics were analyzed from both the patient and practitioner perspective. Results: In this study, the main users of Consult Station were younger women consulting for low-severity seasonal infections. Interestingly, hypertension, diabetes, and preventive medical consultations were almost absent, while they accounted for almost 50% of consultations with a general practitioner (GP). We showed that for all regions where the Consult Station was implemented, the number of consultations increased as GP density decreased. The study of practitioner characteristics showed GPs from metropolitan areas are motivated to work with this device remotely, with a high level of technology acceptability. Conclusions: The multisite implementation of Consult Station booths is suitable for primary care and could also address the challenge of ?medical deserts.? In addition, further studies should be performed to evaluate the possible contribution of Consult Station booths to limiting work absenteeism. UR - https://www.jmir.org/2022/5/e33507 UR - http://dx.doi.org/10.2196/33507 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254263 ID - info:doi/10.2196/33507 ER - TY - JOUR AU - Chen, Lijuan AU - Zhang, Danyang AU - Hou, Mutian PY - 2022/5/11 TI - The Influence of Perceived Social Presence on the Willingness to Communicate in Mobile Medical Consultations: Experimental Study JO - J Med Internet Res SP - e31797 VL - 24 IS - 5 KW - mobile medical consultation KW - mobile medical service KW - perceived social presence KW - willingness to communicate about health KW - COVID-19 N2 - Background: With the rise of online health care service, there is growing discussion on the relationship between physicians and patients online, yet few researchers have paid attention to patients? perception of social presence, especially its influence on their willingness to communicate (WTC). Objective: The goal of the research is to investigate the influence of perceived social presence (PSP) on WTC in mobile medical consultations. Methods: Participants living in Yunnan province during the period of middle to high risk of COVID-19 infection were recruited via the internet. They were assigned randomly into 2 groups interacting with a virtual physician presenting high and low levels of social presence and then asked to complete a questionnaire. Based on the theoretical framework, the study puts forward a model evaluating the relationships among participants? PSP, communication apprehension (CA), self-perceived communication competence (SPCC), and willingness to communicate about health (WTCH) in the computer-mediated communication between virtual physicians and patients. Results: In total 206 (106 in group 1 and 100 in group 2) valid samples were gathered (from 276 log-ins) and 88.8% (183/206) of them were aged 18 to 44 years, which approximately resembles the age distribution of the main population engaging in online medical consultation in China. Independent t test shows that there is significant difference between the PSP of the 2 groups (P=.04), indicating a successful manipulation of social presence. The total effect of PSP on WTCH is 0.56 (P<.001), among which 74.4% is direct effect (P<.001). Among the indirect effects between PSP and WTCH, the mediating effect of SPCC accounts for 68.8% (P<.001) and the sequential mediating effect of CA?SPCC accounts for 19.2% (P<.001), while the mediating effect of CA alone is not significant (P=.08). Conclusions: This study provides a comprehensible model, demonstrating that PSP is an important antecedent of WTCH, and the sequential mediating effect of CA and SPCC found in this study also proves that in the environment of online mobile medical services, CA cannot affect communication directly. The findings will provide some practical inspiration for the popularization of online medical service, especially for the promotion of online physician-patient communication. UR - https://www.jmir.org/2022/5/e31797 UR - http://dx.doi.org/10.2196/31797 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544293 ID - info:doi/10.2196/31797 ER - TY - JOUR AU - Zolnoori, Maryam AU - Vergez, Sasha AU - Kostic, Zoran AU - Jonnalagadda, Reddy Siddhartha AU - V McDonald, Margaret AU - Bowles, H. Kathryn K. AU - Topaz, Maxim PY - 2022/5/11 TI - Audio Recording Patient-Nurse Verbal Communications in Home Health Care Settings: Pilot Feasibility and Usability Study JO - JMIR Hum Factors SP - e35325 VL - 9 IS - 2 KW - patients KW - HHC KW - communications KW - nurse KW - audio recording KW - device N2 - Background: Patients? spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients? spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting. Objective: This study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows. Methods: This study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices?Saramonic Blink500, Sony ICD-TX6, and Black Vox 365?were further evaluated in a clinical setting (patients? homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews. Results: Saramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65% and 26%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management. Conclusions: This study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation. UR - https://humanfactors.jmir.org/2022/2/e35325 UR - http://dx.doi.org/10.2196/35325 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544296 ID - info:doi/10.2196/35325 ER - TY - JOUR AU - Ng, Wen Sock AU - Hwong, Yea Wen AU - Husin, Masliyana AU - Ab Rahman, Norazida AU - Nasir, Hairizan Nazrila AU - Juval, Kawselyah AU - Sivasampu, Sheamini PY - 2022/5/9 TI - Assessing the Availability of Teleconsultation and the Extent of Its Use in Malaysian Public Primary Care Clinics: Cross-sectional Study JO - JMIR Form Res SP - e34485 VL - 6 IS - 5 KW - teleconsultation KW - telemedicine KW - video consultation KW - telephone consultation KW - virtual clinic KW - primary care KW - cross-sectional KW - virtual care KW - Asia N2 - Background: The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries. Objective: The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics. Methods: A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic. Results: In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97). Conclusions: Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service. UR - https://formative.jmir.org/2022/5/e34485 UR - http://dx.doi.org/10.2196/34485 UR - http://www.ncbi.nlm.nih.gov/pubmed/35532973 ID - info:doi/10.2196/34485 ER - TY - JOUR AU - Mignault, Alexandre AU - Tchouaket Nguemeleu, Éric AU - Robins, Stephanie AU - Maillet, Éric AU - Matetsa, Edwige AU - Dupuis, Stéphane PY - 2022/5/6 TI - Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers? Worries JO - JMIR Perioper Med SP - e36208 VL - 5 IS - 1 KW - COVID-19 KW - surgery KW - intraoperative KW - OR nurse KW - communication KW - technology KW - short messaging service KW - SMS KW - text message KW - caregiver KW - anxiety KW - perioperative KW - surgical KW - surgical procedure KW - mHealth KW - mental health KW - digital health KW - digital health care N2 - Background: Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intraoperative period, caregivers seek out informational updates from health care professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. Short messaging service (SMS)-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by health care professionals and may be effective at relieving staff burden. Objective: Here, we describe a quality improvement initiative of a standardized and integrated intraoperative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to improve satisfaction with care, while the secondary goal was to reduce caregiver anxiety. Methods: The initiative followed the framework of the Model for Improvement. A large tertiary care hospital offered the SMS to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers 1 business day after surgery. Data were collected between February 16 and July 14, 2021. Results: Of the 8129 surgeries scheduled, caregivers waiting for 6149 (75.6%) surgeries agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2088 (34%) of the 6149 caregivers. Satisfaction with messages was high, with the majority of respondents reporting that the messages received were adequate (1476/2085, 70.8%), clear (1545/2077, 74.4%), informative (1488/2078, 71.6%), and met their needs (1234/2077, 59.4%). The overall satisfaction score was high (4.5 out of 5), and caregivers reported that receiving text messages resulted in a reduction in anxiety (score=8.2 out of 10). Technical errors were reported by 69 (3.3%) caregivers. Suggestions for improvements included having messages sent more often; providing greater patient details, including the patient?s health status; and the service being offered in other languages. Conclusions: This digital health initiative provided SMS messages that were systematically sent to caregivers waiting for their loved ones undergoing surgery, just as COVID-19 restrictions began preventing waiting onsite. The messages were used across 15 surgical specialties and have since been implemented hospital-wide. Digital health care innovations have the capacity to improve family-centered communication; what patients and their families find useful and appreciate will ultimately determine their success. UR - https://periop.jmir.org/2022/1/e36208 UR - http://dx.doi.org/10.2196/36208 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436760 ID - info:doi/10.2196/36208 ER - TY - JOUR AU - Huang, Ming AU - Khurana, Aditya AU - Mastorakos, George AU - Wen, Andrew AU - He, Huan AU - Wang, Liwei AU - Liu, Sijia AU - Wang, Yanshan AU - Zong, Nansu AU - Prigge, Julie AU - Costello, Brian AU - Shah, Nilay AU - Ting, Henry AU - Fan, Jungwei AU - Patten, Christi AU - Liu, Hongfang PY - 2022/5/5 TI - Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Hum Factors SP - e35187 VL - 9 IS - 2 KW - patient portal KW - patient portal message KW - asynchronous communication KW - COVID-19 KW - utilization KW - digital health KW - healthcare KW - health care KW - remote healthcare KW - virtual care KW - pandemic N2 - Background: During the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. Objective: This study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis. Methods: We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients? sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19?related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression). Results: The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. Conclusions: During the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis. UR - https://humanfactors.jmir.org/2022/2/e35187 UR - http://dx.doi.org/10.2196/35187 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171108 ID - info:doi/10.2196/35187 ER - TY - JOUR AU - Mercadal Rotger, Josep AU - Cabré, Victor PY - 2022/5/2 TI - Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study JO - JMIR Ment Health SP - e36775 VL - 9 IS - 5 KW - online psychological intervention KW - therapeutic alliance KW - digital health KW - mental health KW - mental health education KW - mental health treatment KW - health interventions KW - health professional KW - online health KW - web-based health KW - intervention modality N2 - Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances?observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=?42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. UR - https://mental.jmir.org/2022/5/e36775 UR - http://dx.doi.org/10.2196/36775 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499910 ID - info:doi/10.2196/36775 ER - TY - JOUR AU - White, A. Andrew AU - King, M. Ann AU - D?Addario, E. Angelo AU - Brigham, Berg Karen AU - Dintzis, Suzanne AU - Fay, E. Emily AU - Gallagher, H. Thomas AU - Mazor, M. Kathleen PY - 2022/4/29 TI - Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory JO - JMIR Med Educ SP - e30988 VL - 8 IS - 2 KW - medical error disclosure KW - simulation studies KW - communication assessment KW - graduate medical education KW - crowdsourcing KW - patient-centered care KW - generalizability theory KW - medical education KW - medical error KW - communication N2 - Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents? error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates? and crowdsourced laypeople?s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. UR - https://mededu.jmir.org/2022/2/e30988 UR - http://dx.doi.org/10.2196/30988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486423 ID - info:doi/10.2196/30988 ER - TY - JOUR AU - Gordon, Kayleigh AU - Dainty, N. Katie AU - Steele Gray, Carolyn AU - DeLacy, Jane AU - Shah, Amika AU - Seto, Emily PY - 2022/4/28 TI - Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study JO - JMIR Nursing SP - e36346 VL - 5 IS - 1 KW - telemonitoring KW - TM KW - nurse practitioner KW - NP-led care KW - models of care KW - integrated care KW - disease care model KW - disease KW - nurse KW - nurse-led implementation KW - complex chronic conditions KW - CCC KW - clinical team KW - mobile phone N2 - Background: The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective: This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods: A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results: Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions: Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model. UR - https://nursing.jmir.org/2022/1/e36346 UR - http://dx.doi.org/10.2196/36346 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482375 ID - info:doi/10.2196/36346 ER - TY - JOUR AU - Cloitre, Marylene AU - Amspoker, Bush Amber AU - Fletcher, L. Terri AU - Hogan, B. Julianna AU - Jackson, Christie AU - Jacobs, Adam AU - Shammet, Rayan AU - Speicher, Sarah AU - Wassef, Miryam AU - Lindsay, Jan PY - 2022/4/27 TI - Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study JO - JMIR Ment Health SP - e33080 VL - 9 IS - 4 KW - PTSD KW - depression KW - veterans KW - blended therapy KW - iCBT KW - web-based KW - webSTAIR KW - noninferiority KW - mental health KW - digital health N2 - Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. UR - https://mental.jmir.org/2022/4/e33080 UR - http://dx.doi.org/10.2196/33080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475777 ID - info:doi/10.2196/33080 ER - TY - JOUR AU - Nißen, Marcia AU - Rüegger, Dominik AU - Stieger, Mirjam AU - Flückiger, Christoph AU - Allemand, Mathias AU - v Wangenheim, Florian AU - Kowatsch, Tobias PY - 2022/4/27 TI - The Effects of Health Care Chatbot Personas With Different Social Roles on the Client-Chatbot Bond and Usage Intentions: Development of a Design Codebook and Web-Based Study JO - J Med Internet Res SP - e32630 VL - 24 IS - 4 KW - chatbot KW - conversational agent KW - social roles KW - interpersonal closeness KW - social role theory KW - working alliance KW - design KW - persona KW - digital health intervention KW - web-based experiment N2 - Background: The working alliance refers to an important relationship quality between health professionals and clients that robustly links to treatment success. Recent research shows that clients can develop an affective bond with chatbots. However, few research studies have investigated whether this perceived relationship is affected by the social roles of differing closeness a chatbot can impersonate and by allowing users to choose the social role of a chatbot. Objective: This study aimed at understanding how the social role of a chatbot can be expressed using a set of interpersonal closeness cues and examining how these social roles affect clients? experiences and the development of an affective bond with the chatbot, depending on clients? characteristics (ie, age and gender) and whether they can freely choose a chatbot?s social role. Methods: Informed by the social role theory and the social response theory, we developed a design codebook for chatbots with different social roles along an interpersonal closeness continuum. Based on this codebook, we manipulated a fictitious health care chatbot to impersonate one of four distinct social roles common in health care settings?institution, expert, peer, and dialogical self?and examined effects on perceived affective bond and usage intentions in a web-based lab study. The study included a total of 251 participants, whose mean age was 41.15 (SD 13.87) years; 57.0% (143/251) of the participants were female. Participants were either randomly assigned to one of the chatbot conditions (no choice: n=202, 80.5%) or could freely choose to interact with one of these chatbot personas (free choice: n=49, 19.5%). Separate multivariate analyses of variance were performed to analyze differences (1) between the chatbot personas within the no-choice group and (2) between the no-choice and the free-choice groups. Results: While the main effect of the chatbot persona on affective bond and usage intentions was insignificant (P=.87), we found differences based on participants? demographic profiles: main effects for gender (P=.04, ?p2=0.115) and age (P<.001, ?p2=0.192) and a significant interaction effect of persona and age (P=.01, ?p2=0.102). Participants younger than 40 years reported higher scores for affective bond and usage intentions for the interpersonally more distant expert and institution chatbots; participants 40 years or older reported higher outcomes for the closer peer and dialogical-self chatbots. The option to freely choose a persona significantly benefited perceptions of the peer chatbot further (eg, free-choice group affective bond: mean 5.28, SD 0.89; no-choice group affective bond: mean 4.54, SD 1.10; P=.003, ?p2=0.117). Conclusions: Manipulating a chatbot?s social role is a possible avenue for health care chatbot designers to tailor clients? chatbot experiences using user-specific demographic factors and to improve clients? perceptions and behavioral intentions toward the chatbot. Our results also emphasize the benefits of letting clients freely choose between chatbots. UR - https://www.jmir.org/2022/4/e32630 UR - http://dx.doi.org/10.2196/32630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475761 ID - info:doi/10.2196/32630 ER - TY - JOUR AU - Crotty, H. Bradley AU - Somai, Melek PY - 2022/4/22 TI - Bugs in the Virtual Clinic: Confronting Telemedicine?s Challenges Through Empathy and Support JO - J Particip Med SP - e25688 VL - 14 IS - 1 KW - telemedicine KW - virtual care KW - patient experience KW - consumer informatics KW - telehealth KW - access KW - challenge KW - electronic health record KW - digital health UR - https://jopm.jmir.org/2022/1/e25688 UR - http://dx.doi.org/10.2196/25688 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452399 ID - info:doi/10.2196/25688 ER - TY - JOUR AU - Kainiemi, Emma AU - Vehko, Tuulikki AU - Kyytsönen, Maiju AU - Hörhammer, Iiris AU - Kujala, Sari AU - Jormanainen, Vesa AU - Heponiemi, Tarja PY - 2022/4/22 TI - The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey JO - JMIR Med Inform SP - e37500 VL - 10 IS - 4 KW - patient portal KW - digital technology KW - eHealth KW - nonuse KW - dissatisfaction KW - COVID-19 KW - digital health KW - patient empowerment KW - epidemiology KW - population survey KW - national survey N2 - Background: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public?s confidence in the protection of their confidential data. UR - https://medinform.jmir.org/2022/4/e37500 UR - http://dx.doi.org/10.2196/37500 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404831 ID - info:doi/10.2196/37500 ER - TY - JOUR AU - Mao, Alice AU - Tam, Lydia AU - Xu, Audrey AU - Osborn, Kim AU - Sheffrin, Meera AU - Gould, Christine AU - Schillinger, Erika AU - Martin, Marina AU - Mesias, Matthew PY - 2022/4/19 TI - Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment JO - JMIR Aging SP - e34326 VL - 5 IS - 2 KW - telemedicine KW - barriers to access to care KW - older adults KW - eHealth KW - e-visit KW - access KW - accessibility KW - barrier KW - elder KW - gerontology KW - geriatric KW - need assessment KW - mixed method KW - cross-sectional KW - telehealth KW - community care KW - independent living N2 - Background: Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective: We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits. Methods: We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants? preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes. Results: Survey respondents? (N=249) average age was 84.6 (SD 6.6) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor?s degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor?s degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions: Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives. UR - https://aging.jmir.org/2022/2/e34326 UR - http://dx.doi.org/10.2196/34326 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438648 ID - info:doi/10.2196/34326 ER - TY - JOUR AU - Payne, Thomas AU - Kevric, Jasmina AU - Stelmach, Wanda AU - To, Henry PY - 2022/4/14 TI - The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review JO - JMIR Perioper Med SP - e34661 VL - 5 IS - 1 KW - telemedicine KW - telehealth KW - electronic consultation KW - electronic referral KW - surgery KW - outpatient KW - consultation KW - usage KW - review KW - referral KW - advice KW - communication KW - framework KW - efficacy KW - safety KW - limit N2 - Background: Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective: We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods: We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results: A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions: The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research. UR - https://periop.jmir.org/2022/1/e34661 UR - http://dx.doi.org/10.2196/34661 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436223 ID - info:doi/10.2196/34661 ER - TY - JOUR AU - Dang, Stuti AU - Muralidhar, Kiranmayee AU - Li, Shirley AU - Tang, Fei AU - Mintzer, Michael AU - Ruiz, Jorge AU - Valencia, Marcos Willy PY - 2022/4/8 TI - Gap in Willingness and Access to Video Visit Use Among Older High-risk Veterans: Cross-sectional Study JO - J Med Internet Res SP - e32570 VL - 24 IS - 4 KW - high-risk veterans KW - older adults KW - telemedicine KW - video visits KW - health disparities KW - Area Deprivation Index KW - mobile phone N2 - Background: The recent shift to video care has exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. Developing data-driven approaches to improve access to care necessitates a deeper understanding of HNHR adults? attitudes toward telemedicine and technology access. Objective: This study aims to identify the willingness, access, and ability of HNHR veterans to use telemedicine for health care. Methods: WWe designed a questionnaire conducted via mail or telephone or in person. Among HNHR veterans who were identified using predictive modeling with national Veterans Affairs data, we assessed willingness to use video visits for health care, access to necessary equipment, and comfort with using technology. We evaluated physical health, including frailty, physical function, performance of activities of daily living (ADL) and instrumental ADL (IADL); mental health; and social needs, including Area Deprivation Index, transportation, social support, and social isolation. Results: The average age of the 602 HNHR veteran respondents was 70.6 (SD 9.2; range 39-100) years; 99.7% (600/602) of the respondents were male, 61% (367/602) were White, 36% (217/602) were African American, 17.3% (104/602) were Hispanic, 31.2% (188/602) held at least an associate degree, and 48.2% (290/602) were confident filling medical forms. Of the 602 respondents, 327 (54.3%) reported willingness for video visits, whereas 275 (45.7%) were unwilling. Willing veterans were younger (P<.001) and more likely to have an associate degree (P=.002), be health literate (P<.001), live in socioeconomically advantaged neighborhoods (P=.048), be independent in IADLs (P=.02), and be in better physical health (P=.04). A higher number of those willing were able to use the internet and email (P<.001). Of the willing veterans, 75.8% (248/327) had a video-capable device. Those with video-capable technology were younger (P=.004), had higher health literacy (P=.01), were less likely to be African American (P=.007), were more independent in ADLs (P=.005) and IADLs (P=.04), and were more adept at using the internet and email than those without the needed technology (P<.001). Age, confidence in filling forms, general health, and internet use were significantly associated with willingness to use video visits. Conclusions: Approximately half of the HNHR respondents were unwilling for video visits and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, African American veterans; those with worse physical health; and those living in more socioeconomically disadvantaged neighborhoods. Our study highlights that HNHR veterans have complex needs, which risk being exacerbated by the video care shift. Although technology holds vast potential to improve health care access, certain vulnerable populations are less likely to engage, or have access to, technology. Therefore, targeted interventions are needed to address this inequity, especially among HNHR older adults. UR - https://www.jmir.org/2022/4/e32570 UR - http://dx.doi.org/10.2196/32570 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394440 ID - info:doi/10.2196/32570 ER - TY - JOUR AU - Lawrence, Katharine AU - Chong, Stella AU - Krelle, Holly AU - Roberts, Timothy AU - Thorpe, Lorna AU - Trinh-Shevrin, Chau AU - Yi, Stella AU - Kwon, Simona PY - 2022/4/1 TI - Chinese Americans? Use of Patient Portal Systems: Scoping Review JO - JMIR Hum Factors SP - e27924 VL - 9 IS - 2 KW - patient portal KW - electronic health records KW - personal health records KW - ehealth KW - health equity KW - digital divide KW - Chinese Americans KW - Asian Americans N2 - Background: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. Objective: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. Methods: The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. Results: In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record?based data over qualitative or other methodologies; and a pattern of aggregating Chinese American?related data into a larger Asian or Asian American designation. Conclusions: There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools. UR - https://humanfactors.jmir.org/2022/2/e27924 UR - http://dx.doi.org/10.2196/27924 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363153 ID - info:doi/10.2196/27924 ER - TY - JOUR AU - Sanavro, M. Sanne AU - van der Worp, Henk AU - Jansen, Danielle AU - Koning, Paul AU - Blanker, H. Marco AU - PY - 2022/4/1 TI - Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study JO - JMIR Hum Factors SP - e33630 VL - 9 IS - 2 KW - primary care KW - digital consultation KW - interdisciplinary KW - specialist care N2 - Background: Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective: This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods: We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results: In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions: Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking. UR - https://humanfactors.jmir.org/2022/2/e33630 UR - http://dx.doi.org/10.2196/33630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363155 ID - info:doi/10.2196/33630 ER - TY - JOUR AU - Beauséjour, Waldo AU - Hagens, Simon PY - 2022/3/31 TI - Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses JO - JMIR Nursing SP - e33586 VL - 5 IS - 1 KW - adoption of virtual care KW - secure messaging KW - nurses KW - nursing KW - telehealth KW - telehomecare KW - telemonitoring KW - remote patient monitoring KW - virtual videoconferencing KW - uptake of virtual care N2 - Background: Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. Objective: This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. Methods: We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. Results: In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record?keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses? perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (?24=308.7; P<.001) and knowledge (?24=283.4; P<.001) to use these technologies. Conclusions: This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record?keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery. UR - https://nursing.jmir.org/2022/1/e33586 UR - http://dx.doi.org/10.2196/33586 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357326 ID - info:doi/10.2196/33586 ER - TY - JOUR AU - Shan, Rongzi AU - Chandra, V. Neha AU - Hsu, J. Jeffrey AU - Fraschilla, Stephanie AU - Moore, Melissa AU - Ardehali, Abbas AU - Nsair, Ali AU - Parikh, V. Rushi PY - 2022/3/30 TI - The Impact of Transitioning From In-Person to Virtual Heart Transplantation Selection Committee Meetings: Observational Study JO - JMIR Cardio SP - e35490 VL - 6 IS - 1 KW - telemedicine KW - transplantation KW - heart failure KW - physician KW - heart transplant KW - virtual meeting KW - interprofessional relations KW - health systems KW - selection committee N2 - Background: Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. Objective: The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. Methods: A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). Results: Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48%) were physicians and 26 (52%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50%) from physicians and 23 (50%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54% (22/41) preferred in-person meetings, with 71% (15/21) of nonphysicians preferring in-person meetings compared to only 35% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25% compared to 10/22, 45%; P=.32). Conclusions: The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members? perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities. UR - https://cardio.jmir.org/2022/1/e35490 UR - http://dx.doi.org/10.2196/35490 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353041 ID - info:doi/10.2196/35490 ER - TY - JOUR AU - Maramba, Daniel Inocencio AU - Jones, Ray AU - Austin, Daniela AU - Edwards, Katie AU - Meinert, Edward AU - Chatterjee, Arunangsu PY - 2022/3/29 TI - The Role of Health Kiosks: Scoping Review JO - JMIR Med Inform SP - e26511 VL - 10 IS - 3 KW - kiosk KW - health systems KW - internet KW - review KW - online health information KW - telemonitoring KW - teleconsultation KW - consultation KW - telemedicine KW - behavior KW - promotion KW - health service KW - user experience KW - barrier KW - facilitator KW - remote consultation KW - mobile phone N2 - Background: Health kiosks are publicly accessible computing devices that provide access to services, including health information provision, clinical measurement collection, patient self?check-in, telemonitoring, and teleconsultation. Although the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow. Objective: We seek to clarify the current and future roles of health kiosks by investigating the settings, roles, and clinical domains in which kiosks are used; whether usability evaluations of health kiosks are being reported, and if so, what methods are being used; and what the barriers and facilitators are for the deployment of kiosks. Methods: We conducted a scoping review using a bibliographic search of Google Scholar, PubMed, and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers described the implementation as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and querying the key informants. For each article, we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and whether the kiosk included usability testing. We then summarized the data in frequency tables. Results: A total of 141 articles were included, of which 134 (95%) were primary studies, and 7 (5%) were reviews. Approximately 47% (63/134) of the primary studies described kiosks in secondary care settings. Other settings included community (32/134, 23.9%), primary care (24/134, 17.9%), and pharmacies (8/134, 6%). The most common roles of the health kiosks were providing health information (47/134, 35.1%), taking clinical measurements (28/134, 20.9%), screening (17/134, 12.7%), telehealth (11/134, 8.2%), and patient registration (8/134, 6.0%). The 5 most frequent health domains were multiple conditions (33/134, 24.6%), HIV (10/134, 7.5%), hypertension (10/134, 7.5%), pediatric injuries (7/134, 5.2%), health and well-being (6/134, 4.5%), and drug monitoring (6/134, 4.5%). Kiosks were integrated into the clinical pathway in 70.1% (94/134) of studies, opportunistic kiosks accounted for 23.9% (32/134) of studies, and in 6% (8/134) of studies, kiosks were used in both. Usability evaluations of kiosks were reported in 20.1% (27/134) of papers. Barriers (e.g., use of expensive proprietary software) and enablers (e.g., handling of on-demand consultations) of deploying health kiosks were identified. Conclusions: Health kiosks still play a vital role in the health care system, including collecting clinical measurements and providing access to web-based health services and information to those with little or no digital literacy skills and others without personal internet access. We identified research gaps, such as training needs for teleconsultations and scant reporting on usability evaluation methods. UR - https://medinform.jmir.org/2022/3/e26511 UR - http://dx.doi.org/10.2196/26511 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348457 ID - info:doi/10.2196/26511 ER - TY - JOUR AU - Allen, A. Nancy AU - Litchman, L. Michelle AU - Chamberlain, James AU - Grigorian, G. Ernest AU - Iacob, Eli AU - Berg, A. Cynthia PY - 2022/3/16 TI - Continuous Glucose Monitoring Data Sharing in Older Adults With Type 1 Diabetes: Pilot Intervention Study JO - JMIR Diabetes SP - e35687 VL - 7 IS - 1 KW - older adults KW - type 1 diabetes KW - caregiver KW - CGM KW - data sharing KW - mobile phone N2 - Background: Family members or friends (care partners [CPs]) of older adults with type 1 diabetes (T1DM) regularly become part of the diabetes care team, but they often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Continuous glucose monitoring (CGM) allows a person with diabetes to see their glucose levels continuously and to receive predictive alerts. A smartphone data-sharing app called the Follow app allows the person with diabetes to share continuous glucose numbers with others and to receive predictive alerts of impending hypo- and hyperglycemia. However, there are barriers to sharing this continuous glucose level data with CPs. Objective: This study aimed to address the barriers to sharing CGM data. Our objective was to examine the feasibility of using CGM with the Follow app and a data-sharing intervention called SHARE plus in older adults with T1DM and their CPs. SHARE plus includes dyadic communication strategies, problem-solving strategies, and action planning to facilitate CGM data sharing. Methods: Older adults with T1DM (n=20) and their CPs (n=20) received the SHARE plus intervention at baseline. People with diabetes wore the CGM for 12 weeks while sharing their glucose data using the Follow app with CPs. Feasibility data were analyzed using descriptive statistics. Results: The SHARE plus intervention was feasible and was associated with high self-reported satisfaction for people with diabetes and their CPs as well as high adherence to CGM (mean 96%, SD 6.8%). Broad improvements were shown in the diabetes-related quality of life through the use of CGM in people with diabetes and their CPs. Although the majority of people with diabetes (11/20, 55%) were willing to share hyperglycemia data, several chose not to. The majority of people with diabetes (14/20, 70%) were willing to talk about glucose numbers with a CP. Conclusions: Older adults with T1DM and their CPs identified having someone else aware of glucose levels and working together with a partner on diabetes self-management as positive aspects of the use of the SHARE plus intervention. Clinicians can use these results to provide data sharing coaching in older adults and their CPs. UR - https://diabetes.jmir.org/2022/1/e35687 UR - http://dx.doi.org/10.2196/35687 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293868 ID - info:doi/10.2196/35687 ER - TY - JOUR AU - Beks, Hannah AU - King, Olivia AU - Clapham, Renee AU - Alston, Laura AU - Glenister, Kristen AU - McKinstry, Carol AU - Quilliam, Claire AU - Wellwood, Ian AU - Williams, Catherine AU - Wong Shee, Anna PY - 2022/3/9 TI - Community Health Programs Delivered Through Information and Communications Technology in High-Income Countries: Scoping Review JO - J Med Internet Res SP - e26515 VL - 24 IS - 3 KW - telemedicine KW - delivery of health care KW - pandemics KW - community health services KW - information and communications technology KW - mobile phone N2 - Background: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective: The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods: The Joanna Briggs Institute?s scoping review methodology guided the review of the literature. Results: The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions: Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers. UR - https://www.jmir.org/2022/3/e26515 UR - http://dx.doi.org/10.2196/26515 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262498 ID - info:doi/10.2196/26515 ER - TY - JOUR AU - Yang, Hsuan-Chia AU - Rahmanti, Ristya Annisa AU - Huang, Chih-Wei AU - Li, Jack Yu-Chuan PY - 2022/3/4 TI - How Can Research on Artificial Empathy Be Enhanced by Applying Deepfakes? JO - J Med Internet Res SP - e29506 VL - 24 IS - 3 KW - artificial empathy KW - deepfakes KW - doctor-patient relationship KW - face emotion recognition KW - artificial intelligence KW - facial recognition KW - facial emotion recognition KW - medical images KW - patient KW - physician KW - therapy UR - https://www.jmir.org/2022/3/e29506 UR - http://dx.doi.org/10.2196/29506 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254278 ID - info:doi/10.2196/29506 ER - TY - JOUR AU - Jamieson Gilmore, Kendall AU - Bonciani, Manila AU - Vainieri, Milena PY - 2022/3/4 TI - A Comparison of Census and Cohort Sampling Models for the Longitudinal Collection of User-Reported Data in the Maternity Care Pathway: Mixed Methods Study JO - JMIR Med Inform SP - e25477 VL - 10 IS - 3 KW - longitudinal studies KW - mothers KW - pregnancy KW - survival analysis KW - patient-reported outcome measures KW - patient-reported experience measures KW - surveys KW - maternity KW - postpartum KW - online KW - digital health KW - digital collection N2 - Background: Typical measures of maternity performance remain focused on the technical elements of birth, especially pathological elements, with insufficient measurement of nontechnical measures and those collected pre- and postpartum. New technologies allow for patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to be collected from large samples at multiple time points, which can be considered alongside existing administrative sources; however, such models are not widely implemented or evaluated. Since 2018, a longitudinal, personalized, and integrated user-reported data collection process for the maternal care pathway has been used in Tuscany, Italy. This model has been through two methodological iterations. Objective: The aim of this study was to compare and contrast two sampling models of longitudinal user-reported data for the maternity care pathway, exploring factors influencing participation, cost, and suitability of the models for different stakeholders. Methods: Data were collected by two modes: (1) ?cohort? recruitment at the birth hospital of a predetermined sample size and (2) continuous, ongoing ?census? recruitment of women at the first midwife appointment. Surveys were used to collect experiential and outcome data related to existing services. Women were included who passed 12 months after initial enrollment, meaning that they either received the surveys issued after that interval or dropped out in the intervening period. Data were collected from women in Tuscany, Italy, between September 2018 and July 2020. The total sample included 7784 individuals with 38,656 observations. The two models of longitudinal collection of user-reported data were analyzed using descriptive statistics, survival analysis, cost comparison, and a qualitative review. Results: Cohort sampling provided lower initial participation than census sampling, although very high subsequent response rates (87%) were obtained 1 year after enrollment. Census sampling had higher initial participation, but greater dropout (up to 45% at 1 year). Both models showed high response rates for online surveys. There were nonproportional dropout hazards over time. There were higher rates of dropout for women with foreign nationality (hazard ratio [HR] 1.88, P<.001), and lower rates of dropout for those who had a higher level of education (HR 0.77 and 0.61 for women completing high school and college, respectively; P<.001), were employed (HR 0.87, P=.01), in a relationship (HR 0.84, P=.04), and with previous pregnancies (HR 0.86, P=.002). The census model was initially more expensive, albeit with lower repeat costs and could become cheaper if repeated more than six times. Conclusions: The digital collection of user-reported data enables high response rates to targeted surveys in the maternity care pathway. The point at which pregnant women or mothers are recruited is relevant for response rates and sample bias. The census model of continuous enrollment and real-time data availability offers a wider set of potential benefits, but at an initially higher cost and with the requirement for more substantial data translation and managerial capacity to make use of such data. UR - https://medinform.jmir.org/2022/3/e25477 UR - http://dx.doi.org/10.2196/25477 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254268 ID - info:doi/10.2196/25477 ER - TY - JOUR AU - Marx, Gernot AU - Greiner, Wolfgang AU - Juhra, Christian AU - Elkenkamp, Svenja AU - Gensorowsky, Daniel AU - Lemmen, Sebastian AU - Englbrecht, Jan AU - Dohmen, Sandra AU - Gottschalk, Antje AU - Haverkamp, Miriam AU - Hempen, Annette AU - Flügel-Bleienheuft, Christian AU - Bause, Daniela AU - Schulze-Steinen, Henna AU - Rademacher, Susanne AU - Kistermann, Jennifer AU - Hoch, Stefan AU - Beckmann, Hans-Juergen AU - Lanckohr, Christian AU - Lowitsch, Volker AU - Peine, Arne AU - Juzek-Kuepper, Fabian AU - Benstoem, Carina AU - Sperling, Kathrin AU - Deisz, Robert PY - 2022/3/2 TI - An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e34098 VL - 24 IS - 3 KW - telemedicine KW - infectious disease medicine KW - sepsis KW - evidence-based medicine KW - eHealth N2 - Background: Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings). Objective: This study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. Methods: We performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ?18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. Results: Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95% CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95% CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29% (19/66) in the control group to 23.8% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95% CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95% CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95% CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. Conclusions: Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients. Trial Registration: ClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589 UR - https://www.jmir.org/2022/3/e34098 UR - http://dx.doi.org/10.2196/34098 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103604 ID - info:doi/10.2196/34098 ER - TY - JOUR AU - Zhang, Zhan AU - Joy, Karen AU - Harris, Richard AU - Ozkaynak, Mustafa AU - Adelgais, Kathleen AU - Munjal, Kevin PY - 2022/2/28 TI - Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study JO - JMIR Hum Factors SP - e30883 VL - 9 IS - 1 KW - smart glasses KW - hands-free technologies KW - emergency medical services KW - user studies KW - mobile phone N2 - Background: Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective: The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods: We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users? perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results: We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions: Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology. UR - https://humanfactors.jmir.org/2022/1/e30883 UR - http://dx.doi.org/10.2196/30883 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225816 ID - info:doi/10.2196/30883 ER - TY - JOUR AU - Chow, Aloysius AU - Teo, Huang Sok AU - Kong, Wen Jing AU - Lee, Simon AU - Heng, Kiat Yee AU - van Steensel, Maurice AU - Smith, Helen PY - 2022/2/22 TI - Patients? Experiences of Telemedicine for Their Skin Problems: Qualitative Study JO - JMIR Dermatol SP - e24956 VL - 5 IS - 1 KW - teledermatology KW - qualitative KW - patients experience KW - telemedicine KW - dermatology KW - Singapore N2 - Background: Teledermatology is a cost-effective treatment modality for the management of skin disorders. Most evaluations use quantitative data, and far less is understood about the patients? experience. Objective: This qualitative study aimed to explore patients? perceptions of a teledermatology service linking public primary care clinics to the national specialist dermatology clinic in Singapore. A better understanding of patients? experiences can help refine and develop the care provided. Methods: Semistructured in-depth interviews were conducted with patients who had been referred to the teledermatology service. The interviews were digitally recorded and transcribed before undergoing thematic content analysis. Results: A total of 21 patients aged between 22 and 72 years were recruited. The following 3 themes were identified from the data of patients? experiences: positive perceptions of teledermatology, concerns about teledermatology, and ideas for improving the teledermatology service. The patients found the teledermatology service convenient, saving them time and expense and liberating them from the stresses incurred when making an in-person visit to a specialist facility. They valued the confidence and reassurance they gained from having a dermatologist involved in deciding their management. The patients? concern included data security and the quality of the images shared. Nonetheless, they were keen to see the service expanded beyond the polyclinics. Their experiences and perceptions will inform future service refinement and development. Conclusions: This narrative exploration of users? experiences of teledermatology produced rich data enabling a better understanding of the patients? journey, the way they understand and interpret their experiences, and ideas for service refinement. Telemedicine reduces traveling and enables safe distancing, factors that are much needed during pandemics. UR - https://derma.jmir.org/2022/1/e24956 UR - http://dx.doi.org/10.2196/24956 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632855 ID - info:doi/10.2196/24956 ER - TY - JOUR AU - Alhajri, Noora AU - Simsekler, Emre Mecit Can AU - Alfalasi, Buthaina AU - Alhashmi, Mohamed AU - Memon, Hamda AU - Housser, Emma AU - Abdi, Mustafa Abdulhamid AU - Balalaa, Nahed AU - Al Ali, Maryam AU - Almaashari, Raghda AU - Al Memari, Shammah AU - Al Hosani, Farida AU - Al Zaabi, Yousif AU - Almazrouei, Shereena AU - Alhashemi, Hamed PY - 2022/2/15 TI - Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: Cross-sectional Study JO - JMIR Med Inform SP - e32373 VL - 10 IS - 2 KW - COVID-19 KW - patient satisfaction KW - technology acceptance KW - hospital KW - community clinic KW - video consultation KW - audio consultation KW - outpatient department KW - OPD KW - policy making KW - UAE N2 - Background: Telemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients? perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic. Objective: We aimed to explore the differences in patients? perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine. Methods: In this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients? perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services. Results: A total of 515 patients participated in this survey. Patients? satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8%; community clinics: 114/172, 66.3%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95% CI 1.04-6.33; P=.04) and patients? support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95% CI 1.15-21.19; P=.03), addressed patients? needs (OR 2.63, 95% CI 1.13-6.11; P=.03), and eased expression of patients? medical concerns during the COVID-19 pandemic (OR 2.19, 95% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95% CI 1.09-4.14; P=.03), as compared to any other age group in this study. Conclusions: These findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery. UR - https://medinform.jmir.org/2022/2/e32373 UR - http://dx.doi.org/10.2196/32373 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978281 ID - info:doi/10.2196/32373 ER - TY - JOUR AU - Bucalon, Bernard AU - Shaw, Tim AU - Brown, Kerri AU - Kay, Judy PY - 2022/2/14 TI - State-of-the-art Dashboards on Clinical Indicator Data to Support Reflection on Practice: Scoping Review JO - JMIR Med Inform SP - e32695 VL - 10 IS - 2 KW - practice analytics dashboards KW - data visualization KW - reflective practice KW - professional learning KW - mobile phone N2 - Background: There is an increasing interest in using routinely collected eHealth data to support reflective practice and long-term professional learning. Studies have evaluated the impact of dashboards on clinician decision-making, task completion time, user satisfaction, and adherence to clinical guidelines. Objective: This scoping review aims to summarize the literature on dashboards based on patient administrative, medical, and surgical data for clinicians to support reflective practice. Methods: A scoping review was conducted using the Arksey and O?Malley framework. A search was conducted in 5 electronic databases (MEDLINE, Embase, Scopus, ACM Digital Library, and Web of Science) to identify studies that met the inclusion criteria. Study selection and characterization were performed by 2 independent reviewers (BB and CP). One reviewer extracted the data that were analyzed descriptively to map the available evidence. Results: A total of 18 dashboards from 8 countries were assessed. Purposes for the dashboards were designed for performance improvement (10/18, 56%), to support quality and safety initiatives (6/18, 33%), and management and operations (4/18, 22%). Data visualizations were primarily designed for team use (12/18, 67%) rather than individual clinicians (4/18, 22%). Evaluation methods varied among asking the clinicians directly (11/18, 61%), observing user behavior through clinical indicators and use log data (14/18, 78%), and usability testing (4/18, 22%). The studies reported high scores on standard usability questionnaires, favorable surveys, and interview feedback. Improvements to underlying clinical indicators were observed in 78% (7/9) of the studies, whereas 22% (2/9) of the studies reported no significant changes in performance. Conclusions: This scoping review maps the current literature landscape on dashboards based on routinely collected clinical indicator data. Although there were common data visualization techniques and clinical indicators used across studies, there was diversity in the design of the dashboards and their evaluation. There was a lack of detail regarding the design processes documented for reproducibility. We identified a lack of interface features to support clinicians in making sense of and reflecting on their personal performance data. UR - https://medinform.jmir.org/2022/2/e32695 UR - http://dx.doi.org/10.2196/32695 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156928 ID - info:doi/10.2196/32695 ER - TY - JOUR AU - Grens, Hilde AU - de Bruin, Peter Jan AU - Huppelschoten, Aleida AU - Kremer, M. Jan A. PY - 2022/2/7 TI - Fertility Workup With Video Consultation During the COVID-19 Pandemic: Pilot Quantitative and Qualitative Study JO - JMIR Form Res SP - e32000 VL - 6 IS - 2 KW - COVID-19 KW - patient centeredness KW - video consultation KW - fertility care KW - telemedicine KW - shared decision making N2 - Background: Due to the COVID-19 pandemic, major parts of elective health care in the Netherlands, such as reproductive medicine, were paused. When health care was resumed, video consultation was used as a new solution to continue consultations with the new governmental rules of social distancing. Prior to this COVID-19 situation, video consultation was not used extensively in the Netherlands; therefore, physicians and patients are not familiar with this way of consultation. Objective: The purpose of this study was to measure the level of patient centeredness and shared decision making in infertile couples who have undergone fertility workup through video consultation. Methods: This is a questionnaire study with an additional qualitative part for a more in depth understanding. Infertile couples (ie, male and female partners with an unfulfilled wish for a child after 1 year of unprotected intercourse) were referred to a fertility center and underwent fertility workup through video consultation. The fertility workup consisted of 2 separate video consultations, with diagnostic tests according to a protocol. After the last video consultation couples received a digital questionnaire, which consisted of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) and CollaboRATE questionnaire. Fifty-three eligible infertile couples were approached, and of these, 22 participated. Four women were approached for a semistructured interview. Results: The median score on the modified PCQ-I (scale of 0 to 3) was 2.64. The highest rating was for the subscale communication and information, and the lowest rating was for the subscale organization of care. The median score on the CollaboRATE questionnaire (scale of 1 to 9) was 8 for all 3 subquestions. Patients mentioned privacy, less travel time, and easy use of the program as possible benefits of video consultation. However, patients preferred the first consultation with their physician to be face-to-face consultation as video consultation was considered less personal. Conclusions: The high levels of patient centeredness and shared decision making show that video consultation is a promising way of providing care remotely, although attention has to be payed to mitigate the more impersonal setting of video consultation when compared with face-to-face consultation. UR - https://formative.jmir.org/2022/2/e32000 UR - http://dx.doi.org/10.2196/32000 UR - http://www.ncbi.nlm.nih.gov/pubmed/34936981 ID - info:doi/10.2196/32000 ER - TY - JOUR AU - Scheder-Bieschin, Justus AU - Blümke, Bibiana AU - de Buijzer, Erwin AU - Cotte, Fabienne AU - Echterdiek, Fabian AU - Nacsa, Júlia AU - Ondresik, Marta AU - Ott, Matthias AU - Paul, Gregor AU - Schilling, Tobias AU - Schmitt, Anne AU - Wicks, Paul AU - Gilbert, Stephen PY - 2022/2/7 TI - Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study JO - JMIR Form Res SP - e28199 VL - 6 IS - 2 KW - symptom assessment application KW - anamnesis KW - health care system KW - patient history taking KW - diagnosis KW - emergency department N2 - Background: Establishing rapport and empathy between patients and their health care provider is important but challenging in the context of a busy and crowded emergency department (ED). Objective: We explore the hypotheses that rapport building, documentation, and time efficiency might be improved in the ED by providing patients a digital tool that uses Bayesian reasoning?based techniques to gather relevant symptoms and history for handover to clinicians. Methods: A 2-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital that treats an average of 120 patients daily. Phase 1 observations guided iterative improvement of the digital tool, which was then further evaluated in phase 2. All patients who were willing and able to provide consent were invited to participate, excluding those with severe injury or illness requiring immediate treatment, with traumatic injury, incapable of completing a health assessment, and aged <18 years. Over an 18-day period with 1699 patients presenting to the ED, 815 (47.96%) were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 (60%) were included in the study. In a mixed methods evaluation, patients entered information into the tool, accessed by clinicians through a dashboard. All users completed evaluation Likert-scale questionnaires rating the tool?s performance. The feasibility of a larger trial was evaluated through rates of recruitment and questionnaire completion. Results: Respondents strongly endorsed the tool for facilitating conversation (61/81, 75% of patients, 57/78, 73% of physician ratings, and 10/10, 100% of nurse ratings). Most nurses judged the tool as potentially time saving, whereas most physicians only agreed for a subset of medical specialties (eg, surgery). Patients reported high usability and understood the tool?s questions. The tool was recommended by most patients (63/81, 78%), in 53% (41/77) of physician ratings, and in 76% (61/80) of nurse ratings. Questionnaire completion rates were 100% (81/81) by patients and 96% (78/81 enrolled patients) by physicians. Conclusions: This pilot confirmed that a larger study in the setting would be feasible. The tool has clear potential to improve patient?health care provider interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for whom the history-taking tool has clinical utility. Trial Registration: German Clinical Trials Register DRKS00024115; https://drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024115 UR - https://formative.jmir.org/2022/2/e28199 UR - http://dx.doi.org/10.2196/28199 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129452 ID - info:doi/10.2196/28199 ER - TY - JOUR AU - Yang, Rumei AU - Zeng, Kai AU - Jiang, Yun PY - 2022/2/4 TI - Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study JO - J Med Internet Res SP - e27167 VL - 24 IS - 2 KW - electronic communication KW - quality of care KW - person-related characteristics KW - patient preference KW - HINTS N2 - Background: Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients? use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. Objective: The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. Methods: Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders? personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. Results: The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ?US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (?=.12, 95% CI 0.02-0.22; P=.02). Conclusions: This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults. UR - https://www.jmir.org/2022/2/e27167 UR - http://dx.doi.org/10.2196/27167 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119369 ID - info:doi/10.2196/27167 ER - TY - JOUR AU - Gardner, Tania AU - Schultz, Regina AU - Haskelberg, Hila AU - Newby, M. Jill AU - Wheatley, Jane AU - Millard, Michael AU - Faux, G. Steven AU - Shiner, T. Christine PY - 2022/2/3 TI - The Effect of Adjunct Telephone Support on Adherence and Outcomes of the Reboot Online Pain Management Program: Randomized Controlled Trial JO - J Med Internet Res SP - e30880 VL - 24 IS - 2 KW - chronic pain KW - online pain management KW - telephone support KW - clinician guidance KW - adherence KW - digital health KW - eHealth KW - internet interventions KW - multidisciplinary N2 - Background: Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear. Objective: The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone. Methods: A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)?compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected. Results: Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93%) into the course than those from the control group (35/45, 78%; ?21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91% vs 27/45, 60%, respectively; ?21=11.4; P=.001). Of the participants enrolled in the intervention group, 43% (19/44) completed the course, and of those in the control group, 31% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48%) and control groups (14/27, 52%; ?21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups. Conclusions: Telephone support improves participants? registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167 UR - https://www.jmir.org/2022/2/e30880 UR - http://dx.doi.org/10.2196/30880 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113021 ID - info:doi/10.2196/30880 ER - TY - JOUR AU - Milos Nymberg, Veronica AU - Ellegård, Maria Lina AU - Kjellsson, Gustav AU - Wolff, Moa AU - Borgström Bolmsjö, Beata AU - Wallman, Thorne AU - Calling, Susanna PY - 2022/2/2 TI - Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic JO - JMIR Hum Factors SP - e33034 VL - 9 IS - 1 KW - remote health care KW - telemedicine KW - primary health care KW - respiratory tract infections KW - COVID-19 N2 - Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. UR - https://humanfactors.jmir.org/2022/1/e33034 UR - http://dx.doi.org/10.2196/33034 UR - http://www.ncbi.nlm.nih.gov/pubmed/34846304 ID - info:doi/10.2196/33034 ER - TY - JOUR AU - Neher, Margit AU - Nygårdh, Annette AU - Broström, Anders AU - Lundgren, Johan AU - Johansson, Peter PY - 2022/1/28 TI - Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study JO - J Med Internet Res SP - e28870 VL - 24 IS - 1 KW - clients KW - computer-assisted therapy KW - consultation telehealth KW - decision-makers KW - implementation KW - patients KW - politicians KW - qualitative methods KW - remote KW - mobile phone N2 - Background: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers? conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth. UR - https://www.jmir.org/2022/1/e28870 UR - http://dx.doi.org/10.2196/28870 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089139 ID - info:doi/10.2196/28870 ER - TY - JOUR AU - Schilling, George AU - Villarosa, Leonardo PY - 2022/1/27 TI - An Information Directory App InHouse Call for Streamlining Communication to Optimize Efficiency and Patient Care in a Hospital: Pilot Mixed Methods Design and Utility Study JO - JMIR Hum Factors SP - e23833 VL - 9 IS - 1 KW - InHouse Call KW - communication KW - hospital directory KW - healthcare KW - health care KW - health informatics KW - mHealth KW - mobile app KW - digital health KW - patient records KW - electronic health N2 - Background: Communication failures disrupt physician workflow, lead to poor patient outcomes, and are associated with significant economic burden. To increase efficiency when contacting a team member in a hospital, we have designed an information directory app, InHouse Call. Objective: This study aimed to describe the design of InHouse Call, objectively compare the usefulness of the app versus that of traditional methods (operator or pocket cards, etc), and determine its subjective usefulness through user surveys and a net promoter score (NPS). Methods: This pilot study utilizing before-after trials was carried out at a tertiary academic hospital and involved 20 clinicians, including physiatrists, hospitalists, internal medicine and family medicine residents, and advanced practice providers/nurse practitioners/physician assistants. InHouse Call was designed to efficiently supply contact information to providers through a simple, user-friendly interface. The participants used InHouse Call in timed trials to contact a health care team member in the hospital via a telephone call. The effectiveness of InHouse Call in connecting the user with a contact in the hospital was measured through timed trials comparing the amount of time spent in attempting to make the connection using traditional methods versus the app. Usability was measured through exit surveys and NPS. Results: The average time spent connecting to the correct contact using traditional methods was 59.5 seconds, compared to 13.8 seconds when using InHouse Call. The degree of variance when using traditional methods was 1544.2, compared to 19.7 with InHouse Call. A call made using the traditional methods deviated from the mean by 39.3 seconds, compared to 4.4 seconds when using InHouse Call. InHouse Call achieved an NPS of 95. Conclusions: InHouse Call significantly reduced the average amount of time spent connecting with the correct contact as well as the variability to complete the task, thus proving to be the superior method of communication for health care providers. The app garnered a high NPS and positive subjective feedback. UR - https://humanfactors.jmir.org/2022/1/e23833 UR - http://dx.doi.org/10.2196/23833 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084350 ID - info:doi/10.2196/23833 ER - TY - JOUR AU - Broffman, Lauren AU - Barnes, Melynda AU - Stern, Kevin AU - Westergren, Amy PY - 2022/1/13 TI - Evaluating the Quality of Asynchronous Versus Synchronous Virtual Care in Patients With Erectile Dysfunction: Retrospective Cohort Study JO - JMIR Form Res SP - e32126 VL - 6 IS - 1 KW - telehealth KW - medical informatics KW - side effect KW - virtual health KW - platform KW - medication KW - sync KW - outcome KW - adverse event KW - drug KW - electronic health record KW - treatment KW - erectile dysfunction N2 - Background: Asynchronous health care encounters are becoming an increasingly mainstream form of telehealth. While synchronous phone or video visits have become more widely accepted, US policymakers and other key health care stakeholders have been hesitant to fully embrace asynchronous diagnosis and treatment. This is particularly true in the context of direct-to-consumer (DTC) platforms, where encounters are patient-initiated and there is no preestablished relationship with a provider. This hesitation is compounded by limited research comparing outcomes between asynchronous and synchronous care, especially in the DTC context. Objective: The purpose of this study was to explore whether asynchronous care leads to different patient outcomes in the form of medication-related adverse events when compared to synchronous virtual care. Methods: Using 10,000 randomly sampled patient records from a prominent US-based DTC platform, we analyzed the rates of patient-reported side effects from commonly prescribed erectile dysfunction medications and compared these rates across modalities of treatment. Results: Asynchronous care resulted in lower but nonsignificant differences in the rates of the reported drug-related side effects compared to synchronous treatment. Conclusions: In some circumstances, such as treatment for erectile dysfunction, asynchronous care can offer the same level of safety in prescribing when compared to synchronous care. More research is needed to evaluate the safety of asynchronous care across a wider set of conditions and measures. UR - https://formative.jmir.org/2022/1/e32126 UR - http://dx.doi.org/10.2196/32126 UR - http://www.ncbi.nlm.nih.gov/pubmed/34905499 ID - info:doi/10.2196/32126 ER - TY - JOUR AU - Huang, Ming AU - Fan, Jungwei AU - Prigge, Julie AU - Shah, D. Nilay AU - Costello, A. Brian AU - Yao, Lixia PY - 2022/1/11 TI - Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study JO - J Med Internet Res SP - e17273 VL - 24 IS - 1 KW - patient portal KW - secure message KW - patient-clinician communication KW - workload KW - response time KW - message round N2 - Background: Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care. Objective: The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester. Methods: We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity. Results: During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely ?physician?primary care,? ?registered nurse?specialty,? and ?physician?specialty,? bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The ?nurse practitioner or physician assistant?primary care? and ?physician?primary care? categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4% (22,121/408,526) of their daily messages. The clinicians replied to 72.2% (1,272,069/1,761,739) patient messages within 1 day and 90.6% (1,595,702/1,761,739) within 3 days. In 95.1% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds. Conclusions: Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients? needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency. UR - https://www.jmir.org/2022/1/e17273 UR - http://dx.doi.org/10.2196/17273 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014964 ID - info:doi/10.2196/17273 ER - TY - JOUR AU - Lee, WJ Edmund AU - McCloud, F. Rachel AU - Viswanath, Kasisomayajula PY - 2022/1/7 TI - Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment JO - J Med Internet Res SP - e25419 VL - 24 IS - 1 KW - eHealth KW - mobile health KW - communication inequalities KW - health disparities KW - health informatics KW - mobile phone UR - https://www.jmir.org/2022/1/e25419 UR - http://dx.doi.org/10.2196/25419 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994700 ID - info:doi/10.2196/25419 ER - TY - JOUR AU - Würstle, Silvia AU - Erber, Johanna AU - Hanselmann, Michael AU - Hoffmann, Dieter AU - Werfel, Stanislas AU - Hering, Svenja AU - Weidlich, Simon AU - Schneider, Jochen AU - Franke, Ralf AU - Maier, Michael AU - Henkel, G. Andreas AU - Schmid, M. Roland AU - Protzer, Ulrike AU - Laxy, Michael AU - Spinner, D. Christoph PY - 2022/1/4 TI - A Telemedicine-Guided Self-Collection Approach for PCR-Based SARS-CoV-2 Testing: Comparative Study JO - JMIR Form Res SP - e32564 VL - 6 IS - 1 KW - self-sampling KW - telemedicine KW - test strategy effectiveness KW - simulation model KW - SARS-CoV-2 KW - COVID-19 N2 - Background: Large-scale, polymerase chain reaction (PCR)-based SARS-CoV-2 testing is expensive, resource intensive, and time consuming. A self-collection approach is a probable alternative; however, its feasibility, cost, and ability to prevent infections need to be evaluated. Objective: This study aims to compare an innovative self-collection approach with a regular SARS-CoV-2 testing strategy in a large European industrial manufacturing site. Methods: The feasibility of a telemedicine-guided PCR-based self-collection approach was assessed for 150 employees (intervention group) and compared with a regular SARS-CoV-2 testing approach used for 143 employees (control group). Acceptance, ergonomics, and efficacy were evaluated using a software application. A simulation model was implemented to evaluate the effectiveness. An interactive R shiny app was created to enable customized simulations. Results: The test results were successfully communicated to and interpreted without uncertainty by 76% (114/150) and 76.9% (110/143) of the participants in the intervention and control groups, respectively (P=.96). The ratings for acceptability, ergonomics, and efficacy among intervention group participants were noninferior when compared to those among control group participants (acceptability: 71.6% vs 37.6%; ergonomics: 88.1% vs 74.5%; efficacy: 86.4% vs 77.5%). The self-collection approach was found to be less time consuming (23 min vs 38 min; P<.001). The simulation model indicated that both testing approaches reduce the risk of infection, and the self-collection approach tends to be slightly less effective owing to its lower sensitivity. Conclusions: The self-collection approach for SARS-CoV-2 diagnosis was found to be technically feasible and well rated in terms of acceptance, ergonomics, and efficacy. The simulation model facilitates the evaluation of test effectiveness; nonetheless, considering context specificity, appropriate adaptation by companies is required. UR - https://formative.jmir.org/2022/1/e32564 UR - http://dx.doi.org/10.2196/32564 UR - http://www.ncbi.nlm.nih.gov/pubmed/34803022 ID - info:doi/10.2196/32564 ER - TY - JOUR AU - Wilson-Howard, Danyell AU - Vilaro, J. Melissa AU - Neil, M. Jordan AU - Cooks, J. Eric AU - Griffin, N. Lauren AU - Ashley, T. Taylor AU - Tavassoli, Fatemeh AU - Zalake, S. Mohan AU - Lok, C. Benjamin AU - Odedina, T. Folakemi AU - Modave, Francois AU - Carek, J. Peter AU - George, J. Thomas AU - Krieger, L. Janice PY - 2021/12/24 TI - Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study JO - JMIR Form Res SP - e28709 VL - 5 IS - 12 KW - telehealth KW - digital health KW - eHealth KW - colorectal cancer KW - Black men KW - virtual human KW - technology KW - cancer screening KW - app KW - cancer KW - prevention KW - development N2 - Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one?s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user?s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as ?brother-doctor,? and participants stated ?wanting to interact with ALEX over their regular doctor.? Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. UR - https://formative.jmir.org/2021/12/e28709 UR - http://dx.doi.org/10.2196/28709 UR - http://www.ncbi.nlm.nih.gov/pubmed/34780346 ID - info:doi/10.2196/28709 ER - TY - JOUR AU - Bele, Sumedh AU - Cassidy, Christine AU - Curran, Janet AU - Johnson, W. David AU - Bailey, Michelle J. A. PY - 2021/12/22 TI - Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary?Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study JO - J Med Internet Res SP - e28610 VL - 23 IS - 12 KW - telemedicine KW - eHealth KW - pediatric care KW - inpatient KW - regional KW - rural KW - Canada KW - Theoretical Domains Framework KW - qualitative N2 - Background: Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children?s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children?s Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. Objective: The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. Methods: This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. Results: Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers? motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary?regional relationships. Conclusions: This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers? and family members? perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. International Registered Report Identifier (IRRID): RR2-10.1186/s12913-018-3859-2 UR - https://www.jmir.org/2021/12/e28610 UR - http://dx.doi.org/10.2196/28610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941561 ID - info:doi/10.2196/28610 ER - TY - JOUR AU - Bouamra, Benjamin AU - Chakroun, Karim AU - Medeiros De Bustos, Elisabeth AU - Dobson, Jennifer AU - Rouge, Jeanne-Antide AU - Moulin, Thierry PY - 2021/12/22 TI - Simulation-Based Teaching of Telemedicine for Future Users of Teleconsultation and Tele-Expertise: Feasibility Study JO - JMIR Med Educ SP - e30440 VL - 7 IS - 4 KW - telemedicine KW - teleconsultation KW - simulation training KW - health care KW - training KW - education KW - digital training KW - medical education N2 - Background: Health care professionals worldwide are increasingly using telemedicine in their daily clinical practice. However, there is still a lack of dedicated education and training even though it is needed to improve the quality of the diverse range of telemedicine activities. Simulation-based training may be a useful tool in telemedicine education and training delivery. Objective: This study aims to assess the feasibility and acceptability of simulation-based telemedicine training. Methods: We assessed five telemedicine training sessions conducted in a simulation laboratory. The training was focused on video teleconsultations between a patient and a health care professional. The assessment included the participants? satisfaction and attitudes toward the training. Results: We included 29 participants in total. Participant satisfaction was high (mean score 4.9 of 5), and those that took part stated the high applicability of the simulation-based training to their telemedicine practices (mean score 4.6 of 5). They also stated that they intended to use telemedicine in the future (mean score 4.5 of 5). Conclusions: Simulation-based training of telemedicine dedicated to video teleconsultation was feasible and showed high satisfaction from participants. However, it remains difficult to scale for a high number of health care professionals. UR - https://mededu.jmir.org/2021/4/e30440 UR - http://dx.doi.org/10.2196/30440 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941553 ID - info:doi/10.2196/30440 ER - TY - JOUR AU - Passardi, Alessandro AU - Serra, Patrizia AU - Donati, Caterina AU - Fiori, Federica AU - Prati, Sabrina AU - Vespignani, Roberto AU - Taglioni, Gabriele AU - Farfaneti Ghetti, Patrizia AU - Martinelli, Giovanni AU - Nanni, Oriana AU - Altini, Mattia AU - Frassineti, Luca Giovanni AU - Minguzzi, Vittoria Martina PY - 2021/12/20 TI - An Integrated Model to Improve Medication Reconciliation in Oncology: Prospective Interventional Study JO - J Med Internet Res SP - e31321 VL - 23 IS - 12 KW - medication recognition KW - medication reconciliation KW - IT platform KW - community pharmacies KW - healthcare transitions KW - pharmacy KW - oncology KW - drug incompatibility KW - information technology KW - drug interactions N2 - Background: Accurate medication reconciliation reduces the risk of drug incompatibilities and adverse events that can occur during transitions in care. Community pharmacies (CPs) are a crucial part of the health care system and could be involved in collecting essential information on conventional and supplementary drugs used at home. Objective: The aim of this paper was to establish an alliance between our cancer institute, Istituto Romagnolo per lo Studio dei Tumori (IRST), and CPs, the latter entrusted with the completion of a pharmacological recognition survey. We also aimed to integrate the national information technology (IT) platform of CPs with the electronic medical records of IRST. Methods: Cancer patients undergoing antiblastic treatments were invited to select a CP taking part in the study and to complete the pharmacological recognition step. The information collected by the pharmacist was sent to the electronic medical records of IRST through the new IT platform, after which the oncologist performed the reconciliation process. Results: A total of 66 CPs completed surveys for 134 patients. An average of 5.9 drugs per patient was used at home, with 12 or more used in the most advanced age groups. Moreover, 60% (80/134) of the patients used nonconventional products or critical foods. Some potential interactions between nonconventional medications and cancer treatments were reported. Conclusions: In the PROF-1 (Progetto di Rete in Oncologia con le Farmacie di comunità della Romagna) study, an alliance was created between our cancer center and CPs to improve medication reconciliation, and a new integrated IT platform was validated. Trial Registration: ClinicalTrials.gov NCT04796142; https://clinicaltrials.gov/ct2/show/NCT04796142 UR - https://www.jmir.org/2021/12/e31321 UR - http://dx.doi.org/10.2196/31321 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932001 ID - info:doi/10.2196/31321 ER - TY - JOUR AU - Edwards, J. Katie AU - Jones, B. Ray AU - Shenton, Deborah AU - Page, Toni AU - Maramba, Inocencio AU - Warren, Alison AU - Fraser, Fiona AU - Kri?aj, Tanja AU - Coombe, Tristan AU - Cowls, Hazel AU - Chatterjee, Arunangsu PY - 2021/12/20 TI - The Use of Smart Speakers in Care Home Residents: Implementation Study JO - J Med Internet Res SP - e26767 VL - 23 IS - 12 KW - voice-activated technology KW - smart speaker KW - care home KW - technology-enabled care KW - older people KW - learning disability KW - digital technology KW - consumer device KW - smart device N2 - Background: The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective: The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods: Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results: Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions: Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice. UR - https://www.jmir.org/2021/12/e26767 UR - http://dx.doi.org/10.2196/26767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932010 ID - info:doi/10.2196/26767 ER - TY - JOUR AU - Pecina, L. Jennifer AU - Nigon, M. Leah AU - Penza, S. Kristine AU - Murray, A. Martha AU - Kronebusch, J. Beckie AU - Miller, E. Nathaniel AU - Jensen, B. Teresa PY - 2021/12/20 TI - Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study JO - J Med Internet Res SP - e25899 VL - 23 IS - 12 KW - strep pharygitis KW - e-visit KW - electronic visit KW - telemedicine KW - telecare KW - virtual visit KW - McIssac score KW - nurse phone triage KW - scoring system KW - sore throat KW - group A streptococcus KW - telehealth KW - nurse KW - phone KW - triage N2 - Background: The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective: We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods: This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results: There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions: McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing. UR - https://www.jmir.org/2021/12/e25899 UR - http://dx.doi.org/10.2196/25899 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932016 ID - info:doi/10.2196/25899 ER - TY - JOUR AU - Choemprayong, Songphan AU - Charoenlap, Chris AU - Piromsopa, Krerk PY - 2021/12/20 TI - Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study JO - JMIR Hum Factors SP - e31130 VL - 8 IS - 4 KW - teleconsultation KW - remote consultation KW - mobile applications KW - usability KW - orthopedics KW - physician-to-physician consultation KW - electronic medical records KW - mobile phone N2 - Background: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective: This study aimed to explore usability issues emerging from users? interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated. UR - https://humanfactors.jmir.org/2021/4/e31130 UR - http://dx.doi.org/10.2196/31130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931991 ID - info:doi/10.2196/31130 ER - TY - JOUR AU - Pronk, Yvette AU - Pilot, Peter AU - van der Weegen, Walter AU - Brinkman, Justus-Martijn AU - Schreurs, Willem Berend PY - 2021/12/20 TI - A Patient-Reported Outcome Tool to Triage Total Hip Arthroplasty Patients to Hospital or Video Consultation: Pilot Study With Expert Panels and a Cohort of 1228 Patients JO - JMIR Form Res SP - e31232 VL - 5 IS - 12 KW - PROMs KW - total hip arthroplasty KW - triage tool KW - video consultation KW - telemedicine KW - digital transformation N2 - Background: The digital transformation in health care has been accelerated by the COVID-19 pandemic. Video consultation has become the alternative for hospital consultation. It remains unknown how to select patients suitable for video consultation. Objective: This study aimed to develop a tool based on patient-reported outcomes (PROs) to triage total hip arthroplasty (THA) patients to hospital or video consultation. Methods: A pilot study with expert panels and a retrospective cohort with prospectively collected data from 1228 THA patients was executed. The primary outcome was a PRO triage tool to allocate THA patients to hospital or video consultation 6 weeks postoperatively. Expert panels defined the criteria and selected the patient-reported outcome measure (PROM) questions including thresholds. Data were divided into training and test cohorts. Distribution, floor effect, correlation, responsiveness, PRO patient journey, and homogeneity of the selected questions were investigated in the training cohort. The test cohort was used to provide an unbiased evaluation of the final triage tool. Results: The expert panels selected moderate or severe pain and using 2 crutches as the triage tool criteria. PROM questions included in the final triage tool were numeric rating scale (NRS) pain during activity, 3-level version of the EuroQol 5 dimensions (EQ-5D-3L) questions 1 and 4, and Oxford Hip Score (OHS) questions 6, 8, and 12. Of the training cohort, 201 (201/703, 28.6%) patients needed a hospital consultation, which was statistically equal to the 150 (150/463, 32.4%) patients in the test cohort who needed a hospital consultation (P=.19). Conclusions: A PRO triage tool based on moderate or severe pain and using 2 crutches was developed. Around 70% of THA patients could safely have a video consultation, and 30% needed a hospital consultation 6 weeks postoperatively. This tool is promising for selecting patients for video consultation while using an existing PROM infrastructure. UR - https://formative.jmir.org/2021/12/e31232 UR - http://dx.doi.org/10.2196/31232 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931989 ID - info:doi/10.2196/31232 ER - TY - JOUR AU - Sajnani, Jocelyn AU - Swan, Kimberly AU - Wolff, Sharon AU - Drummond, Kelsi PY - 2021/12/14 TI - Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study JO - JMIR Perioper Med SP - e22681 VL - 4 IS - 2 KW - communication KW - hysterectomy KW - minimally invasive KW - laparoscopy KW - postoperative KW - patient satisfaction N2 - Background: With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. Objective:  This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. Methods:  We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient. Results:  A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ?9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ?9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ?9). Conclusions:  Postoperative text messages increased patients? perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate. UR - https://periop.jmir.org/2021/2/e22681 UR - http://dx.doi.org/10.2196/22681 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904957 ID - info:doi/10.2196/22681 ER - TY - JOUR AU - Bekkelund, Ivar Svein AU - Müller, Ivar Kai PY - 2021/12/13 TI - One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial JO - J Med Internet Res SP - e30151 VL - 23 IS - 12 KW - chronic headache KW - remission KW - video consultation KW - telemedicine KW - eHealth KW - digital consultation KW - consultation KW - treatment KW - follow-up KW - RCT KW - randomized controlled trial N2 - Background: Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective: The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods: Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ?15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results: From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions: One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration: ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177 UR - https://www.jmir.org/2021/12/e30151 UR - http://dx.doi.org/10.2196/30151 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898455 ID - info:doi/10.2196/30151 ER - TY - JOUR AU - Ali, Lilas AU - Wallström, Sara AU - Fors, Andreas AU - Barenfeld, Emmelie AU - Fredholm, Eva AU - Fu, Michael AU - Goudarzi, Mahboubeh AU - Gyllensten, Hanna AU - Lindström Kjellberg, Irma AU - Swedberg, Karl AU - Vanfleteren, W. Lowie E. G. AU - Ekman, Inger PY - 2021/12/13 TI - Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial JO - J Med Internet Res SP - e26794 VL - 23 IS - 12 KW - chronic heart failure KW - chronic obstructive pulmonary disease KW - digital platform KW - eHealth KW - patient-centered care KW - person-centered care KW - randomized controlled trial KW - telehealth N2 - Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective: The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods: A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention?s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results: No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions: PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration: ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817 UR - https://www.jmir.org/2021/12/e26794 UR - http://dx.doi.org/10.2196/26794 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898447 ID - info:doi/10.2196/26794 ER - TY - JOUR AU - Rising, J. Camella AU - Gaysynsky, Anna AU - Blake, D. Kelly AU - Jensen, E. Roxanne AU - Oh, April PY - 2021/12/13 TI - Willingness to Share Data From Wearable Health and Activity Trackers: Analysis of the 2019 Health Information National Trends Survey Data JO - JMIR Mhealth Uhealth SP - e29190 VL - 9 IS - 12 KW - mobile health KW - population health KW - health communication KW - survey methodology KW - mobile apps KW - devices KW - online social networking KW - mobile phone N2 - Background: Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults? willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information?sharing behaviors. Objective: This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults? willingness to share wearable data with health care providers and family or friends. Methods: Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. Results: Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. Conclusions: The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings. UR - https://mhealth.jmir.org/2021/12/e29190 UR - http://dx.doi.org/10.2196/29190 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898448 ID - info:doi/10.2196/29190 ER - TY - JOUR AU - Lajonchere, Clara AU - Naeim, Arash AU - Dry, Sarah AU - Wenger, Neil AU - Elashoff, David AU - Vangala, Sitaram AU - Petruse, Antonia AU - Ariannejad, Maryam AU - Magyar, Clara AU - Johansen, Liliana AU - Werre, Gabriela AU - Kroloff, Maxwell AU - Geschwind, Daniel PY - 2021/12/8 TI - An Integrated, Scalable, Electronic Video Consent Process to Power Precision Health Research: Large, Population-Based, Cohort Implementation and Scalability Study JO - J Med Internet Res SP - e31121 VL - 23 IS - 12 KW - biobanking KW - precision medicine KW - electronic consent KW - privacy KW - consent KW - patient privacy KW - clinical data KW - eHealth KW - recruitment KW - population health KW - data collection KW - research methods KW - video KW - research KW - validation KW - scalability N2 - Background: Obtaining explicit consent from patients to use their remnant biological samples and deidentified clinical data for research is essential for advancing precision medicine. Objective: We aimed to describe the operational implementation and scalability of an electronic universal consent process that was used to power an institutional precision health biobank across a large academic health system. Methods: The University of California, Los Angeles, implemented the use of innovative electronic consent videos as the primary recruitment tool for precision health research. The consent videos targeted patients aged ?18 years across ambulatory clinical laboratories, perioperative settings, and hospital settings. Each of these major areas had slightly different workflows and patient populations. Sociodemographic information, comorbidity data, health utilization data (ambulatory visits, emergency room visits, and hospital admissions), and consent decision data were collected. Results: The consenting approach proved scalable across 22 clinical sites (hospital and ambulatory settings). Over 40,000 participants completed the consent process at a rate of 800 to 1000 patients per week over a 2-year time period. Participants were representative of the adult University of California, Los Angeles, Health population. The opt-in rates in the perioperative (16,500/22,519, 73.3%) and ambulatory clinics (2308/3390, 68.1%) were higher than those in clinical laboratories (7506/14,235, 52.7%; P<.001). Patients with higher medical acuity were more likely to opt in. The multivariate analyses showed that African American (odds ratio [OR] 0.53, 95% CI 0.49-0.58; P<.001), Asian (OR 0.72, 95% CI 0.68-0.77; P<.001), and multiple-race populations (OR 0.73, 95% CI 0.69-0.77; P<.001) were less likely to participate than White individuals. Conclusions: This is one of the few large-scale, electronic video?based consent implementation programs that reports a 65.5% (26,314/40,144) average overall opt-in rate across a large academic health system. This rate is higher than those previously reported for email (3.6%) and electronic biobank (50%) informed consent rates. This study demonstrates a scalable recruitment approach for population health research. UR - https://www.jmir.org/2021/12/e31121 UR - http://dx.doi.org/10.2196/31121 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889741 ID - info:doi/10.2196/31121 ER - TY - JOUR AU - Alodhayani, A. Abdulaziz AU - Hassounah, Mazen Marwah AU - Qadri, R. Fatima AU - Abouammoh, A. Noura AU - Ahmed, Zakiuddin AU - Aldahmash, M. Abdullah PY - 2021/12/8 TI - Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers JO - J Med Internet Res SP - e26002 VL - 23 IS - 12 KW - connected health KW - digital health KW - telehealth KW - telemedicine KW - culture KW - Islam KW - Arab KW - mobile phone N2 - Background: There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill. Objective: This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia. Methods: A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. Results: A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program. Conclusions: We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers. UR - https://www.jmir.org/2021/12/e26002 UR - http://dx.doi.org/10.2196/26002 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889740 ID - info:doi/10.2196/26002 ER - TY - JOUR AU - North, Frederick AU - Nelson, M. Elissa AU - Buss, J. Rebecca AU - Majerus, J. Rebecca AU - Thompson, C. Matthew AU - Crum, A. Brian PY - 2021/12/7 TI - The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison JO - JMIR Med Inform SP - e27072 VL - 9 IS - 12 KW - electronic health record KW - schedule KW - patient appointment KW - preventive health service KW - office visit KW - outpatient care KW - mammogram KW - software tool KW - computer software application KW - mobile applications KW - self-schedule KW - app KW - EHR KW - screening KW - diagnostic KW - cancer N2 - Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective: The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods: We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results: For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or ?clean up? self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions: Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends. UR - https://medinform.jmir.org/2021/12/e27072 UR - http://dx.doi.org/10.2196/27072 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878997 ID - info:doi/10.2196/27072 ER - TY - JOUR AU - Choi, Yeon Jah AU - Kim, Bak Ji AU - Lee, Sunki AU - Lee, Seo-Joon AU - Shin, Eon Seung AU - Park, Hyun Se AU - Park, Jin Eun AU - Kim, Woohyeun AU - Na, Oh Jin AU - Choi, Ung Cheol AU - Rha, Seung-Woon AU - Park, Gyu Chang AU - Seo, Seog Hong AU - Ahn, Jeonghoon AU - Jeong, Hyun-Ghang AU - Kim, Ju Eung PY - 2021/12/7 TI - A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study JO - JMIR Med Inform SP - e23285 VL - 9 IS - 12 KW - cardiac rehabilitation KW - smartphone app KW - coronary heart disease N2 - Background: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research. UR - https://medinform.jmir.org/2021/12/e23285 UR - http://dx.doi.org/10.2196/23285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878987 ID - info:doi/10.2196/23285 ER - TY - JOUR AU - Hertling, Stefan AU - Hertling, Doreen AU - Martin, David AU - Graul, Isabel PY - 2021/12/3 TI - Acceptance, Use, and Barriers of Telemedicine in Transgender Health Care in Times of SARS-CoV-2: Nationwide Cross-sectional Survey JO - JMIR Public Health Surveill SP - e30278 VL - 7 IS - 12 KW - telemedicine KW - health services research KW - COVID-19 KW - transgender health care KW - acceptance KW - usage KW - barrier KW - telehealth KW - gender KW - identity KW - transgender KW - cross-sectional KW - survey KW - Germany KW - framework KW - implementation N2 - Background: The global incidence in the treatment of transgender people is increasing. During the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in the management of transgender health care could support physicians. Objective: The aim of this study was to analyze the acceptance, use, and barriers of telemedicine in transgender health care in times of SARS-CoV-2 in Germany. Methods: This prospective cross-sectional study was based on a survey of gynecological endocrinologists and transgender patients undergoing gender-affirming hormone treatment in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations. Results: We analyzed responses of 269 transgender patients and 202 gynecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they did not currently use telemedicine, although they would like to do so. Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19. The majority in both groups agreed on the implementation of virtual visits in the context of stable disease conditions. In the treatment phases, 74.3% (150/202) of the physicians said they would use telemedicine during follow-ups. Half of the physicians said they would choose tele-counseling as a specific approach to improving care (128/202, 63.4%). Obstacles to the introduction of telemedicine among physicians included the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.4%), and poor reimbursement (106/202, 52.5%). Conclusions: Telemedicine in transgender health care found limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge of physicians in the use of telemedicine. More research in tele-endogynecology is needed. Future studies should include large-scale randomized controlled trials, economic analyses, and the exploration of user preferences. UR - https://publichealth.jmir.org/2021/12/e30278 UR - http://dx.doi.org/10.2196/30278 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591783 ID - info:doi/10.2196/30278 ER - TY - JOUR AU - Finkelstein, B. Julia AU - Tremblay, S. Elise AU - Van Cain, Melissa AU - Farber-Chen, Aaron AU - Schumann, Caitlin AU - Brown, Christina AU - Shah, S. Ankoor AU - Rhodes, T. Erinn PY - 2021/12/2 TI - Pediatric Clinicians? Use of Telemedicine: Qualitative Interview Study JO - JMIR Hum Factors SP - e29941 VL - 8 IS - 4 KW - pediatrics KW - telemedicine KW - video visits KW - communication KW - webside manner N2 - Background: Bedside manner describes how clinicians relate to patients in person. Telemedicine allows clinicians to connect virtually with patients using digital tools. Effective virtual communication or webside manner may require modifications to traditional bedside manner. Objective: This study aims to understand the experiences of telemedicine providers with patient-to-provider virtual visits and communication with families at a single large-volume children?s hospital to inform program development and training for future clinicians. Methods: A total of 2 focus groups of pediatric clinicians (N=11) performing virtual visits before the COVID-19 pandemic, with a range of experiences and specialties, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semistructured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded, and the corresponding transcripts were reviewed for data analysis. The transcripts were coded based on the identified main themes and subthemes. On the basis of a higher-level analysis of these codes, the study authors generated a final set of key themes to describe the collected data. Results: Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialties and practices. A total of 3 key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt that telemedicine required new skills for patient interaction, and not all were comfortable with their training. Conclusions: Telemedicine provides benefits as well as challenges to health care delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. The inclusion of webside manner instructions within training curricula is crucial as telemedicine becomes an established modality for providing health care. UR - https://humanfactors.jmir.org/2021/4/e29941 UR - http://dx.doi.org/10.2196/29941 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860669 ID - info:doi/10.2196/29941 ER - TY - JOUR AU - Jorge, Serafim Ana Elisa AU - Bennell, Louise Kim AU - Kimp, Jared Alexander AU - Campbell, Kate Penny AU - Hinman, Shane Rana PY - 2021/12/1 TI - An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data JO - JMIR Med Educ SP - e30378 VL - 7 IS - 4 KW - osteoarthritis KW - knee KW - physiotherapy KW - exercise KW - e-learning KW - telehealth KW - pain KW - education KW - implementation KW - evaluation KW - professional development KW - rehabilitation N2 - Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown. Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules. Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion. Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65% (2463/6720) commencing the program and precourse survey and 19.61% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3%) and patient information booklets in their clinical practice (75/142, 52.8%). Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning. UR - https://mededu.jmir.org/2021/4/e30378 UR - http://dx.doi.org/10.2196/30378 UR - http://www.ncbi.nlm.nih.gov/pubmed/34587585 ID - info:doi/10.2196/30378 ER - TY - JOUR AU - Aminoff, Hedvig AU - Meijer, Sebastiaan AU - Groth, Kristina AU - Arnelo, Urban PY - 2021/11/30 TI - User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service JO - JMIR Hum Factors SP - e30867 VL - 8 IS - 4 KW - telemedicine KW - user experience KW - satisfaction KW - technology acceptance KW - usability KW - perioperative KW - surgery KW - consultation KW - surgeons KW - performance KW - evaluation KW - teleguidance KW - telehealth KW - telemedicine implementation N2 - Background: Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective: We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology?s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. Methods: We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. Results: In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%). Conclusions: Users? satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes. UR - https://humanfactors.jmir.org/2021/4/e30867 UR - http://dx.doi.org/10.2196/30867 UR - http://www.ncbi.nlm.nih.gov/pubmed/34851302 ID - info:doi/10.2196/30867 ER - TY - JOUR AU - Tsou, Christina AU - Robinson, Suzanne AU - Boyd, James AU - Jamieson, Andrew AU - Blakeman, Robert AU - Yeung, Justin AU - McDonnell, Josephine AU - Waters, Stephanie AU - Bosich, Kylie AU - Hendrie, Delia PY - 2021/11/26 TI - Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review JO - J Med Internet Res SP - e30632 VL - 23 IS - 11 KW - telehealth KW - telemedicine KW - clinical effectiveness KW - treatment outcome KW - rural population KW - rural health KW - remote N2 - Background: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. Objective: The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. Methods: The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. Results: A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and?depending on the context?improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Conclusions: Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial Registration: PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry UR - https://www.jmir.org/2021/11/e30632 UR - http://dx.doi.org/10.2196/30632 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842537 ID - info:doi/10.2196/30632 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan AU - Mirzaei, Tala AU - Dharanikota, Spurthy PY - 2021/11/25 TI - Patients? Perceptions Toward Human?Artificial Intelligence Interaction in Health Care: Experimental Study JO - J Med Internet Res SP - e25856 VL - 23 IS - 11 KW - AI clinical applications KW - collective intelligence KW - in-person examinations KW - perceived benefits KW - perceived risks N2 - Background: It is believed that artificial intelligence (AI) will be an integral part of health care services in the near future and will be incorporated into several aspects of clinical care such as prognosis, diagnostics, and care planning. Thus, many technology companies have invested in producing AI clinical applications. Patients are one of the most important beneficiaries who potentially interact with these technologies and applications; thus, patients? perceptions may affect the widespread use of clinical AI. Patients should be ensured that AI clinical applications will not harm them, and that they will instead benefit from using AI technology for health care purposes. Although human-AI interaction can enhance health care outcomes, possible dimensions of concerns and risks should be addressed before its integration with routine clinical care. Objective: The main objective of this study was to examine how potential users (patients) perceive the benefits, risks, and use of AI clinical applications for their health care purposes and how their perceptions may be different if faced with three health care service encounter scenarios. Methods: We designed a 2×3 experiment that crossed a type of health condition (ie, acute or chronic) with three different types of clinical encounters between patients and physicians (ie, AI clinical applications as substituting technology, AI clinical applications as augmenting technology, and no AI as a traditional in-person visit). We used an online survey to collect data from 634 individuals in the United States. Results: The interactions between the types of health care service encounters and health conditions significantly influenced individuals? perceptions of privacy concerns, trust issues, communication barriers, concerns about transparency in regulatory standards, liability risks, benefits, and intention to use across the six scenarios. We found no significant differences among scenarios regarding perceptions of performance risk and social biases. Conclusions: The results imply that incompatibility with instrumental, technical, ethical, or regulatory values can be a reason for rejecting AI applications in health care. Thus, there are still various risks associated with implementing AI applications in diagnostics and treatment recommendations for patients with both acute and chronic illnesses. The concerns are also evident if the AI applications are used as a recommendation system under physician experience, wisdom, and control. Prior to the widespread rollout of AI, more studies are needed to identify the challenges that may raise concerns for implementing and using AI applications. This study could provide researchers and managers with critical insights into the determinants of individuals? intention to use AI clinical applications. Regulatory agencies should establish normative standards and evaluation guidelines for implementing AI in health care in cooperation with health care institutions. Regular audits and ongoing monitoring and reporting systems can be used to continuously evaluate the safety, quality, transparency, and ethical factors of AI clinical applications. UR - https://www.jmir.org/2021/11/e25856 UR - http://dx.doi.org/10.2196/25856 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842535 ID - info:doi/10.2196/25856 ER - TY - JOUR AU - Mercer, Kathryn AU - Carter, Caitlin AU - Burns, Catherine AU - Tennant, Ryan AU - Guirguis, Lisa AU - Grindrod, Kelly PY - 2021/11/25 TI - Including the Reason for Use on Prescriptions Sent to Pharmacists: Scoping Review JO - JMIR Hum Factors SP - e22325 VL - 8 IS - 4 KW - patient safety KW - human factors KW - patient engagement KW - multidisciplinary N2 - Background: In North America, although pharmacists are obligated to ensure prescribed medications are appropriate, information about a patient?s reason for use is not a required component of a legal prescription. The benefits of prescribers including the reason for use on prescriptions is evident in the current literature. However, it is not standard practice to share this information with pharmacists. Objective: Our aim was to characterize the research on how including the reason for use on a prescription impacts pharmacists. Methods: We performed an interdisciplinary scoping review, searching literature in the fields of health care, informatics, and engineering. The following databases were searched between December 2018 and January 2019: PubMed, Institute of Electrical and Electronics Engineers (IEEE), Association for Computing Machinery (ACM), International Pharmaceutical Abstracts (IPA), and EMBASE. Results: A total of 3912 potentially relevant articles were identified, with 9 papers meeting the inclusion criteria. The studies used different terminology (eg, indication, reason for use) and a wide variety of study methodologies, including prospective and retrospective observational studies, randomized controlled trials, and qualitative interviews and focus groups. The results suggest that including the reason for use on a prescription can help the pharmacist catch more errors, reduce the need to contact prescribers, support patient counseling, impact communication, and improve patient safety. Reasons that may prevent prescribers from adding the reason for use information are concerns about workflow and patient privacy. Conclusions: More research is needed to understand how the reason for use information should be provided to pharmacists. In the limited literature to date, there is a consensus that the addition of this information to prescriptions benefits patient safety and enables pharmacists to be more effective. Future research should use an implementation science or theory-based approach to improve prescriber buy-in and, consequently, adoption. UR - https://humanfactors.jmir.org/2021/4/e22325 UR - http://dx.doi.org/10.2196/22325 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842545 ID - info:doi/10.2196/22325 ER - TY - JOUR AU - Zhang, Zhan AU - Kmoth, Lukas AU - Luo, Xiao AU - He, Zhe PY - 2021/11/25 TI - User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study JO - JMIR Hum Factors SP - e26017 VL - 8 IS - 4 KW - clinical laboratory results KW - patient-centered care KW - patient portal KW - health communication N2 - Background: Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results. Objective: The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers. Methods: We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results. Results: The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions. Conclusions: We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic. UR - https://humanfactors.jmir.org/2021/4/e26017 UR - http://dx.doi.org/10.2196/26017 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842529 ID - info:doi/10.2196/26017 ER - TY - JOUR AU - Santos, D. Amanda AU - Caine, Vera AU - Robson, J. Paula AU - Watson, Linda AU - Easaw, C. Jacob AU - Petrovskaya, Olga PY - 2021/11/24 TI - Oncology Patients? Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada JO - JMIR Cancer SP - e32609 VL - 7 IS - 4 KW - patient portal KW - MyChart KW - health information and communication technology KW - eHealth KW - personal health information KW - oncology KW - cancer care KW - Canada KW - qualitative KW - context of technology implementation N2 - Background: With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients? experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. Objective: The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta?s unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. Methods: This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. Results: Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta?s patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants? broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient?provider relationship. Conclusions: Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them. UR - https://cancer.jmir.org/2021/4/e32609 UR - http://dx.doi.org/10.2196/32609 UR - http://www.ncbi.nlm.nih.gov/pubmed/34822338 ID - info:doi/10.2196/32609 ER - TY - JOUR AU - Sandbæk, Amanda AU - Christensen, Due Line AU - Larsen, Lykke Lotte AU - Primholdt Christensen, Nina AU - Kofod, Greek Frida AU - Guassora, Dorrit Ann AU - Merrild, Hoffmann Camilla AU - Assing Hvidt, Elisabeth PY - 2021/11/24 TI - Guidance for Implementing Video Consultations in Danish General Practice: Rapid Cycle Coproduction Study JO - JMIR Form Res SP - e27323 VL - 5 IS - 11 KW - general practice KW - remote consultation KW - implementation science KW - resource guide KW - communication KW - video consultation KW - coproduction KW - rapid analysis KW - workshop KW - intervention development N2 - Background: The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. Objective: The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. Methods: The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. Results: A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients? use of VCs, the performance of VCs, and the arrangements for booking a VC. Conclusions: The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period. UR - https://formative.jmir.org/2021/11/e27323 UR - http://dx.doi.org/10.2196/27323 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821560 ID - info:doi/10.2196/27323 ER - TY - JOUR AU - Rego, Nazaré AU - Pereira, Silva Helena AU - Crispim, José PY - 2021/11/23 TI - Perceptions of Patients and Physicians on Teleconsultation at Home for Diabetes Mellitus: Survey Study JO - JMIR Hum Factors SP - e27873 VL - 8 IS - 4 KW - teleconsultation KW - diabetes mellitus KW - telemedicine KW - eHealth KW - mobile phone N2 - Background: Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians? or patients? perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important. Objective: The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations. Methods: Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis. Results: Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R2 of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians? willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians? answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient?s health and patient management, National Health System costs reduction, and reciprocity relative to patients? willingness to engage in teleconsultations. Conclusions: To promote the use of home teleconsultations for DM, decision makers should improve patients? health literacy so the physician?patient communication is more effective; explore information and communication technology developments to reduce current limitations of non?face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians. UR - https://humanfactors.jmir.org/2021/4/e27873 UR - http://dx.doi.org/10.2196/27873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817394 ID - info:doi/10.2196/27873 ER - TY - JOUR AU - Cabral, F. Danylo AU - Hinchman, A. Carrie AU - Nunez, Christina AU - Rice, Jordyn AU - Loewenstein, A. David AU - Cahalin, P. Lawrence AU - Rundek, Tatjana AU - Pascual-Leone, Alvaro AU - Gomes-Osman, Joyce PY - 2021/11/23 TI - Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study JO - JMIR Res Protoc SP - e33589 VL - 10 IS - 11 KW - exercise KW - neuroplasticity KW - cognition KW - brain health KW - cardiorespiratory fitness KW - cardiovascular function KW - trophic factors KW - telehealth KW - aging adult N2 - Background: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. Objective: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. Methods: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. Results: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. Conclusions: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. Trial Registration: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528 International Registered Report Identifier (IRRID): RR1-10.2196/33589 UR - https://www.researchprotocols.org/2021/11/e33589 UR - http://dx.doi.org/10.2196/33589 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817393 ID - info:doi/10.2196/33589 ER - TY - JOUR AU - Taguchi, Kayoko AU - Numata, Noriko AU - Takanashi, Rieko AU - Takemura, Ryo AU - Yoshida, Tokiko AU - Kutsuzawa, Kana AU - Yoshimura, Kensuke AU - Nozaki-Taguchi, Natsuko AU - Ohtori, Seiji AU - Shimizu, Eiji PY - 2021/11/22 TI - Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial JO - J Med Internet Res SP - e30690 VL - 23 IS - 11 KW - cognitive behavioral therapy KW - chronic pain KW - medical economic evaluation KW - EQ-5D-5L KW - telemedicine N2 - Background: Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. Objective: This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. Methods: This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. Results: In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (?1.43, 95% CI ?2.49 to ?0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (?9.42, 95% CI ?14.47 to ?4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (?1.95, 95% CI ?3.33 to ?0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. Conclusions: The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Trial Registration: University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb UR - https://www.jmir.org/2021/11/e30690 UR - http://dx.doi.org/10.2196/30690 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813489 ID - info:doi/10.2196/30690 ER - TY - JOUR AU - Schopow, Nikolas AU - Osterhoff, Georg AU - von Dercks, Nikolaus AU - Girrbach, Felix AU - Josten, Christoph AU - Stehr, Sebastian AU - Hepp, Pierre PY - 2021/11/18 TI - Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review JO - JMIR Public Health Surveill SP - e33509 VL - 7 IS - 11 KW - telemedical consultation KW - patient allocation KW - algorithm-based treatment KW - telemedicine KW - telehealth KW - consultation KW - allocation KW - algorithm KW - treatment KW - COVID-19 KW - coordination KW - Germany KW - economic KW - review KW - establishment KW - management N2 - Background: During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. Objective: This study describes the establishment and management of a CCCC at a German university hospital. Methods: We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. Results: During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than ?52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. Conclusions: Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient?s life against another?s. UR - https://publichealth.jmir.org/2021/11/e33509 UR - http://dx.doi.org/10.2196/33509 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623955 ID - info:doi/10.2196/33509 ER - TY - JOUR AU - Wilroy, Jereme AU - Lai, Byron AU - Currie, Madison AU - Young, Hui-Ju AU - Thirumalai, Mohanraj AU - Mehta, Tapan AU - Giannone, John AU - Rimmer, James PY - 2021/11/18 TI - Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study JO - JMIR Form Res SP - e29799 VL - 5 IS - 11 KW - telehealth KW - disability KW - COVID-19 KW - exercise KW - assessments KW - feasibility KW - mHealth KW - teleassessment KW - mobility impairment KW - home exercise KW - participation KW - physical disabilities N2 - Background: The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. Objective: This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. Methods: The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants? home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ?90% criteria set a priori. Efficiency was measured by a session duration of ?2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. Results: Data from 36 participants were included in this feasibility study, and 34 (94%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. Conclusions: The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. Trial Registration: ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 UR - https://formative.jmir.org/2021/11/e29799 UR - http://dx.doi.org/10.2196/29799 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792477 ID - info:doi/10.2196/29799 ER - TY - JOUR AU - Paré, Guy AU - Raymond, Louis AU - Castonguay, Alexandre AU - Grenier Ouimet, Antoine AU - Trudel, Marie-Claude PY - 2021/11/16 TI - Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study JO - JMIR Med Inform SP - e30485 VL - 9 IS - 11 KW - medical appointment scheduling system KW - electronic booking KW - e-booking KW - primary care KW - accessibility of care KW - availability of care KW - advance access KW - electronic medical record N2 - Background: The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. Objective: This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? Methods: A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. Results: A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly ?automated appointment confirmation and reminders? and ?online appointment confirmation, modification, or cancellation by the patient.? More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic?s electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. Conclusions: The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions. UR - https://medinform.jmir.org/2021/11/e30485 UR - http://dx.doi.org/10.2196/30485 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783670 ID - info:doi/10.2196/30485 ER - TY - JOUR AU - Wood, M. Sarah AU - Pickel, Julia AU - Phillips, W. Alexis AU - Baber, Kari AU - Chuo, John AU - Maleki, Pegah AU - Faust, L. Haley AU - Petsis, Danielle AU - Apple, E. Danielle AU - Dowshen, Nadia AU - Schwartz, A. Lisa PY - 2021/11/15 TI - Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences JO - JMIR Pediatr Parent SP - e32708 VL - 4 IS - 4 KW - telehealth KW - telemedicine KW - adolescent KW - COVID-19 KW - acceptability KW - feasibility KW - young adult KW - teenager KW - cross-sectional KW - patient experience KW - experience KW - efficiency KW - equity KW - survey N2 - Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents? concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. UR - https://pediatrics.jmir.org/2021/4/e32708 UR - http://dx.doi.org/10.2196/32708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779782 ID - info:doi/10.2196/32708 ER - TY - JOUR AU - Neves, Luisa Ana AU - Smalley, R. Katelyn AU - Freise, Lisa AU - Harrison, Paul AU - Darzi, Ara AU - Mayer, K. Erik PY - 2021/11/11 TI - Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study JO - J Med Internet Res SP - e23481 VL - 23 IS - 11 KW - patient portals KW - electronic health records KW - patient participation N2 - Background: Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. Objective: This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. Methods: A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. Results: A total of 1083 participants replied to the survey (186% of the estimated minimum target sample). The proportion of users was 61.58% (667/1083). Among these, most (385/667, 57.7%) used the portal at least once a month. To characterize the system?s users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8% women; 551/650, 84.8% >40 years). Most participants were White (498/650, 76.6%) and resided in London (420/650, 64.6%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95% CI 1.04-2.39 and OR 2.38, 95% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (?30) were associated with higher odds of being a user (adjusted OR 2.96, 95% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95% CI 0.37-0.91). Conclusions: This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care. UR - https://www.jmir.org/2021/11/e23481 UR - http://dx.doi.org/10.2196/23481 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762063 ID - info:doi/10.2196/23481 ER - TY - JOUR AU - Burmann, Anja AU - Tischler, Max AU - Faßbach, Mira AU - Schneitler, Sophie AU - Meister, Sven PY - 2021/11/11 TI - The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study JO - JMIR Med Inform SP - e31527 VL - 9 IS - 11 KW - digitalization KW - digital transformation KW - health care KW - human factor KW - physicians KW - digital natives KW - web-based survey KW - digital health N2 - Background: Digitalization affects all areas of society, including the health care sector. However, the digitalization of health care provision is progressing slowly compared to other sectors. In the professional and political literature, physicians are partially portrayed as digitalization sceptics. Thus, the role of physicians in this process requires further investigation. The theory of ?digital natives? suggests a lower hurdle for younger generations to engage with digital technologies. Objective: The objective of this study was to investigate the role of physicians in the process of digitalizing health care provision in Germany and to assess the age factor. Methods: We conducted a large-scale study to assess the role of this professional group in the progress of the digital transformation of the German health care sector. Therefore, in an anonymous online survey, we inquired about the current digital penetration of the personal working environment, expectations, attitude toward, and concerns regarding digitalization. Based on these data, we studied associations with the nominal variable age and variations across 2 age groups. Results: The 1274 participants included in the study generally showed a high affinity towards digitalization with a mean of 3.88 on a 5-point Likert scale; 723 respondents (56.75%) stated they personally use mobile apps in their everyday working life, with a weak tendency to be associated with the respondents? age (?=0.26). Participants saw the most noticeable existing benefits through digitalization in data quality and readability (882/1274, 69.23%) and the least in patient engagement (213/1274, 16.72%). Medical practitioners preponderantly expect further improvements through increased digitalization across almost all queried areas but the most in access to medical knowledge (1136/1274, 89.17%), treatment of orphan diseases (1016/1274, 79.75%), and medical research (1023/1274, 80.30%). Conclusions: Respondents defined their role in the digitalization of health care provision as ambivalent: ?scrutinizing? on the one hand but ?active? and ?open? on the other. A gap between willingness to participate and digital sovereignty was indicated. Thus, education on digitalization as a means to support health care provision should not only be included in the course of study but also in the continuing process of further and advanced training. UR - https://medinform.jmir.org/2021/11/e31527 UR - http://dx.doi.org/10.2196/31527 UR - http://www.ncbi.nlm.nih.gov/pubmed/34545813 ID - info:doi/10.2196/31527 ER - TY - JOUR AU - Keniston, Angela AU - McBeth, Lauren AU - Pell, Jonathan AU - Bowden, Kasey AU - Metzger, Anna AU - Nordhagen, Jamie AU - Anthony, Amanda AU - Rice, John AU - Burden, Marisha PY - 2021/11/8 TI - The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study JO - JMIR Hum Factors SP - e27568 VL - 8 IS - 4 KW - discharge planning KW - health information technology KW - quasi-experimental design KW - multidisciplinary KW - teamwork N2 - Background: In the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication. Objective: The aim of this study is to evaluate the effectiveness of a discharge communication tool. Methods: This was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider. Results: During the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88% of providers, and 34/34, 100% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=.06). Conclusions: The Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations. UR - https://humanfactors.jmir.org/2021/4/e27568 UR - http://dx.doi.org/10.2196/27568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747702 ID - info:doi/10.2196/27568 ER - TY - JOUR AU - Lin, Yuchen AU - Lemos, Martin AU - Neuschaefer-Rube, Christiane PY - 2021/11/5 TI - Digital Health and Digital Learning Experiences Across Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary Survey Study JO - JMIR Med Educ SP - e30873 VL - 7 IS - 4 KW - digital learning KW - e-learning KW - speech-language pathology KW - phoniatrics KW - otolaryngology KW - communication disorders KW - mobile phone N2 - Background: Advances in digital health and digital learning are transforming the lives of patients, health care providers, and health professional students. In the interdisciplinary field of communication sciences and disorders (CSD), digital uptake and incorporation of digital topics and technologies into clinical training programs has lagged behind other medical fields. There is a need to understand professional and student experiences, opinions, and needs regarding digital health and learning topics so that effective strategies for implementation can be optimized. Objective: This cross-sectional survey study aims to interdisciplinarily investigate professional and student knowledge, use, attitudes, and preferences toward digital health and learning in the German-speaking population. Methods: An open-ended, web-based survey was developed and conducted with professionals and students in CSD including phoniatricians and otolaryngologists, speech-language pathologists (German: Logopäd*innen), medical students, and speech-language pathology students. Differences in knowledge, use, attitudes, and preferences across profession, generation, and years of experience were analyzed. Results: A total of 170 participants completed the survey. Respondents demonstrated greater familiarity with digital learning as opposed to eHealth concepts. Significant differences were noted across profession (P<.001), generation (P=.001), and years of experience (P<.001), which demonstrated that students and younger participants were less familiar with digital health terminology. Professional (P<.001) and generational differences were also found (P=.04) in knowledge of digital therapy tools, though no significant differences were found for digital learning tools. Participants primarily used computers, tablets, and mobile phones; non?eHealth-specific tools (eg, word processing and videoconferencing applications); and digital formats such as videos, web courses, and apps. Many indicated a desire for more interactive platforms, such as virtual reality. Significant differences were found across generations for positive views toward digitalization (P<.001) and across profession for feelings of preparedness (P=.04). Interestingly, across profession (P=.03), generation (P=.006), and years of experience (P=.01), students and younger participants demonstrated greater support for medical certification. Commonly reported areas of concern included technical difficulties, quality and validity of digital materials, data privacy, and social presence. Respondents tended to prefer blended learning, a limited to moderate level of interactivity, and time and space?flexible learning environments (63/170, 37.1%), with a notable proportion still preferring traditional time and space?dependent learning (49/170, 28.8%). Conclusions: This comprehensive investigation into the current state of CSD student and professional opinions and experiences has shown that incorporation of digital topics and skills into academic and professional development curricula will be crucial for ensuring that the field is prepared for the ever-digitalizing health care environment. Deeper empirical investigation into efficacy and acceptance of digital learning and practice strategies and systematic training and practical organizational supports must be planned to ensure adaptive education and practice. UR - https://mededu.jmir.org/2021/4/e30873 UR - http://dx.doi.org/10.2196/30873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34738911 ID - info:doi/10.2196/30873 ER - TY - JOUR AU - Winkler, Olga AU - Dhaliwal, Raman AU - Greenshaw, Andrew AU - O'Shea, Katie AU - Abba-Aji, Adam AU - Chima, Chidi AU - Purdon, E. Scot AU - Burback, Lisa PY - 2021/11/4 TI - Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30711 VL - 10 IS - 11 KW - suicide KW - trauma KW - eye movement desensitization and reprocessing (EMDR) KW - telemedicine KW - psychotherapy KW - digital health KW - eHealth KW - remote delivery KW - virtual care N2 - Background: Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. Objective: The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. Methods: In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. Results: The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. Conclusions: The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. Trial Registration: ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047 International Registered Report Identifier (IRRID): DERR1-10.2196/30711 UR - https://www.researchprotocols.org/2021/11/e30711 UR - http://dx.doi.org/10.2196/30711 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734835 ID - info:doi/10.2196/30711 ER - TY - JOUR AU - Guinemer, Camille AU - Boeker, Martin AU - Fürstenau, Daniel AU - Poncette, Akira-Sebastian AU - Weiss, Björn AU - Mörgeli, Rudolf AU - Balzer, Felix PY - 2021/11/3 TI - Telemedicine in Intensive Care Units: Scoping Review JO - J Med Internet Res SP - e32264 VL - 23 IS - 11 KW - tele-ICU KW - telemedicine KW - critical care KW - implementation KW - telehealth KW - health care system KW - intensive care unit KW - health technology KW - digital health KW - care compliance KW - tertiary hospitals KW - hospital KW - review N2 - Background: The role of telemedicine in intensive care has been increasing steadily. Tele?intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. Objective: This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. Methods: A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. Results: A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. Conclusions: The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. International Registered Report Identifier (IRRID): RR2-10.2196/19695 UR - https://www.jmir.org/2021/11/e32264 UR - http://dx.doi.org/10.2196/32264 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730547 ID - info:doi/10.2196/32264 ER - TY - JOUR AU - Cher, Y. Benjamin A. AU - Wilson, A. Eric AU - Pinsky, M. Alexa AU - Townshend, F. Ryan AU - Wolski, V. Ann AU - Broderick, Michael AU - Milen, M. Allison AU - Lau, Audrey AU - Singh, Amrit AU - Cinti, K. Sandro AU - Engelke, G. Carl AU - Saha, K. Anjan PY - 2021/11/1 TI - Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study JO - J Med Internet Res SP - e28105 VL - 23 IS - 11 KW - triage KW - telephone KW - COVID-19 KW - utility KW - telemedicine KW - telehealth KW - patient information KW - concern KW - implementation KW - innovation KW - hospital N2 - Background: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. Conclusions: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases. UR - https://www.jmir.org/2021/11/e28105 UR - http://dx.doi.org/10.2196/28105 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559669 ID - info:doi/10.2196/28105 ER - TY - JOUR AU - Lundereng, David Elias AU - Nes, Goncalves Andrea Aparecida AU - Holmen, Heidi AU - Winger, Anette AU - Thygesen, Hilde AU - Jøranson, Nina AU - Borge, Råheim Chrstine AU - Chen, Weiqin AU - Dajani, Olav AU - Mariussen, L. Kari AU - Steindal, A. Simen PY - 2021/10/29 TI - Health Care Professionals? Experiences and Perspectives on Using Telehealth for Home-Based Palliative Care: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e33305 VL - 10 IS - 10 KW - health care technology KW - home care services KW - palliative care KW - review KW - telehealth KW - telemedicine N2 - Background: Telehealth seems feasible for use in home-based palliative care. However, acceptance among health care professionals (HCPs) is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs on the use of telehealth for home-based palliative care. Objective: The aim of this review is to systematically map published studies on HCPs? experiences and perspectives on the use of telehealth in home-based palliative care. Methods: The proposed scoping review will employ the methodology of Arksey and O?Malley. This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). A systematic search will be performed in MEDLINE, PsycINFO, EMBASE, CINAHL, Allied and Complementary Medicine (AMED), and Web of Science for studies published between January 2000 and July 5, 2021. We will also hand search the reference lists of included papers to identify additional studies of relevance. The search will be updated in 2022. Pairs of authors will independently assess the eligibility of studies and extract data. The first 2 stages of thematic synthesis will be used to thematically organize the data. Because the scoping review methodology consists of reviewing and collecting data from publicly available materials, this study does not require ethics approval. Results: The database searches; testing of eligibility criteria; and screening of titles, abstracts, and full-text papers will be performed by fall 2021. The results from this scoping review will be presented as a descriptive summary of the results from all included papers, and will be inductively organized into descriptive themes. A frequency table illustrating which papers were included in which descriptive themes will be made. Results are anticipated by the fall of 2022. Conclusions: A mapping of studies could identify research gaps regarding HCPs? experiences and perspectives on the use of telehealth in home-based palliative care and may determine the value and feasibility of conducting a full systematic review. International Registered Report Identifier (IRRID): PRR1-10.2196/33305 UR - https://www.researchprotocols.org/2021/10/e33305 UR - http://dx.doi.org/10.2196/33305 UR - http://www.ncbi.nlm.nih.gov/pubmed/34714254 ID - info:doi/10.2196/33305 ER - TY - JOUR AU - Xiao, Jin AU - Meyerowitz, Cyril AU - Ragusa, Patricia AU - Funkhouser, Kimberly AU - Lischka, R. Tamara AU - Mendez Chagoya, Alberto Luis AU - Al Jallad, Nisreen AU - Wu, Tong Tong AU - Fiscella, Kevin AU - Ivie, Eden AU - Strange, Michelle AU - Collins, Jamie AU - Kopycka-Kedzierawski, T. Dorota AU - PY - 2021/10/26 TI - Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice?Based Research Network: Protocol for Design, Implementation, and Usability Testing JO - JMIR Res Protoc SP - e32345 VL - 10 IS - 10 KW - teledentistry KW - mDentistry KW - oral diseases KW - virtual visit KW - intraoral camera KW - pandemic response KW - COVID-19 KW - mHealth N2 - Background: Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. Objective: In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient?s capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). Methods: This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient?s capability of taking intraoral photos, by analyzing obtained photos and recorded videos. Results: The study is supported by the US National Institute of Dental and Craniofacial Research. This study received ?single? institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. Conclusions: The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. International Registered Report Identifier (IRRID): PRR1-10.2196/32345 UR - https://www.researchprotocols.org/2021/10/e32345 UR - http://dx.doi.org/10.2196/32345 UR - http://www.ncbi.nlm.nih.gov/pubmed/34597259 ID - info:doi/10.2196/32345 ER - TY - JOUR AU - Nilsson, Evalill AU - Sverker, Annette AU - Bendtsen, Preben AU - Eldh, Catrine Ann PY - 2021/10/18 TI - A Human, Organization, and Technology Perspective on Patients? Experiences of a Chat-Based and Automated Medical History?Taking Service in Primary Health Care: Interview Study Among Primary Care Patients JO - J Med Internet Res SP - e29868 VL - 23 IS - 10 KW - digital encounter KW - digital healthcare KW - e-consultation KW - e-health KW - interview KW - patient perspective KW - primary healthcare KW - qualitative study KW - telemedicine KW - telehealth N2 - Background: The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective: This study aims to explore patients? experiences using a chat-based and automated medical history?taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods: Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history?taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results: The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history?taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one?s time and reflect on one?s situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions: Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service. UR - https://www.jmir.org/2021/10/e29868 UR - http://dx.doi.org/10.2196/29868 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661544 ID - info:doi/10.2196/29868 ER - TY - JOUR AU - Seiler, Amber AU - Biundo, Eliana AU - Di Bacco, Marco AU - Rosemas, Sarah AU - Nicolle, Emmanuelle AU - Lanctin, David AU - Hennion, Juliette AU - de Melis, Mirko AU - Van Heel, Laura PY - 2021/10/15 TI - Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation JO - JMIR Cardio SP - e27720 VL - 5 IS - 2 KW - cardiac implantable electronic devices KW - remote monitoring KW - patient management KW - clinic efficiency KW - digital health KW - mobile phone N2 - Background: The number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. Objective: This study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. Methods: A time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. Results: A total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. Conclusions: The CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow. UR - https://cardio.jmir.org/2021/2/e27720 UR - http://dx.doi.org/10.2196/27720 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156344 ID - info:doi/10.2196/27720 ER - TY - JOUR AU - Wherton, Joseph AU - Greenhalgh, Trisha AU - Shaw, E. Sara PY - 2021/10/7 TI - Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study JO - J Med Internet Res SP - e31374 VL - 23 IS - 10 KW - technology-enabled care KW - video consultations KW - quality improvement KW - COVID-19 KW - PERCS framework N2 - Background: Scotland?a country of 5.5 million people?has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland?s video consultation services both before and during the pandemic. Methods: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations? general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn. UR - https://www.jmir.org/2021/10/e31374 UR - http://dx.doi.org/10.2196/31374 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516389 ID - info:doi/10.2196/31374 ER - TY - JOUR AU - Payne, H. Thomas AU - Keller, Carolyn AU - Arora, Pallavi AU - Brusati, Allison AU - Levin, Jesse AU - Salgaonkar, Monica AU - Li, Xi AU - Zech, Jennifer AU - Lees, Fischer A. PY - 2021/10/6 TI - Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study JO - J Med Internet Res SP - e30165 VL - 23 IS - 10 KW - electronic documentation KW - electronic health records KW - hospital progress notes KW - copy-paste KW - EHR KW - patient records KW - workflow KW - human factors KW - clinical communication KW - physician communication KW - hospital N2 - Background: Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. Objective: We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. Methods: Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. Results: We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment & Plan note section. A total of 29% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader?s professional role. Conclusions: Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements. UR - https://www.jmir.org/2021/10/e30165 UR - http://dx.doi.org/10.2196/30165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612825 ID - info:doi/10.2196/30165 ER - TY - JOUR AU - Bragin, Ilya AU - Cohen, T. Dylan PY - 2021/10/6 TI - Certified Examination Assistants in the Age of Telemedicine: A Blueprint Through Neurology JO - JMIR Med Educ SP - e28335 VL - 7 IS - 4 KW - telemedicine KW - physical examination KW - neurological exam KW - telemedicine assistants KW - telemedicine implementation KW - telemedicine certification KW - telemedicine jobs KW - telemedicine education KW - telehealth KW - teleneurology UR - https://mededu.jmir.org/2021/4/e28335 UR - http://dx.doi.org/10.2196/28335 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612828 ID - info:doi/10.2196/28335 ER - TY - JOUR AU - Rigamonti, Lia AU - Secchi, Matteo AU - Lawrence, B. Jimmy AU - Labianca, Luca AU - Wolfarth, Bernd AU - Peters, Harm AU - Bonaventura, Klaus AU - Back, Alexander David PY - 2021/10/5 TI - An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study JO - J Med Internet Res SP - e28767 VL - 23 IS - 10 KW - augmented reality KW - ultrasound KW - social media KW - remote KW - exercise science N2 - Background: Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19?related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange. Objective: This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations. Methods: A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire. Results: In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians? examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive. Conclusions: The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination?based research questions. UR - https://www.jmir.org/2021/10/e28767 UR - http://dx.doi.org/10.2196/28767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609312 ID - info:doi/10.2196/28767 ER - TY - JOUR AU - McKinstry, Brian AU - Alexander, Helen AU - Maxwell, Gabriela AU - Blaikie, Lesley AU - Patel, Sameer AU - Guthrie, Bruce AU - PY - 2021/9/27 TI - The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study JO - JMIR Form Res SP - e20131 VL - 5 IS - 9 KW - telemonitoring KW - eHealth KW - COVID-19 KW - primary care N2 - Background: Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective: The aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration. Methods: A multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service. Results: We investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ?93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system ?very safe,? 3 (27%) thought it ?could be safer,? and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high. Conclusions: Supported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients. UR - https://formative.jmir.org/2021/9/e20131 UR - http://dx.doi.org/10.2196/20131 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449404 ID - info:doi/10.2196/20131 ER - TY - JOUR AU - Der-Martirosian, Claudia AU - Wyte-Lake, Tamar AU - Balut, Michelle AU - Chu, Karen AU - Heyworth, Leonie AU - Leung, Lucinda AU - Ziaeian, Boback AU - Tubbesing, Sarah AU - Mullur, Rashmi AU - Dobalian, Aram PY - 2021/9/23 TI - Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e29429 VL - 5 IS - 9 KW - telehealth KW - telemedicine KW - veterans KW - US Department of Veterans Affairs KW - primary care KW - cardiology KW - home-based primary care KW - COVID-19 N2 - Background: At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective: We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods: We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results: Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions: Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic. UR - https://formative.jmir.org/2021/9/e29429 UR - http://dx.doi.org/10.2196/29429 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477554 ID - info:doi/10.2196/29429 ER - TY - JOUR AU - Commiskey, Patricia AU - Armstrong, W. April AU - Coker, R. Tumaini AU - Dorsey, Ray Earl AU - Fortney, C. John AU - Gaines, J. Kenneth AU - Gibbons, M. Brittany AU - Nguyen, Q. Huong AU - Singla, R. Daisy AU - Szigethy, Eva AU - Krupinski, A. Elizabeth PY - 2021/9/20 TI - A Blueprint for the Conduct of Large, Multisite Trials in Telemedicine JO - J Med Internet Res SP - e29511 VL - 23 IS - 9 KW - telemedicine trials KW - randomized trials KW - challenges KW - multisite KW - mobile phone UR - https://www.jmir.org/2021/9/e29511 UR - http://dx.doi.org/10.2196/29511 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542417 ID - info:doi/10.2196/29511 ER - TY - JOUR AU - Damery, Sarah AU - Jones, Janet AU - O'Connell Francischetto, Elaine AU - Jolly, Kate AU - Lilford, Richard AU - Ferguson, James PY - 2021/9/17 TI - Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic JO - J Med Internet Res SP - e19232 VL - 23 IS - 9 KW - digital health KW - remote consultation KW - patient satisfaction KW - feasibility KW - VSQ-9 KW - secondary care KW - liver transplant patients KW - mobile phone N2 - Background: Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. Objective: This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. Methods: Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. Results: Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that?according to patients?remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. Conclusions: Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. Trial Registration: ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2953-4 UR - https://www.jmir.org/2021/9/e19232 UR - http://dx.doi.org/10.2196/19232 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533461 ID - info:doi/10.2196/19232 ER - TY - JOUR AU - Milne-Ives, Madison AU - Lam, Ching AU - Meinert, Edward PY - 2021/9/17 TI - Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials JO - JMIR Pediatr Parent SP - e27999 VL - 4 IS - 3 KW - asthma KW - disease management KW - child KW - adolescent KW - telemedicine N2 - Background: Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. Objective: This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. Methods: This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. Results: A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. Conclusions: A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways. UR - https://pediatrics.jmir.org/2021/3/e27999 UR - http://dx.doi.org/10.2196/27999 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533463 ID - info:doi/10.2196/27999 ER - TY - JOUR AU - Zhi, Lihua AU - Yin, Pei AU - Ren, Jingjing AU - Wei, Guoqing AU - Zhou, Jun AU - Wu, Jun AU - Shen, Qun PY - 2021/9/16 TI - Running an Internet Hospital in China: Perspective Based on a Case Study JO - J Med Internet Res SP - e18307 VL - 23 IS - 9 KW - internet hospitals KW - telemedicine KW - medical service KW - medical procedures KW - operation management KW - network security UR - https://www.jmir.org/2021/9/e18307 UR - http://dx.doi.org/10.2196/18307 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342267 ID - info:doi/10.2196/18307 ER - TY - JOUR AU - Kozlov, Elissa AU - McDarby, Meghan AU - Prescott, Maximo AU - Altman, Myra PY - 2021/9/15 TI - Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study JO - JMIR Form Res SP - e30162 VL - 5 IS - 9 KW - stepped care KW - technology KW - mental health care KW - patient-centered care N2 - Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. UR - https://formative.jmir.org/2021/9/e30162 UR - http://dx.doi.org/10.2196/30162 UR - http://www.ncbi.nlm.nih.gov/pubmed/34343965 ID - info:doi/10.2196/30162 ER - TY - JOUR AU - Fleisher, E. Jori AU - Hess, Serena AU - Sennott, J. Brianna AU - Myrick, Erica AU - Wallace, Klostermann Ellen AU - Lee, Jeanette AU - Sanghvi, Maya AU - Woo, Katheryn AU - Ouyang, Bichun AU - Wilkinson, R. Jayne AU - Beck, James AU - Johnson, J. Tricia AU - Hall, A. Deborah AU - Chodosh, Joshua PY - 2021/9/14 TI - Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial JO - JMIR Res Protoc SP - e31690 VL - 10 IS - 9 KW - home visits KW - telehealth, Parkinson disease KW - homebound KW - palliative care KW - quality of life KW - interdisciplinary care KW - caregiver KW - caregiver strain N2 - Background: The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. Objective: The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. Methods: In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage?matched control dyads drawn from US participants in the longitudinal Parkinson?s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. Results: The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. Conclusions: To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. Trial Registration: ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. International Registered Report Identifier (IRRID): PRR1-10.2196/31690 UR - https://www.researchprotocols.org/2021/9/e31690 UR - http://dx.doi.org/10.2196/31690 UR - http://www.ncbi.nlm.nih.gov/pubmed/34238753 ID - info:doi/10.2196/31690 ER - TY - JOUR AU - Gilkey, B. Melissa AU - Kong, Yi Wei AU - Huang, Qian AU - Grabert, K. Brigid AU - Thompson, Peyton AU - Brewer, T. Noel PY - 2021/9/10 TI - Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals JO - J Med Internet Res SP - e31240 VL - 23 IS - 9 KW - adolescent health KW - primary care KW - telemedicine KW - health communication KW - health services KW - telehealth KW - adolescent KW - young adult KW - teenager KW - COVID-19 KW - survey KW - policy KW - access N2 - Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs? recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. UR - https://www.jmir.org/2021/9/e31240 UR - http://dx.doi.org/10.2196/31240 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406974 ID - info:doi/10.2196/31240 ER - TY - JOUR AU - Ziadni, S. Maisa AU - Gonzalez-Castro, Lluvia AU - Anderson, Steven AU - Krishnamurthy, Parthasarathy AU - Darnall, D. Beth PY - 2021/9/10 TI - Efficacy of a Single-Session ?Empowered Relief? Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic JO - J Med Internet Res SP - e29672 VL - 23 IS - 9 KW - single-session KW - empowered relief KW - Zoom-delivered KW - pain catastrophizing KW - pain intensity KW - randomized-controlled trial KW - chronic pain N2 - Background: Cognitive behavioral therapy?pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas. Objective: The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment. Methods: We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%). Results: Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS ?8.72, 42.25% reduction; WLC: PCS ?2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. Conclusions: Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. Trial Registration: ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685 UR - https://www.jmir.org/2021/9/e29672 UR - http://dx.doi.org/10.2196/29672 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505832 ID - info:doi/10.2196/29672 ER - TY - JOUR AU - Zengul, Ayse AU - Evans, Eric AU - Hall, Allyson AU - Qu, Haiyan AU - Willig, Amanda AU - Cherrington, Andrea AU - Thirumalai, Mohanraj PY - 2021/9/10 TI - Telehealth Behavioral Intervention for Diabetes Management in Adults With Physical Disabilities: Intervention Fidelity Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31695 VL - 10 IS - 9 KW - telehealth KW - health coaching KW - artificial intelligence KW - diabetes mellitus KW - intervention fidelity KW - mobile phone N2 - Background: Diabetes mellitus is a major health problem among people with physical disabilities. Health coaching has been proven to be an effective approach in terms of behavioral changes, patient self-efficacy, adherence to treatment, health service use, and health outcomes. Telehealth systems combined with health coaching have the potential to improve the quality of health care by increasing access to services. Treatment fidelity is particularly important for behavior change studies; however, fidelity protocols are inadequately administered and reported in the literature. Objective: The aim of this study is to outline all the intervention fidelity strategies and procedures of a telecoaching intervention?artificial intelligence for diabetes management (AI4DM)?which is a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of a telehealth platform in adults with type 2 diabetes and permanent impaired mobility. AI4DM aims to create a web-based disability-inclusive diabetes self-management program. We selected the National Institutes of Health Behavior Change Consortium (NIH BCC) fidelity framework to describe strategies to ensure intervention fidelity in our research. Methods: We have developed fidelity strategies based on the five fidelity domains outlined by the NIH BCC?focusing on study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. The design of the study is grounded in the social cognitive theory and is intended to ensure that both arms would receive the same amount of attention from the intervention. All providers will receive standardized training to deliver consistent health coaching to the participants. The intervention will be delivered through various controlling and monitoring strategies to reduce differences within and between treatment groups. The content and structure of the study are delivered to ensure comprehension and participation among individuals with low health literacy. By constantly reviewing and monitoring participant progress and protocol adherence, we intend to ensure that participants use cognitive and behavioral skills in real-world settings to engage in health behavior. Results: Enrollment for AI4DM will begin in October 2021 and end in October 2022. The results of this study will be reported in late 2022. Conclusions: Developing and using fidelity protocols in behavior change studies is essential to ensure the internal and external validity of interventions. This study incorporates NIH BCC recommendations into an artificial intelligence embedded telecoaching platform for diabetes management designed for people with physical disabilities. The developed fidelity protocol can provide guidance for other researchers conducting telehealth interventions within behavioral health settings to present more consistent and reproducible research. Trial Registration: ClinicalTrials.gov NCT04927377; http://clinicaltrials.gov/ct2/show/NCT04927377. International Registered Report Identifier (IRRID): PRR1-10.2196/31695 UR - https://www.researchprotocols.org/2021/9/e31695 UR - http://dx.doi.org/10.2196/31695 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505835 ID - info:doi/10.2196/31695 ER - TY - JOUR AU - Evans, Eric AU - Zengul, Ayse AU - Hall, Allyson AU - Qu, Haiyan AU - Willig, Amanda AU - Cherrington, Andrea AU - Thirumalai, Mohanraj PY - 2021/9/10 TI - Disability-Inclusive Diabetes Self-management Telehealth Program: Protocol for a Pilot and Feasibility Study JO - JMIR Res Protoc SP - e31689 VL - 10 IS - 9 KW - telehealth KW - health coaching KW - artificial intelligence KW - diabetes mellitus KW - mobile phone N2 - Background: Individuals with disabilities and type 2 diabetes require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching has been shown to be an effective approach for improving behavioral changes in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of and access to health services. Objective: This protocol outlines the study design for implementing the Artificial Intelligence for Diabetes Management (AI4DM) intervention. The protocol will assess the feasibility, acceptability, and preliminary efficacy of the AI4DM telehealth platform for people with disabilities. Methods: The AI4DM study is a 2-arm randomized controlled trial for evaluating the delivery of a 12-month intervention, which will involve telecoaching, diabetes educational content, and technology access, to 90 individuals with diabetes and physical disabilities. The hypothesis is that this pilot project is feasible and acceptable for adults with permanently impaired mobility and type 2 diabetes. We also hypothesize that adults in the AI4DM intervention groups will have significantly better glycemic control (glycated hemoglobin) and psychosocial and psychological measures than the attention control group at the 3-, 6-, and 12-month follow-ups. Results: The AI4DM study was approved by the university?s institutional review board, and recruitment and enrollment will begin in October 2021. Conclusions: The AI4DM study will improve our understanding of the feasibility and efficacy of a web-based diabetes self-management program for people with disabilities. The AI4DM intervention has the potential to become a scalable and novel method for successfully managing type 2 diabetes in people with disabilities. Trial Registration: ClinicalTrials.gov NCT04927377; https://clinicaltrials.gov/ct2/show/NCT04927377 International Registered Report Identifier (IRRID): PRR1-10.2196/31689 UR - https://www.researchprotocols.org/2021/9/e31689 UR - http://dx.doi.org/10.2196/31689 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505831 ID - info:doi/10.2196/31689 ER - TY - JOUR AU - Blasi, Livio AU - Bordonaro, Roberto AU - Serretta, Vincenzo AU - Piazza, Dario AU - Firenze, Alberto AU - Gebbia, Vittorio PY - 2021/9/10 TI - Virtual Clinical and Precision Medicine Tumor Boards?Cloud-Based Platform?Mediated Implementation of Multidisciplinary Reviews Among Oncology Centers in the COVID-19 Era: Protocol for an Observational Study JO - JMIR Res Protoc SP - e26220 VL - 10 IS - 9 KW - virtual tumor board KW - multidisciplinary collaboration KW - oncology KW - multidisciplinary communication KW - health services KW - multidisciplinary oncology consultations KW - virtual health KW - digital health KW - precision medicine KW - tumor KW - cancer KW - cloud-based KW - platform KW - implementation KW - COVID-19 N2 - Background: Multidisciplinary tumor boards play a pivotal role in the patient-centered clinical management and in the decision-making process to provide best evidence-based, diagnostic, and therapeutic care to patients with cancer. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore, the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key point to successfully obtain an oncology team and implement a network among health professionals and institutions. This need is stronger than ever during the COVID-19 pandemic. Objective: This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily, Italy. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients? outcomes, and patient satisfaction. Methods: This protocol encompasses a pragmatic, observational, multicenter, noninterventional, prospective trial. The study?s programmed duration is 5 years, with a half-yearly analysis of the primary and secondary objectives? measurements. Oncology care health professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a nonhierarchic manner. VMTB employs an innovative, virtual, cloud-based platform to share anonymized medical data that are discussed via a videoconferencing system both satisfying security criteria and compliance with the Health Insurance Portability and Accountability Act. Results: The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region. The results of this study will particularly focus on the organization of VMTBs, involving oncology units present in different hospitals spread in the area, and creating a network to allow best patient care pathways and a hub-and-spoke relationship. The present results will also include data concerning organization skills and pitfalls, barriers, efficiency, number, and types with respect to clinical cases and customer satisfaction. Conclusions: VMTB represents a unique opportunity to optimize patient management through a patient-centered approach. An efficient virtualization and data-banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully be useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. International Registered Report Identifier (IRRID): DERR1-10.2196/26220 UR - https://www.researchprotocols.org/2021/9/e26220 UR - http://dx.doi.org/10.2196/26220 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387553 ID - info:doi/10.2196/26220 ER - TY - JOUR AU - Stamenova, Vess AU - Chu, Cherry AU - Pang, Andrea AU - Tadrous, Mina AU - Bhatia, Sacha R. AU - Cram, Peter PY - 2021/9/7 TI - Using Administrative Data to Explore Potentially Aberrant Provision of Virtual Care During COVID-19: Retrospective Cohort Study of Ontario Provincial Data JO - J Med Internet Res SP - e29396 VL - 23 IS - 9 KW - telemedicine KW - virtual care KW - COVID-19 KW - pandemic KW - virtual health KW - telehealth KW - ambulatory visits KW - physicians KW - patients KW - digital health N2 - Background: The COVID-19 pandemic has led to a rapid increase in virtual care use across the globe. Many health care systems have responded by creating virtual care billing codes that allow physicians to see their patients over telephone or video. This rapid liberalization of billing requirements, both in Canada and other countries, has led to concerns about potential abuse, but empirical data are limited. Objective: The objectives of this study were to examine whether there were substantial changes in physicians? ambulatory visit volumes coinciding with the liberalization of virtual care billing rules and to describe the characteristics of physicians who significantly increased their ambulatory visit volumes during this period. We also sought to describe the relationship between visit volume changes in 2020 and the volumes of virtual care use among individual physicians and across specialties. Methods: We conducted a population-based, retrospective cohort study using health administrative data from the Ontario Health Insurance Plan, which was linked to the ICES Physician Database. We identified a unique cohort of providers based on physicians? billings and calculated the ratio of total in-person and virtual ambulatory visits over the period from January to June 2020 (virtual predominating) relative to that over the period from January to June 2019 (in-person predominating) for each physician. Based on these ratios, we then stratified physicians into four groups: low-, same-, high-, and very high?use physicians. We then calculated various demographic and practice characteristics of physicians in each group. Results: Among 28,383 eligible physicians in 2020, the mean ratio of ambulatory visits in January to June 2020:2019 was 0.99 (SD 2.53; median 0.81, IQR 0.59-1.0). Out of 28,383 physicians, only 2672 (9.4%) fell into the high-use group and only 291 (1.0%) fell into the very high?use group. High-use physicians were younger, more recent graduates, more likely female, and less likely to be international graduates. They also had, on average, lower-volume practices. There was a significant positive correlation between percent virtual care and the 2020:2019 ratio only in the group of physicians who maintained their practice (R=0.35, P<.001). There was also a significant positive correlation between the 2020:2019 ratio and the percent virtual care per specialty (R=0.59, P<.01). Conclusions: During the early stages of the pandemic, the introduction of virtual care did not lead to significant increases in visit volume. Our results provide reassuring evidence that relaxation of billing requirements early in the COVID-19 pandemic in Ontario were not associated with widespread and aberrant billing behaviors. Furthermore, the strong relationship between the ability to maintain practice volumes and the use of virtual care suggests that the introduction of virtual care allowed for continued access to care for patients. UR - https://www.jmir.org/2021/9/e29396 UR - http://dx.doi.org/10.2196/29396 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313590 ID - info:doi/10.2196/29396 ER - TY - JOUR AU - Quinn, Marie Lauren AU - Olajide, Oluwafumbi AU - Green, Marsha AU - Sayed, Hazem AU - Ansar, Humera PY - 2021/8/31 TI - Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study JO - J Med Internet Res SP - e25549 VL - 23 IS - 8 KW - antenatal KW - virtual clinic KW - technology KW - COVID-19 KW - United Kingdom KW - pandemic KW - feasibility KW - effective KW - telehealth KW - virtual health N2 - Background: The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective: We evaluated patients? and professionals? experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods: A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results: We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions: Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals. UR - https://www.jmir.org/2021/8/e25549 UR - http://dx.doi.org/10.2196/25549 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254940 ID - info:doi/10.2196/25549 ER - TY - JOUR AU - Gomes, Antunes Luís AU - Gregório, João Maria AU - Iakovleva, A. Tatiana AU - Sousa, de Rute Dinis AU - Bessant, John AU - Oliveira, Pedro AU - Branco, C. Jaime AU - Canhão, Helena AU - Rodrigues, Maria Ana PY - 2021/8/31 TI - A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study JO - J Med Internet Res SP - e26871 VL - 23 IS - 8 KW - food insecurity KW - eHealth KW - television app KW - elderly people KW - vulnerable population KW - cognitive behavioral strategy KW - health innovation KW - multidisciplinary program N2 - Background: Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. Objective: This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. Methods: A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). Results: A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean ?3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean ?0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean ?1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. Conclusions: The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants? fatigue and physical function. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6626 UR - https://www.jmir.org/2021/8/e26871 UR - http://dx.doi.org/10.2196/26871 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463638 ID - info:doi/10.2196/26871 ER - TY - JOUR AU - Khairat, Saif AU - McDaniel, Phillip AU - Jansen, Matthew AU - Francis, Tia AU - Edson, Barbara AU - Gianforcaro, Robert PY - 2021/8/30 TI - Analysis of Social Determinants and the Utilization of Pediatric Tele?Urgent Care During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Pediatr Parent SP - e25873 VL - 4 IS - 3 KW - telehealth KW - pediatrics KW - social KW - determinants KW - COVID-19 KW - use KW - children KW - infant KW - consultation KW - telemedicine KW - urgent care KW - vulnerable population KW - cross-sectional KW - minority N2 - Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele?urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele?urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele?urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele?urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 North Carolina zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% (56/317) of the tele?urgent care visits originated from. The majority (215/317, 67.8%) of tele?urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele?urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele?urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19?confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. UR - https://pediatrics.jmir.org/2021/3/e25873 UR - http://dx.doi.org/10.2196/25873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34459742 ID - info:doi/10.2196/25873 ER - TY - JOUR AU - Gmunder, Nicole Kristin AU - Ruiz, W. Jose AU - Franceschi, Dido AU - Suarez, M. Maritza PY - 2021/8/27 TI - Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study JO - JMIR Med Inform SP - e27977 VL - 9 IS - 8 KW - telemedicine KW - COVID-19 KW - patient portals KW - delivery of health care KW - telehealth KW - pandemic KW - digital health N2 - Background: With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. Objective: The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. Methods: Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. Results: Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider?s specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. Conclusions: The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider?s specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff. UR - https://medinform.jmir.org/2021/8/e27977 UR - http://dx.doi.org/10.2196/27977 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254936 ID - info:doi/10.2196/27977 ER - TY - JOUR AU - van Rijt, Mattheus Antonius AU - Hulter, Pauline AU - Weggelaar-Jansen, Marie Anne AU - Ahaus, Kees AU - Pluut, Bettine PY - 2021/8/27 TI - Mental Health Care Professionals? Appraisal of Patients? Use of Web-Based Access to Their Electronic Health Record: Qualitative Study JO - J Med Internet Res SP - e28045 VL - 23 IS - 8 KW - patient portals KW - eHealth KW - mental health care professionals KW - mental health KW - eMental health KW - mental health care KW - patient-accessible KW - electronic health records KW - Open Notes KW - normalization process theory KW - NPT N2 - Background: Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient?s well-being and privacy as well as the professional?s own workload. Objective: This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. Methods: We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. Results: Our study provides insights into mental health care professionals? appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. Conclusions: Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals. UR - https://www.jmir.org/2021/8/e28045 UR - http://dx.doi.org/10.2196/28045 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448705 ID - info:doi/10.2196/28045 ER - TY - JOUR AU - Butzner, Michael AU - Cuffee, Yendelela PY - 2021/8/26 TI - Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review JO - J Med Internet Res SP - e29575 VL - 23 IS - 8 KW - telehealth KW - telemedicine KW - rural health KW - health outcomes KW - social determinants of health KW - eHealth KW - health care accessibility N2 - Background: In rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health. Objective: The aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States. Methods: A narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms included telehealth, telemedicine, rural, and outcomes. Results: Among 15 included studies, 9 studies analyzed telehealth interventions in patients, 3 in health care professionals, and 3 in both patients and health care professionals. The included studies reported positive outcomes and experiences of telehealth use in rural populations including acceptability and increased satisfaction; they also noted that technology is convenient and efficient. Other notable benefits included decreased direct and indirect costs to the patient (travel cost and time) and health care service provider (staffing), lower onsite health care resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and health care professionals. Conclusions: Telehealth models were associated with positive outcomes for patients and health care professionals, suggesting these models are feasible and can be effective. Future telehealth interventions and studies examining these programs are warranted, especially in rural communities, and future research should evaluate the impact of increased telehealth use as a result of the COVID-19 pandemic. UR - https://www.jmir.org/2021/8/e29575 UR - http://dx.doi.org/10.2196/29575 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435965 ID - info:doi/10.2196/29575 ER - TY - JOUR AU - Knop, Michael AU - Mueller, Marius AU - Niehaves, Bjoern PY - 2021/8/26 TI - Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-Based Primary Care: Mixed Methods Study JO - J Med Internet Res SP - e28151 VL - 23 IS - 8 KW - digital health KW - digital health care technologies KW - telemedicine KW - user perceptions KW - delegation KW - primary care KW - ambulant health care KW - medical assistants KW - general practitioners KW - COVID-19 KW - mixed method study KW - multidimensional scaling KW - mobile phone N2 - Background: Owing to the shortage of medical professionals, as well as demographic and structural challenges, new care models have emerged to find innovative solutions to counter medical undersupply. Team-based primary care using medical delegation appears to be a promising approach to address these challenges; however, it demands efficient communication structures and mechanisms to reinsure patients and caregivers receive a delegated, treatment-related task. Digital health care technologies hold the potential to render these novel processes effective and demand driven. Objective: The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. Methods: We conducted a combination of 19 individual and group interviews with 12 GPs and 14 MAs, seeking to identify relevant technologies for delegation purposes as well as stakeholders? perceptions of their effectiveness. Furthermore, a web-based survey was conducted asking the interviewees to order identified technologies based on their assessed applicability in multi-actor patient care. Interview data were analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize the survey data, leading to a triangulation of the results. Results: Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed to improve the development and distribution of innovative technologies and to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultations, portable electrocardiograms, or telemedical stethoscopes, can counteract current challenges in primary care because of its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. Conclusions: Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance of such innovative approaches increases with the tremendous need for differentiated and effective care, such as during the ongoing COVID-19 pandemic. For the successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role as mediators between GPs and patients, MAs are potentially able to counteract patients? resistance toward using innovative technology and compensate for patients? limited access to technology and care facilities. UR - https://www.jmir.org/2021/8/e28151 UR - http://dx.doi.org/10.2196/28151 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435959 ID - info:doi/10.2196/28151 ER - TY - JOUR AU - Lapão, Velez Luís AU - Peyroteo, Mariana AU - Maia, Melanie AU - Seixas, Jorge AU - Gregório, João AU - Mira da Silva, Miguel AU - Heleno, Bruno AU - Correia, César Jorge PY - 2021/8/26 TI - Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach JO - J Med Internet Res SP - e24181 VL - 23 IS - 8 KW - primary healthcare KW - information systems KW - telemedicine KW - implementation KW - design science research KW - COVID-19 KW - monitoring KW - chronic disease KW - elderly KW - digital health N2 - Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient?s health related outcomes. UR - https://www.jmir.org/2021/8/e24181 UR - http://dx.doi.org/10.2196/24181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313591 ID - info:doi/10.2196/24181 ER - TY - JOUR AU - Tai-Seale, Ming AU - Rosen, Rebecca AU - Ruo, Bernice AU - Hogarth, Michael AU - Longhurst, A. Christopher AU - Lander, Lina AU - Walker, L. Amanda AU - Stults, D. Cheryl AU - Chan, Albert AU - Mazor, Kathleen AU - Garber, Lawrence AU - Millen, Marlene PY - 2021/8/26 TI - Implementation of Patient Engagement Tools in Electronic Health Records to Enhance Patient-Centered Communication: Protocol for Feasibility Evaluation and Preliminary Results JO - JMIR Res Protoc SP - e30431 VL - 10 IS - 8 KW - electronic health record KW - patient portal KW - patient?physician communication KW - agenda setting KW - patient priorities KW - patient engagement KW - health care teams KW - electronic health record documentation KW - standard work KW - digital health N2 - Background: Patient?physician communication during clinical encounters is essential to ensure quality of care. Many studies have attempted to improve patient?physician communication. Incorporating patient priorities into agenda setting and medical decision-making are fundamental to patient-centered communication. Efficient and scalable approaches are needed to empower patients to speak up and prepare physicians to respond. Leveraging electronic health records (EHRs) in engaging patients and health care teams has the potential to enhance the integration of patient priorities in clinical encounters. A systematic approach to eliciting and documenting patient priorities before encounters could facilitate effective communication in such encounters. Objective: In this paper, we report the design and implementation of a set of EHR tools built into clinical workflows for facilitating patient?physician joint agenda setting and the documentation of patient concerns in the EHRs for ambulatory encounters. Methods: We engaged health information technology leaders and users in three health care systems for developing and implementing a set of EHR tools. The goal of these tools is to standardize the elicitation of patient priorities by using a previsit ?patient important issue? questionnaire distributed through the patient portal to the EHR. We built additional EHR documentation tools to facilitate patient?staff communication when the staff records the vital signs and the reason for the visit in the EHR while in the examination room, with a simple transmission method for physicians to incorporate patient concerns in EHR notes. Results: The study is ongoing. The anticipated completion date for survey data collection is November 2021. A total of 34,037 primary care patients from three health systems (n=26,441; n=5136; and n=2460 separately recruited from each system) used the previsit patient important issue questionnaire in 2020. The adoption of the digital previsit questionnaire during the COVID-19 pandemic was much higher in one health care system because it expanded the use of the questionnaire from physicians participating in trials to all primary care providers midway through the year. It also required the use of this previsit questionnaire for eCheck-ins, which are required for telehealth encounters. Physicians and staff suggested anecdotally that this questionnaire helped patient?clinician communication, particularly during the COVID-19 pandemic. Conclusions: EHR tools have the potential to facilitate the integration of patient priorities into agenda setting and documentation in real-world primary care practices. Early results suggest the feasibility and acceptability of such digital tools in three health systems. EHR tools can support patient engagement and clinicians? work during in-person and telehealth visits. They could potentially exert a sustained influence on patient and clinician communication behaviors in contrast to prior ad hoc educational efforts targeting patients or clinicians. Trial Registration: ClinicalTrials.gov NCT03385512; https://clinicaltrials.gov/ct2/show/NCT03385512 International Registered Report Identifier (IRRID): DERR1-10.2196/30431 UR - https://www.researchprotocols.org/2021/8/e30431 UR - http://dx.doi.org/10.2196/30431 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435960 ID - info:doi/10.2196/30431 ER - TY - JOUR AU - Bae, Seul Ye AU - Kim, Hwan Kyung AU - Choi, Won Sae AU - Ko, Taehoon AU - Lim, Seo Jun AU - Piao, Meihua PY - 2021/8/26 TI - Satisfaction and Usability of an Information and Communications Technology?Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study JO - JMIR Form Res SP - e26227 VL - 5 IS - 8 KW - COVID-19 KW - mobile app KW - telemedicine KW - wearable device KW - vital sign KW - satisfaction KW - usability N2 - Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)?based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the ?self-reporting? item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. UR - https://formative.jmir.org/2021/8/e26227 UR - http://dx.doi.org/10.2196/26227 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254946 ID - info:doi/10.2196/26227 ER - TY - JOUR AU - Neves, Luísa Ana AU - Li, Edmond AU - Serafini, Alice AU - Jimenez, Geronimo AU - Lingner, Heidrun AU - Koskela, H. Tuomas AU - Hoffman, D. Robert AU - Collins, Claire AU - Petek, Davorina AU - Claveria, Ana AU - Tsopra, Rosy AU - Irving, Greg AU - Gusso, Gustavo AU - O?Neill, Gregory Braden AU - Hoedebecke, Kyle AU - Espitia, Milena Sandra AU - Ungan, Mehmet AU - Nessler, Katarzyna AU - Lazic, Vanja AU - Laranjo, Liliana AU - Memarian, Ensieh AU - Fernandez, Jose Maria AU - Ghafur, Saira AU - Fontana, Gianluca AU - Majeed, Azeem AU - Car, Josip AU - Darzi, Ara PY - 2021/8/26 TI - Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study JO - JMIR Res Protoc SP - e30099 VL - 10 IS - 8 KW - primary care KW - telemedicine KW - virtual care KW - digital-first models KW - quality of care KW - patient safety N2 - Background: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. Objective: This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. Methods: This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers? personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants? characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. Results: Data collection took place from June 2020 to September 2020. As of this manuscript?s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. Conclusions: The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. International Registered Report Identifier (IRRID): DERR1-10.2196/30099 UR - https://www.researchprotocols.org/2021/8/e30099 UR - http://dx.doi.org/10.2196/30099 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292867 ID - info:doi/10.2196/30099 ER - TY - JOUR AU - Motz, Victoria AU - Faust, Alison AU - Dahmus, Jessica AU - Stern, Benjamin AU - Soriano, Christopher AU - Stine, G. Jonathan PY - 2021/8/17 TI - Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study JO - JMIR Form Res SP - e30239 VL - 5 IS - 8 KW - physical activity KW - fatty liver KW - telemedicine KW - liver KW - nonalcoholic fatty liver disease KW - liver disease KW - fatty liver disease KW - aerobic training KW - telehealth KW - fitness KW - feasibility KW - steatohepatitis N2 - Background: Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective: The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods: In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio?visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results: Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80% of exercise sessions (mean 84% [SD 3%]) and no adverse events occurred. Body weight (mean ?5.1% [SD 3.7%]), body fat (mean ?4.4% [SD 2.3%]), and waist circumference (mean ?1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1% (SD 8.8%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (?0.5% [SD 0.2%] and ?4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions: This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration: ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294 UR - https://formative.jmir.org/2021/8/e30239 UR - http://dx.doi.org/10.2196/30239 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402795 ID - info:doi/10.2196/30239 ER - TY - JOUR AU - Zhang, Lu AU - McLeod, L. Howard AU - Liu, Ke-Ke AU - Liu, Wen-Hui AU - Huang, Hang-Xing AU - Huang, Ya-Min AU - Sun, Shu-Sen AU - Chen, Xiao-Ping AU - Chen, Yao AU - Liu, Fang-Zhou AU - Xiao, Jian PY - 2021/8/16 TI - Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e24555 VL - 9 IS - 8 KW - cancer pain KW - self-management KW - ambulatory setting KW - digital health KW - physician-pharmacist N2 - Background: Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective: We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods: Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results: A total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions: The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901 UR - https://mhealth.jmir.org/2021/8/e24555 UR - http://dx.doi.org/10.2196/24555 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398796 ID - info:doi/10.2196/24555 ER - TY - JOUR AU - Jonnergård, Karin AU - Petersson, Lena AU - Erlingsdóttir, Gudbjörg PY - 2021/8/16 TI - Communicating the Implementation of Open Notes to Health Care Professionals: Mixed Methods Study JO - JMIR Med Inform SP - e22391 VL - 9 IS - 8 KW - implementation KW - health care KW - electronic health records KW - communication strategy KW - eHealth KW - telemedicine KW - PAEHRs KW - Open Notes KW - professions KW - EHR N2 - Background: The literature on how to communicate reform in organizations has mainly focused on levels of hierarchy and has largely ignored the variety of professions that may be found within an organization. In this study, we focus on the relationship between media type and professional responses. Objective: The objective of this study was to investigate whether and how belonging to a profession influences the choice of communication media and the perception of information when a technical innovation is implemented in a health care setting. Methods: This study followed a mixed methods design based on observations and participant studies, as well as a survey of professionals in psychiatric health care in Sweden. The ?2 test was used to detect differences in perceptions between professional groups. Results: The use of available communication media differed among professions. These differences seem to be related to the status attached to each profession. The sense-making of the information appears to be similar among the professions, but is based on their traditional professional norms rather than on reflection on the reform at hand. Conclusions: When communicating about the implementation of a new technology, the choice of media and the message need to be attuned to the employees in both hierarchical and professional terms. This also applies to situations where professional employees are only indirectly affected by the implementation. A differentiated communication strategy is preferred over a downward cascade of information. UR - https://medinform.jmir.org/2021/8/e22391 UR - http://dx.doi.org/10.2196/22391 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398794 ID - info:doi/10.2196/22391 ER - TY - JOUR AU - Hettiachchi, Danula AU - Hayes, Lachie AU - Goncalves, Jorge AU - Kostakos, Vassilis PY - 2021/8/16 TI - Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager JO - JMIR Med Inform SP - e28245 VL - 9 IS - 8 KW - task assignment KW - smartphones KW - hospital communication KW - clinical workflows KW - mobile app KW - clinical platform KW - mHealth N2 - Background: Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. Objective: We seek to identify whether the structure of the collected communication data provides insights into hospitals? workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. Methods: We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. Results: We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). Conclusions: Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff. UR - https://medinform.jmir.org/2021/8/e28245 UR - http://dx.doi.org/10.2196/28245 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398797 ID - info:doi/10.2196/28245 ER - TY - JOUR AU - Reid, Amanda AU - Kresovich, Alex PY - 2021/8/13 TI - Copyright as a Barrier to Music Therapy Telehealth Interventions: Qualitative Interview Study JO - JMIR Form Res SP - e28383 VL - 5 IS - 8 KW - telehealth KW - music therapy KW - diffusion of innovations KW - COVID-19 KW - copyright law KW - fair use N2 - Background: Music therapy is a multifaceted discipline that harnesses the power of music to treat a wide range of patient populations. A therapist who plays music in a private room for a patient is not subject to copyright restrictions on public performances. However, in the wake of the COVID-19 pandemic, music therapy is no longer strictly confined to the face-to-face setting. This study explores music therapists? perceptions of copyright law with respect to their ability to provide mediated services to their clients. Objective: The objectives of our study were two-fold. The first was to investigate whether concerns about copyright law are hampering the diffusion of telehealth innovations, and the second was whether these concerns are causing music therapists to avoid therapeutically beneficial telehealth interventions. Methods: Semistructured interviews were conducted with credentialed music therapists (n=18) in the United States between May 2020 and June 2020. With participants? consent, we used video conference technology to record and transcribe the in-depth interviews. The median interview length was 45 (SD 16.37) minutes. This theoretically informed study employed thematic analysis of the interview data. Results: The COVID-19 pandemic accelerated the adoption of telehealth interventions to facilitate therapy outside of private face-to-face environments: environments where music therapy practices are largely shielded from copyright infringement concerns. Five main themes emerged, including therapists? uncertainty about permissible uses of music and therapists? erring on the side of caution causing lost opportunities for care. Our interview data suggest music therapists have altered telehealth interventions in suboptimal ways to avoid copyright liability in a physically distanced environment. Conclusions: Some music therapists ?drag their feet? on offering therapeutically appropriate telehealth services to clients because of copyright concerns. Our findings suggest innovative mediated therapies were shied away from or abandoned. These findings offer a novel contribution to the public health literature by highlighting copyright law as an unexpected and unwelcome barrier to the diffusion of music therapy practices in technology-mediated settings. UR - https://formative.jmir.org/2021/8/e28383 UR - http://dx.doi.org/10.2196/28383 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319241 ID - info:doi/10.2196/28383 ER - TY - JOUR AU - Nies, Sarah AU - Patel, Shae AU - Shafer, Melissa AU - Longman, Laura AU - Sharif, Iman AU - Pina, Paulo PY - 2021/8/13 TI - Understanding Physicians? Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e26565 VL - 5 IS - 8 KW - telemedicine KW - federally qualified health care center KW - primary care KW - COVID-19 KW - telehealth KW - physician KW - doctor KW - preference KW - perspective KW - dissemination KW - appropriate KW - cross-sectional KW - survey N2 - Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. Results: Of 272 health care providers who were sent the electronic survey, 157 (58%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91%] vs 65/90 [72%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95% CI 1.7-16.2; younger age: odds ratio 1.05, 95% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. Conclusions: The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. UR - https://formative.jmir.org/2021/8/e26565 UR - http://dx.doi.org/10.2196/26565 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227993 ID - info:doi/10.2196/26565 ER - TY - JOUR AU - Smith-MacDonald, Lorraine AU - Jones, Chelsea AU - Sevigny, Phillip AU - White, Allison AU - Laidlaw, Alexa AU - Voth, Melissa AU - Mikolas, Cynthia AU - Heber, Alexandra AU - Greenshaw, J. Andrew AU - Brémault-Phillips, Suzette PY - 2021/8/12 TI - The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis JO - JMIR Form Res SP - e26369 VL - 5 IS - 8 KW - trauma KW - mental health KW - telemedicine KW - therapy KW - rehabilitation KW - digital health KW - psychotherapy KW - military KW - veteran KW - first responder KW - public safety personnel KW - teletherapy KW - telepsychiatry KW - mobile phone N2 - Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants? responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers? perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. UR - https://formative.jmir.org/2021/8/e26369 UR - http://dx.doi.org/10.2196/26369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387549 ID - info:doi/10.2196/26369 ER - TY - JOUR AU - Rankine, Jacquelin AU - Yeramosu, Deepika AU - Matheo, Loreta AU - Sequeira, M. Gina AU - Miller, Elizabeth AU - Ray, N. Kristin PY - 2021/8/5 TI - Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design JO - JMIR Hum Factors SP - e25568 VL - 8 IS - 3 KW - referral KW - consultation KW - telemedicine KW - telehealth KW - adolescents KW - child health KW - child health services KW - confidentiality KW - access to health care N2 - Background: e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. Objective: This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. Methods: We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. Results: Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. Conclusions: Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs. UR - https://humanfactors.jmir.org/2021/3/e25568 UR - http://dx.doi.org/10.2196/25568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383665 ID - info:doi/10.2196/25568 ER - TY - JOUR AU - Jambaulikar, D. Guruprasad AU - Marshall, Andrew AU - Hasdianda, Adrian Mohammad AU - Cao, Chenzhe AU - Chen, Paul AU - Miyawaki, Steven AU - Baugh, W. Christopher AU - Zhang, Haipeng AU - McCabe, Jonathan AU - Su, Jennifer AU - Landman, B. Adam AU - Chai, Ray Peter PY - 2021/8/4 TI - Electronic Paper Displays in Hospital Operations: Proposal for Deployment and Implementation JO - JMIR Form Res SP - e30862 VL - 5 IS - 8 KW - electronic ink KW - patient satisfaction KW - display systems KW - whiteboards KW - hospital KW - deployment KW - proposal KW - implementation KW - communication KW - engagement KW - efficiency KW - usage N2 - Background: Display signage is ubiquitous and essential in hospitals to serve several clerical, operational, and clinical functions, including displaying notices, providing directions, and presenting clinical information. These functions improve efficiency and patient engagement, reduce errors, and enhance the continuity of care. Over time, signage has evolved from analog approaches such as whiteboards and handwritten notices to digital displays such as liquid crystal displays, light emitting diodes, and, now, electronic ink displays. Electronic ink displays are paper-like displays that are not backlit and show content by aligning microencapsulated color beads in response to an applied electric current. Power is only required to generate content and not to retain it. These displays are very readable, with low eye strain; minimize the emission of blue light; require minimal power; and can be driven by several data sources, ranging from virtual servers to electronic health record systems. These attributes make adapting electronic ink displays to hospitals an ideal use case. Objective: In this paper, we aimed to outline the use of signage and displays in hospitals with a focus on electronic ink displays. We aimed to assess the advantages and limitations of using these displays in hospitals and outline the various public-facing and patient-facing applications of electronic ink displays. Finally, we aimed to discuss the technological considerations and an implementation framework that must be followed when adopting and deploying electronic ink displays. Methods: The public-facing applications of electronic ink displays include signage and way-finders, timetables for shared workspaces, and noticeboards and bulletin boards. The clinical display applications may be smaller form factors such as door signs or bedside cards. The larger, ?40-inch form factors may be used within patient rooms or at clinical command centers as a digital whiteboard to display general information, patient and clinician information, and care plans. In all these applications, such displays could replace analog whiteboards, noticeboards, and even other digital screens. Results: We are conducting pilot research projects to delineate best use cases and practices in adopting electronic ink displays in clinical settings. This will entail liaising with key stakeholders, gathering objective logistical and feasibility data, and, ultimately, quantifying and describing the effect on clinical care and patient satisfaction. Conclusions: There are several use cases in a clinical setting that may lend themselves perfectly to electronic ink display use. The main considerations to be studied in this adoption are network connectivity, content management, privacy and security robustness, and detailed comparison with existing modalities. Electronic ink displays offer a superior opportunity to future-proof existing practices. There is a need for theoretical considerations and real-world testing to determine if the advantages outweigh the limitations of electronic ink displays. UR - https://formative.jmir.org/2021/8/e30862 UR - http://dx.doi.org/10.2196/30862 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346904 ID - info:doi/10.2196/30862 ER - TY - JOUR AU - de Pennington, Nick AU - Mole, Guy AU - Lim, Ernest AU - Milne-Ives, Madison AU - Normando, Eduardo AU - Xue, Kanmin AU - Meinert, Edward PY - 2021/7/28 TI - Safety and Acceptability of a Natural Language Artificial Intelligence Assistant to Deliver Clinical Follow-up to Cataract Surgery Patients: Proposal JO - JMIR Res Protoc SP - e27227 VL - 10 IS - 7 KW - artificial intelligence KW - natural language processing KW - telemedicine KW - cataract KW - aftercare KW - speech recognition software KW - medical informatics KW - health services KW - health communication KW - delivery of health care KW - patient acceptance of health care KW - mental health KW - cell phone KW - internet KW - conversational agent KW - chatbot KW - expert systems KW - dialogue system KW - relational agent N2 - Background: Due to an aging population, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high-volume workloads, driving increasing costs for providers. Artificial intelligence (AI), in the form of conversational agents, presents a possible opportunity to enable efficiency in the delivery of care. Objective: This study aims to evaluate the effectiveness, usability, and acceptability of Dora agent: Ufonia?s autonomous voice conversational agent, an AI-enabled autonomous telemedicine call for the detection of postoperative cataract surgery patients who require further assessment. The objectives of this study are to establish Dora?s efficacy in comparison with an expert clinician, determine baseline sensitivity and specificity for the detection of true complications, evaluate patient acceptability, collect evidence for cost-effectiveness, and capture data to support further development and evaluation. Methods: Using an implementation science construct, the interdisciplinary study will be a mixed methods phase 1 pilot establishing interobserver reliability of the system, usability, and acceptability. This will be done using the following scales and frameworks: the system usability scale; assessment of Health Information Technology Interventions in Evidence-Based Medicine Evaluation Framework; the telehealth usability questionnaire; and the Non-Adoption, Abandonment, and Challenges to the Scale-up, Spread and Suitability framework. Results: The evaluation is expected to show that conversational technology can be used to conduct an accurate assessment and that it is acceptable to different populations with different backgrounds. In addition, the results will demonstrate how successfully the system can be delivered in organizations with different clinical pathways and how it can be integrated with their existing platforms. Conclusions: The project?s key contributions will be evidence of the effectiveness of AI voice conversational agents and their associated usability and acceptability. International Registered Report Identifier (IRRID): PRR1-10.2196/27227 UR - https://www.researchprotocols.org/2021/7/e27227 UR - http://dx.doi.org/10.2196/27227 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319248 ID - info:doi/10.2196/27227 ER - TY - JOUR AU - Kumwichar, Ponlagrit AU - Chongsuvivatwong, Virasakdi AU - Prappre, Tagoon PY - 2021/7/27 TI - Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study JO - JMIR Form Res SP - e29463 VL - 5 IS - 7 KW - app KW - mixed-methods analysis KW - remote monitoring KW - therapy KW - tuberculosis KW - user experience KW - video directly observed therapy KW - video-enhanced therapy KW - video-observed therapy N2 - Background: Directly observed therapy programs for monitoring tuberculosis (TB) treatment in Thailand are unsustainable, especially during the COVID-19 pandemic. The current video-observed therapy (VOT) system, the Thai VOT (TH VOT), was developed to replace the directly observed therapy program. Objective: This study aimed to describe the VOT system design and identify the potential for system improvements. Methods: This pilot study was conducted in Na Yong district, a small district in Trang province, south of Thailand. The TH VOT system consists of a smartphone app for patients, a secured web-based platform for staff, items used, and standard operating procedures. There were three groups of users: observers who were TB staff, healthy volunteers as simulated patients, and patients with active TB. All participants were trained to follow the standard operating procedures. After 2-week usage, VOT session records were analyzed to measure the compliance of the patients and observers. The User Experience Questionnaire was used to lead the participant users to focus on 6 standard dimensions of usability, and was supplemented with an in-depth interview to identify potential system improvements from users? experience. Results: Only 2 of 16 patients with currently active TB had a usable smartphone. Sixty of 70 drug-taking sessions among 2 patients and 3 simulated patients in 2 weeks were recorded and uploaded. Only 37 sessions were inspected by the observers within 24 hours. All participants needed a proper notification system. An audit system was also requested. Conclusions: Before upscaling, the cost of smartphone lending, audit management, and notification systems should be elucidated. UR - https://formative.jmir.org/2021/7/e29463 UR - http://dx.doi.org/10.2196/29463 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313602 ID - info:doi/10.2196/29463 ER - TY - JOUR AU - Clarke, A. Martina AU - Fruhling, L. Ann AU - Lyden, L. Elizabeth AU - Tarrell, E. Alvin AU - Bernard, L. Tamara AU - Windle, R. John PY - 2021/7/26 TI - The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers JO - JMIR Hum Factors SP - e19191 VL - 8 IS - 3 KW - patient portal KW - communication KW - patients KW - precision medicine KW - health literacy N2 - Background: In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. Objective: The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. Methods: A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). Results: There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). Conclusions: In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients? use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients? preferences and abilities when developing effective user-friendly health information technologies. UR - https://humanfactors.jmir.org/2021/3/e19191 UR - http://dx.doi.org/10.2196/19191 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309574 ID - info:doi/10.2196/19191 ER - TY - JOUR AU - Echelard, Jean-François PY - 2021/7/26 TI - Use of Telemedicine in Depression Care by Physicians: Scoping Review JO - JMIR Form Res SP - e29159 VL - 5 IS - 7 KW - telemedicine KW - telepsychiatry KW - depression KW - mental health KW - videoconferencing N2 - Background: Depression is a common disorder, and it creates burdens on people?s mental and physical health as well as societal costs. Although traditional in-person consultations are the usual mode of caring for patients with depression, telemedicine may be well suited to psychiatric assessment and management. Telepsychiatry can be defined as the use of information and communication technologies such as videoconferencing and telephone calls for the care of psychopathologies. Objective: This review aims to evaluate the extent and nature of the existing literature on the use of telemedicine for the care of depression by physicians. This review also aims to examine the effects and perceptions regarding this virtual care and determine how it compares to traditional in-person care. Methods: The Arksey and O?Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed. Relevant articles were identified through a search of three databases (MEDLINE, Cochrane Database of Systematic Reviews, and PsycArticles) on October 11, 2020. The search terms were ?(virtual OR telemedicine OR teleconsultation* OR telehealth OR phone* OR webcam* OR telepsychiatry) AND (depress*)?. Eligibility criteria were applied to select studies about the use of telemedicine for the care of patients with depression specifically by physicians. An Excel file (Microsoft Corporation) was used to chart data from all included articles. Results: The search resulted in the identification of 28 articles, and all 13 nonreview studies were analyzed in detail. Most nonreview studies were conducted in the United States during the last decade. Most telemedicine programs were led by psychiatrists, and the average study population size was 135. In all applicable studies, telepsychiatry tended to perform at least as well as in-person care regarding improvement in depression severity, patient satisfaction, quality of life, functioning, cost-effectiveness, and most other perceptions and variables. Cultural sensitivity and collaborative care were part of the design of some telemedicine programs. Conclusions: Additional randomized, high-quality studies are recommended to evaluate various outcomes of the use of telemedicine for depression care, including depression variables, perceptions, health care outcomes and other outcomes. Studies should be conducted in various clinical contexts, including primary care. Telepsychiatry is a promising modality of care for patients suffering from depression. UR - https://formative.jmir.org/2021/7/e29159 UR - http://dx.doi.org/10.2196/29159 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309571 ID - info:doi/10.2196/29159 ER - TY - JOUR AU - van der Kamp, Mattienne AU - Reimering Hartgerink, Pamela AU - Driessen, Jean AU - Thio, Bernard AU - Hermens, Hermie AU - Tabak, Monique PY - 2021/7/26 TI - Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study JO - JMIR Form Res SP - e24634 VL - 5 IS - 7 KW - telemedicine KW - feasibility studies KW - child KW - self-management KW - asthma KW - patient acceptance of health care KW - ambulatory care KW - remote sensing technology KW - cost-benefit analysis KW - health care costs N2 - Background: Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. Objective: The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. Methods: We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. Results: Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80% gross reduction (from ?71,784 to ?14,018, US $1=?0.85) in health care utilization, 8.6% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4% improved (from 71.2 to 76.8, P=.02) therapy adherence. Conclusions: eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care. UR - https://formative.jmir.org/2021/7/e24634 UR - http://dx.doi.org/10.2196/24634 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309568 ID - info:doi/10.2196/24634 ER - TY - JOUR AU - Brehon, Katelyn AU - Carriere, Jay AU - Churchill, Katie AU - Loyola-Sanchez, Adalberto AU - O'Connell, Petra AU - Papathanassoglou, Elisavet AU - MacIsaac, Rob AU - Tavakoli, Mahdi AU - Ho, Chester AU - Pohar Manhas, Kiran PY - 2021/7/23 TI - Evaluating Community-Facing Virtual Modalities to Support Complex Neurological Populations During the COVID-19 Pandemic: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e28267 VL - 10 IS - 7 KW - telehealth KW - evaluation KW - rehabilitation KW - musculoskeletal KW - neurological KW - COVID-19 KW - spinal cord injury KW - advice line KW - webinar KW - artificial intelligence KW - machine learning KW - community engagement N2 - Background: The COVID-19 pandemic and concomitant governmental responses have created the need for innovative and collaborative approaches to deliver services, especially for populations that have been inequitably affected. In Alberta, Canada, two novel approaches were created in Spring 2020 to remotely support patients with complex neurological conditions and rehabilitation needs. The first approach is a telehealth service that provides wayfinding and self-management advice to Albertans with physical concerns related to existing neurological or musculoskeletal conditions or post-COVID-19 recovery needs. The second approach is a webinar series aimed at supporting self-management and social connectedness of individuals living with spinal cord injury. Objective: The study aims to evaluate the short- and long-term impacts and sustainability of two virtual modalities (telehealth initiative called Rehabilitation Advice Line [RAL] and webinar series called Alberta Spinal Cord Injury Community Interactive Learning Seminars [AB-SCILS]) aimed at advancing self-management, connectedness, and rehabilitation needs during the COVID-19 pandemic and beyond. Methods: We will use a mixed-methods evaluation approach. Evaluation of the approaches will include one-on-one semistructured interviews and surveys. The evaluation of the telehealth initiative will include secondary data analyses and analysis of call data using artificial intelligence. The evaluation of the webinar series will include analysis of poll questions collected during the webinars and YouTube analytics data. Results: The proposed study describes unique pandemic virtual modalities and our approaches to evaluating them to ensure effectiveness and sustainability. Implementing and evaluating these virtual modalities synchronously allows for the building of knowledge on the complementarity of these methods. At the time of submission, we have completed qualitative and quantitative data collection for the telehealth evaluation. For the webinar series, so far, we have distributed the evaluation survey following three webinars and have conducted five attendee interviews. Conclusions: Understanding the impact and sustainability of the proposed telehealth modalities is important. The results of the evaluation will provide data that can be actioned and serve to improve other telehealth modalities in the future, since health systems need this information to make decisions on resource allocation, especially in an uncertain pandemic climate. Evaluating the RAL and AB-SCILS to ensure their effectiveness demonstrates that Alberta Health Services and the health system care about ensuring the best practice even after a shift to primarily virtual care. International Registered Report Identifier (IRRID): DERR1-10.2196/28267 UR - https://www.researchprotocols.org/2021/7/e28267 UR - http://dx.doi.org/10.2196/28267 UR - http://www.ncbi.nlm.nih.gov/pubmed/34101610 ID - info:doi/10.2196/28267 ER - TY - JOUR AU - Mundt, P. Adrian AU - Irarrázaval, Matías AU - Martínez, Pablo AU - Fernández, Olga AU - Martínez, Vania AU - Rojas, Graciela PY - 2021/7/22 TI - Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study JO - JMIR Public Health Surveill SP - e25836 VL - 7 IS - 7 KW - telemedicine KW - psychiatry KW - primary health care KW - child protective services N2 - Background: Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities. Objective: The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services. Methods: We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program. Results: During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions. Conclusions: The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation. UR - https://publichealth.jmir.org/2021/7/e25836 UR - http://dx.doi.org/10.2196/25836 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292164 ID - info:doi/10.2196/25836 ER - TY - JOUR AU - Winward, Sam AU - Patel, Tejal AU - Al-Saffar, Mazin AU - Noble, Matthew PY - 2021/7/22 TI - The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis JO - J Med Internet Res SP - e24917 VL - 23 IS - 7 KW - primary health care KW - family practice KW - general practice KW - cost KW - cost analysis KW - telemedicine KW - digital technology KW - digital health KW - digital care KW - virtual care KW - hospital KW - retrospective KW - observational KW - cohort KW - finance KW - economics KW - health services research N2 - Background: Digital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective. Objective: The aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending. Methods: A retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or ?weight? the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20. Results: The NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was £1.6 billion and £1.65 billion (a currency exchange rate of £1=US $1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (£93, P=.047; £223, P<.001; and £389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (£114, P=.006; £246, P<.001; and £362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of £1.37, £4.40 million, and £11.6 million, respectively, in FY18/19; and £3.26 million, £9.54 million, and £18.8 million, respectively, in FY19/20. Conclusions: Patients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs. UR - https://www.jmir.org/2021/7/e24917 UR - http://dx.doi.org/10.2196/24917 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292160 ID - info:doi/10.2196/24917 ER - TY - JOUR AU - Primholdt Christensen, Nina AU - Skou, Emilie Karen AU - Boe Danbjørg, Dorthe PY - 2021/7/21 TI - Health Care Professionals? Experiences With the Use of Video Consultation: Qualitative Study JO - JMIR Form Res SP - e27094 VL - 5 IS - 7 KW - video consultation KW - hematology KW - outpatient clinic KW - telehealth KW - doctor?s perspective N2 - Background: The number of remote video consultations between doctors and patients has increased during the last few years and especially during the COVID-19 pandemic. The health care service is faced with rising rates of chronic illness and many patients who are more confident in self-management of their illnesses. In addition, there is an improved long-term outlook for serious conditions, such as cancer, that might require flexibility in everyday life. Objective: This study aimed to investigate how medical doctors in the outpatient clinic use and experience the use of video consultations with hematological patients, with a focus on relational and organizational aspects. Methods: The study was designed as an explorative and qualitative study. Data were collected via participant observations and focus group interviews with medical doctors. Results: The study identified possibilities and barriers in relation to adapting to the alternative way of meeting patients in the clinical setting. One of the main findings in this study is that the medical doctors were afraid that they missed important observations, as they were not able to perform a physical examination, if needed. They also emphasized that handshake and eye contact were important in order to get an overall impression of the patient?s situation. It also became clear that the medical doctors used body language a lot more during video consultation compared with consultation in a physical setting. The medical doctors found the contact with the patients via the screen to be good, and the fact that the technology was working well made them feel comfortable with the video consultation. Conclusions: In this study, we found that the medical doctors were able to maintain good contact with the patients despite the screen and were able to assess the patients in a satisfying manner. However, there were still uncertainties among some doctors about the fact that they could not examine the patients physically. New knowledge about how to use gestures and body language during video consultation was obtained. UR - https://formative.jmir.org/2021/7/e27094 UR - http://dx.doi.org/10.2196/27094 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287207 ID - info:doi/10.2196/27094 ER - TY - JOUR AU - Mulgund, Pavankumar AU - Sharman, Raj AU - Rifkin, Daniel AU - Marrazzo, Sam PY - 2021/7/19 TI - Design, Development, and Evaluation of a Telemedicine Platform for Patients With Sleep Apnea (Ognomy): Design Science Research Approach JO - JMIR Form Res SP - e26059 VL - 5 IS - 7 KW - design science research KW - telemedicine platform KW - sleep apnea care KW - mHealth KW - telemedicine KW - sleep apnea KW - mobile health KW - web application KW - mobile phone N2 - Background: With an aging population and the escalating cost of care, telemedicine has become a societal imperative. Telemedicine alternatives are especially relevant to patients seeking care for sleep apnea, with its prevalence approaching one billion cases worldwide. Increasing awareness has led to a surge in demand for sleep apnea care; however, there is a shortage of the resources and expertise necessary to cater to the rising demand. Objective: The aim of this study is to design, develop, and evaluate a telemedicine platform, called Ognomy, for the consultation, diagnosis, and treatment of patients with sleep apnea. Methods: Using the design science research methodology, we developed a telemedicine platform for patients with sleep apnea. To explore the problem, in the analysis phase, we conducted two brainstorming workshops and structured interviews with 6 subject matter experts to gather requirements. Following that, we conducted three design and architectural review sessions to define and evaluate the system architecture. Subsequently, we conducted 14 formative usability assessments to improve the user interface of the system. In addition, 3 trained test engineers performed end-to-end system testing to comprehensively evaluate the platform. Results: Patient registration and data collection, physician appointments, video consultation, and patient progress tracking have emerged as critical functional requirements. A telemedicine platform comprising four artifacts?a mobile app for patients, a web app for providers, a dashboard for reporting, and an artificial intelligence?based chatbot for customer onboarding and support?was developed to meet these requirements. Design reviews emphasized the need for a highly cohesive but loosely coupled interaction among the platform?s components, which was achieved through a layered modular architecture using third-party application programming interfaces. In contrast, critical findings from formative usability assessments focused on the need for a more straightforward onboarding process for patients, better status indicators during patient registration, and reorganization of the appointment calendar. Feedback from the design reviews and usability assessments was translated into technical improvements and design enhancements that were implemented in subsequent iterations. Conclusions: Sleep apnea is an underdiagnosed and undertreated condition. However, with increasing awareness, the demand for quality sleep apnea care is likely to surge, and creative alternatives are needed. The results of this study demonstrate the successful application of a framework using a design science research paradigm to design, develop, and evaluate a telemedicine platform for patients with sleep apnea and their providers. UR - https://formative.jmir.org/2021/7/e26059 UR - http://dx.doi.org/10.2196/26059 UR - http://www.ncbi.nlm.nih.gov/pubmed/34279237 ID - info:doi/10.2196/26059 ER - TY - JOUR AU - Cui, Fangfang AU - He, Xianying AU - Zhai, Yunkai AU - Lyu, Minzhao AU - Shi, Jinming AU - Sun, Dongxu AU - Jiang, Shuai AU - Li, Chenchen AU - Zhao, Jie PY - 2021/7/12 TI - Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis JO - J Med Internet Res SP - e28009 VL - 23 IS - 7 KW - telemedicine KW - regional telemedicine service platform KW - remote consultation KW - efficiency KW - satisfaction degree KW - telehealth KW - mobile health KW - mHealth KW - remote KW - China N2 - Background: Telemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field. Objective: Our work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China. Methods: We collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method. Results: The regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness. Conclusions: The development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services. UR - https://www.jmir.org/2021/7/e28009 UR - http://dx.doi.org/10.2196/28009 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255686 ID - info:doi/10.2196/28009 ER - TY - JOUR AU - Shah, K. Megha AU - Gibbs, Christina Ashley AU - Ali, K. Mohammed AU - Narayan, Venkat K. M. AU - Islam, Nadia PY - 2021/7/8 TI - Overcoming the Digital Divide in the Post?COVID-19 ?Reset?: Enhancing Group Virtual Visits with Community Health Workers JO - J Med Internet Res SP - e27682 VL - 23 IS - 7 KW - community health workers KW - COVID-19 KW - diabetes mellitus KW - eHealth KW - elderly KW - health equity KW - telemedicine KW - virtual KW - vulnerable populations UR - https://www.jmir.org/2021/7/e27682 UR - http://dx.doi.org/10.2196/27682 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152995 ID - info:doi/10.2196/27682 ER - TY - JOUR AU - Milne-Ives, Madison AU - Swancutt, Dawn AU - Burns, Lorna AU - Pinkney, Jonathan AU - Tarrant, Mark AU - Calitri, Raff AU - Chatterjee, Arunangsu AU - Meinert, Edward PY - 2021/6/30 TI - The Effectiveness and Usability of Online, Group-Based Interventions for People With Severe Obesity: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e26619 VL - 10 IS - 6 KW - internet-based interventions KW - telemedicine KW - group-based interventions KW - obesity KW - severe obesity KW - obesity management KW - weight loss KW - weight reduction programs KW - diet therapy KW - exercise KW - systematic review KW - weight management N2 - Background: Globally, obesity is a growing crisis. Despite obesity being preventable, over a quarter of the UK adult population is currently considered clinically obese (typically body mass index ?35 kg/m2). Access to treatment for people with severe obesity is limited by long wait times and local availability. Online and group-based interventions provide means of increasing the accessibility of obesity prevention and treatment services. However, there has been no prior review of the effectiveness of group-based interventions delivered online for people with severe obesity. Objective: The purpose of this systematic review protocol is to provide an evaluation of the effectiveness and usability of different types of online, group-based interventions for people with severe obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were used to structure this review. The review will systematically search 7 databases: MEDLINE, Embase, the Cumulative Index of Nursing and Allied Health Literature, APA PsycNet, Web of Science, CENTRAL, and the ProQuest Dissertations and Theses databases. Two authors (MM-I and LB) will independently screen the titles and abstracts of identified articles, select studies for inclusion based on the eligibility criteria, and extract data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer (EM) if necessary. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 tool and a descriptive analysis will be used to evaluate effectiveness and usability. Results: The systematic review has not yet been started. It is expected to be completed and submitted for publication by December 2021. Conclusions: This systematic review will summarize the effectiveness and usability of online, group-based interventions for people with obesity. It will identify the types of online delivery that have the strongest support to help inform the development of more useful and engaging interventions for people with severe obesity. Trial Registration: National Institute for Health Research, PROSPERO CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101 International Registered Report Identifier (IRRID): PRR1-10.2196/26619 UR - https://www.researchprotocols.org/2021/6/e26619 UR - http://dx.doi.org/10.2196/26619 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255710 ID - info:doi/10.2196/26619 ER - TY - JOUR AU - Haun, N. Jolie AU - Paykel, Jacquelyn AU - Melillo, Christine PY - 2021/6/29 TI - Transforming Health and Resiliency Through Integration of Values-based Experiences: Implementation of an Electronic Evidence-based Whole Health Clinical Program JO - JMIR Form Res SP - e26030 VL - 5 IS - 6 KW - virtual care KW - group medical appointment KW - complementary and integrative health KW - veteran KW - implementation N2 - Background: Complementary and integrative health (CIH) is the foundation of the Department of Veterans Affairs (VA) Whole Health System program (WH), including Transforming Health and Resiliency through Integration of Values-based Experiences (THRIVE). The global COVID-19 pandemic prompted an urgent need to provide services such as THRIVE while following guidelines for social distancing. Objective: The objective of this paper was to describe the systematic implementation of THRIVE using an electronic delivery model. Methods: The study involved an observational clinical program implementation project using the RE-AIM framework to contextualize the implementation strategies and results, and then the implementation of an electronically delivered CIH group medical appointment program (eTHRIVE). Results: Clinical staff transitioned to 100% electronic delivery of the THRIVE curriculum using the new eTHRIVE delivery model. The current electronic delivery model, eTHRIVE, has effectively enrolled 10-12 veterans per cohort, with 8 cohorts, totaling 87 veterans to date. eTHRIVE attrition has been 6% (5/87) since initiation. Conclusions: The current climate of the VA WH programmatic initiative combined with the public health needs during a global pandemic prompted the move of THRIVE program into an electronic format to broaden scalability and reach. UR - https://formative.jmir.org/2021/6/e26030 UR - http://dx.doi.org/10.2196/26030 UR - http://www.ncbi.nlm.nih.gov/pubmed/34184996 ID - info:doi/10.2196/26030 ER - TY - JOUR AU - Saigí-Rubió, Francesc AU - Vidal-Alaball, Josep AU - Torrent-Sellens, Joan AU - Jiménez-Zarco, Ana AU - López Segui, Francesc AU - Carrasco Hernandez, Marta AU - Alzaga Reig, Xavier AU - Bonet Simó, Maria Josep AU - Abizanda González, Mercedes AU - Piera-Jimenez, Jordi AU - Solans, Oscar PY - 2021/6/24 TI - Determinants of Catalan Public Primary Care Professionals? Intention to Use Digital Clinical Consultations (eConsulta) in the Post?COVID-19 Context: Mixed Methods Study JO - J Med Internet Res SP - e28944 VL - 23 IS - 6 KW - COVID-19 KW - teleconsultation KW - eConsultation KW - eHealth KW - intention to use KW - digital health KW - Technology Acceptance Model KW - TAM KW - remote consultation KW - telemedicine KW - digital technology KW - intention KW - technology assessment KW - telehealth KW - pandemic KW - digital tool N2 - Background: Telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care during lockdowns due to the COVID-19 pandemic. It has been used to support the health care needs of patients with COVID-19 and routine primary care patients alike. However, this change has not been fully consolidated. Objective: The objective of this study was to analyze the determinants of health care professionals? intention to use the eConsulta digital clinical consultation tool in the post?COVID-19 context. Methods: A literature review of the Technology Acceptance Model allowed us to construct a theoretical model and establish a set of hypotheses on the influence of a variety of different factors relating to health care professionals, as well as the institutions where they work, on their intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data collection instrument. The data were analyzed using univariate and bivariate analysis techniques. To confirm the theoretical model, exploratory factor analysis and binary logistic regression were applied. Results: The most important variables were related to perceived benefits (B=2.408) and the type of use that individuals habitually made of eConsulta (B=0.715). Environmental pressure (B=0.678), experience with technology (B=0.542), gender (B=0.639), and the degree to which eConsulta had been implemented (B=0.266) were other variables influencing the intention to use the tool in the post?COVID-19 context. When replicating the previous analysis according to professional group, experience with technology and gender in the physician group, and experience with tool use and the center where a professional worked in the nurse group, were found to be of considerable importance. Conclusions: The implementation and use of eConsulta had increased significantly as a consequence of the COVID-19 pandemic, and the majority of health care professionals were satisfied with its use in practice and planned to incorporate it into their practices in the post?COVID-19 context. Perceived benefits and environmental pressure were determining factors in their attitude toward and intention to use eConsulta. UR - https://www.jmir.org/2021/6/e28944/ UR - http://dx.doi.org/10.2196/28944 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/28944 ER - TY - JOUR AU - Nguyen, Huy Ngoc AU - Nguyen, Quang An AU - Ha, Bich Van Thi AU - Duong, Xuan Phuong AU - Nguyen, Van Thong PY - 2021/6/22 TI - Using Emerging Telehealth Technology as a Future Model in Vietnam During the COVID-19 Pandemic: Practical Experience From Phutho General Hospital JO - JMIR Form Res SP - e27968 VL - 5 IS - 6 KW - telehealth KW - telemedicine KW - teleconsultation KW - COVID-19 KW - Vietnam KW - digital health KW - pandemic UR - https://formative.jmir.org/2021/6/e27968 UR - http://dx.doi.org/10.2196/27968 UR - http://www.ncbi.nlm.nih.gov/pubmed/34078590 ID - info:doi/10.2196/27968 ER - TY - JOUR AU - Aminoff, Hedvig AU - Meijer, Sebastiaan AU - Arnelo, Urban AU - Groth, Kristina PY - 2021/6/21 TI - Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting JO - JMIR Form Res SP - e26505 VL - 5 IS - 6 KW - telemedicine KW - telementoring KW - implementation context KW - surgical guidance KW - health technology KW - usability KW - work domain analysis KW - cognitive work analysis N2 - Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative ?discovery and modeling? approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment. UR - https://formative.jmir.org/2021/6/e26505 UR - http://dx.doi.org/10.2196/26505 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152278 ID - info:doi/10.2196/26505 ER - TY - JOUR AU - Safaeinili, Nadia AU - Vilendrer, Stacie AU - Williamson, Emma AU - Zhao, Zicheng AU - Brown-Johnson, Cati AU - Asch, M. Steven AU - Shieh, Lisa PY - 2021/6/16 TI - Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study JO - JMIR Form Res SP - e26452 VL - 5 IS - 6 KW - telemedicine KW - inpatient KW - COVID-19 KW - qualitative KW - RE-AIM KW - infection control KW - personal protective equipment KW - implementation science KW - quality improvement N2 - Background: The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective: To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods: Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33%), attending physicians (5/15, 33%), and resident physicians (5/15, 33%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results: All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient?clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions: Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team. UR - https://formative.jmir.org/2021/6/e26452 UR - http://dx.doi.org/10.2196/26452 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033576 ID - info:doi/10.2196/26452 ER - TY - JOUR AU - Melian, Christina AU - Frampton, Christopher AU - Wyatt, Charles Michael AU - Kieser, David PY - 2021/6/15 TI - Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences JO - JMIR Form Res SP - e28140 VL - 5 IS - 6 KW - telemedicine KW - patient satisfaction KW - orthopedic surgery KW - telehealth KW - COVID-19 KW - pandemic N2 - Background: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. Objective: The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures. Methods: This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001). Conclusions: Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic. UR - https://formative.jmir.org/2021/6/e28140 UR - http://dx.doi.org/10.2196/28140 UR - http://www.ncbi.nlm.nih.gov/pubmed/34048355 ID - info:doi/10.2196/28140 ER - TY - JOUR AU - Beresford, Thomas AU - Ronan, J. Patrick AU - Hipp, Daniel PY - 2021/6/14 TI - A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series JO - JMIR Form Res SP - e26417 VL - 5 IS - 6 KW - cognition KW - COVID-19 KW - safety KW - remote use KW - delirium KW - brain injury, brain KW - diagnosis KW - assessment KW - test KW - telehealth KW - telemedicine N2 - Background: Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective: The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods: We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results: The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions: Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus. UR - https://formative.jmir.org/2021/6/e26417 UR - http://dx.doi.org/10.2196/26417 UR - http://www.ncbi.nlm.nih.gov/pubmed/34010137 ID - info:doi/10.2196/26417 ER - TY - JOUR AU - Koppel, D. Paula AU - De Gagne, C. Jennie PY - 2021/6/14 TI - Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study JO - JMIR Res Protoc SP - e27940 VL - 10 IS - 6 KW - nursing KW - oncology ambulatory care KW - provider-patient relationship KW - rapport KW - telehealth KW - videoconferencing visits N2 - Background: Telehealth videoconferencing has largely been embraced by health care providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests that videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships exist across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, and body language to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, evidence regarding the effects of these strategies on rapport and clinical care outcomes is lacking. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. Objective: This study aims to investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. The objectives include exploring how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and similarities and differences identified by patients with cancer and nurses between experiences of rapport in videoconferencing and in-person visits. Methods: Semistructured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate an understanding of the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, although not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, and the team will maintain a detailed audit trail of analytical decisions. In addition, member checking will enhance the rigor of the study. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side by side in the final analysis to provide a comparative analysis. Data management and analysis will be performed using NVivo 12. Results: Data collection will begin during summer 2021, with results from the data analysis anticipated by winter 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. Conclusions: This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted in videoconferencing telehealth visits, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits. International Registered Report Identifier (IRRID): PRR1-10.2196/27940 UR - https://www.researchprotocols.org/2021/6/e27940 UR - http://dx.doi.org/10.2196/27940 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125073 ID - info:doi/10.2196/27940 ER - TY - JOUR AU - Matthewman, Spencer AU - Spencer, Sarah AU - Lavergne, Ruth M. AU - McCracken, K. Rita AU - Hedden, Lindsay PY - 2021/6/11 TI - An Environmental Scan of Virtual ?Walk-In? Clinics in Canada: Comparative Study JO - J Med Internet Res SP - e27259 VL - 23 IS - 6 KW - virtual care KW - primary care KW - Canada KW - virtual health KW - patients KW - physicians N2 - Background: Canada has been slow to implement virtual care relative to other countries. However, in recent years, the availability of on-demand, ?walk-in? virtual clinics has increased, with the COVID-19 pandemic contributing to the increased demand and provision of virtual care nationwide. Although virtual care facilitates access to physicians while maintaining physical distancing, there are concerns regarding the continuity and quality of care as well as equitable access. There is a paucity of research documenting the availability of virtual care in Canada, thus hampering the efforts to evaluate the impacts of its relatively rapid emergence on the broader health care system and on individual health. Objective: We conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics, cataloging the services they offer and whether they are operating through public or private payment. Methods: We developed a power term and implemented a structured Google search to identify relevant clinics. From each clinic meeting our inclusion criteria, we abstracted data on the payment model, region of operation, services offered, and continuity of care. We compared clinics operating under different payment models using Fisher exact tests. Results: We identified 18 virtual walk-in clinics. Of the 18 clinics, 10 (56%) provided some services under provincial public insurance, although 44% (8/18) operated on a fully private payment model while an additional 39% (7/18) charged patients out of pocket for some services. The most common supplemental services offered included dermatology (15/18, 83%), mental health services (14/18, 78%), and sexual health (11/18, 61%). Continuity, information sharing, or communication with the consumers? existing primary care providers were mentioned by 22% (4/18) of the clinics. Conclusions: Virtual walk-in clinics have proliferated; however, concerns about equitable access, continuity of care, and diversion of physician workforce within these models highlight the importance of supporting virtual care options within the context of longitudinal primary care. More research is needed to support quality virtual care and understand its effects on patient and provider experiences and the overall health system utilization and costs. UR - https://www.jmir.org/2021/6/e27259 UR - http://dx.doi.org/10.2196/27259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114963 ID - info:doi/10.2196/27259 ER - TY - JOUR AU - Trettin, Bettina AU - Danbjørg, Boe Dorthe AU - Andersen, Flemming AU - Feldman, Steven AU - Agerskov, Hanne PY - 2021/6/8 TI - An mHealth App to Support Patients With Psoriasis in Relation to Follow-up Consultations: Qualitative Study JO - JMIR Dermatol SP - e28882 VL - 4 IS - 1 KW - psoriasis KW - teledermatology KW - qualitative KW - video consultations KW - app KW - participatory design KW - mHealth KW - telehealth KW - patient-physician relationship KW - dermatology N2 - Background: Teledermatology has the potential to help deliver health care by transforming the relationship between patients and health care professionals (HCPs), shifting the power of consultation so that patients can become more informed, assertive, and involved in their care. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis on systemic treatment. In an attempt to facilitate a more patient-centered approach in clinical practice, we designed and developed an mHealth solution to support patients with self-management and empowerment. Objective: The aim of this study is to explore the experiences and perceptions of patients and health care professionals of using an mHealth solution that was developed using a participatory design approach. Methods: This was an exploratory qualitative study. Data were collected through semistructured interviews with patients and focus group interviews with HCPs. Results: All participants found it easy to use the mHealth solution, and the patients found it convenient. Patients? reflexivity was improved because they could prepare ahead of consultations. Video consultations provided patients with a degree of freedom in their everyday lives, with not having to attend in-person visits. Among the HCPs, there were concerns regarding their medical responsibilities, as they could not assess the patients? skin as they used to. The mHealth solution required new workflows and procedures that were not part of the existing consultation routines. Conclusions: The mHealth solution can strengthen the relationship between HCPs and patients and facilitate patients to become more active in their care. Alignment and structure in relation to the selection of eligible patient candidates for being offered the mHealth solution could reduce social health inequalities. In addition, video consultations changed HCPs? work practice, necessitating new types of skills to communicate with patients. UR - https://derma.jmir.org/2021/1/e28882 UR - http://dx.doi.org/10.2196/28882 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632803 ID - info:doi/10.2196/28882 ER - TY - JOUR AU - Chen, Qin AU - Jin, Jiahua AU - Zhang, Tingting AU - Yan, Xiangbin PY - 2021/6/3 TI - The Effects of Log-in Behaviors and Web Reviews on Patient Consultation in Online Health Communities: Longitudinal Study JO - J Med Internet Res SP - e25367 VL - 23 IS - 6 KW - online health communities KW - digital health KW - patient consultation KW - log-in behavior KW - web reviews KW - offline status N2 - Background: With the rapid development of information technology and web-based communities, a growing number of patients choose to consult physicians in online health communities (OHCs) for information and treatment. Although extant research has primarily discussed factors that influence the consulting choices of OHC patients, there is still a lack of research on the effects of log-in behaviors and web reviews on patient consultation. Objective: This study aims to explore the impact of physicians? log-in behavior and web reviews on patient consultation. Methods: We conducted a longitudinal study to examine the effects of physicians? log-in behaviors and web reviews on patient consultation by analyzing short-panel data from 911 physicians over five periods in a Chinese OHC. Results: The results showed that the physician?s log-in behavior had a positive effect on patient consultation. The maximum number of days with no log-ins for a physician should be 20. The two web signals (log-in behavior and web reviews) had no complementary relationship. Moreover, the offline signal (ie, offline status) has different moderating effects on the two web signals, positively moderating the relationship between web reviews and patient consultation. Conclusions: Our study contributes to the eHealth literature and advances the understanding of physicians? web-based behaviors. This study also provides practical implications, showing that physicians? log-in behavior alone can affect patient consultation rather than complementing web reviews. UR - https://www.jmir.org/2021/6/e25367 UR - http://dx.doi.org/10.2196/25367 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081008 ID - info:doi/10.2196/25367 ER - TY - JOUR AU - Alhajri, Noora AU - Simsekler, Emre Mecit Can AU - Alfalasi, Buthaina AU - Alhashmi, Mohamed AU - AlGhatrif, Majd AU - Balalaa, Nahed AU - Al Ali, Maryam AU - Almaashari, Raghda AU - Al Memari, Shammah AU - Al Hosani, Farida AU - Al Zaabi, Yousif AU - Almazroui, Shereena AU - Alhashemi, Hamed AU - Baltatu, C. Ovidiu PY - 2021/6/1 TI - Physicians? Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Med Inform SP - e29251 VL - 9 IS - 6 KW - audio consultation KW - clinical decision-making KW - clinical training KW - communication KW - COVID-19 KW - outpatient department KW - perception KW - telemedicine KW - United Arab Emirates KW - video consultation N2 - Background: To mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic. Objective: This study aimed to evaluate whether differences exist in physicians? attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic. Methods: This survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician?s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians? sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians? characteristics with the perceived outcomes of the web-based consultation. Results: Compared to audio consultations, video consultations were significantly associated with physicians? confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians? confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008). Conclusions: These results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services. UR - https://medinform.jmir.org/2021/6/e29251 UR - http://dx.doi.org/10.2196/29251 UR - http://www.ncbi.nlm.nih.gov/pubmed/34001497 ID - info:doi/10.2196/29251 ER - TY - JOUR AU - Liu, Jialin AU - Liu, Siru AU - Zheng, Tao AU - Bi, Yongdong PY - 2021/6/1 TI - Physicians? Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study JO - JMIR Med Inform SP - e26463 VL - 9 IS - 6 KW - telemedicine KW - COVID-19 KW - survey KW - physician N2 - Background: Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non?COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. Objective: The purpose of this study was to understand physicians? attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. Methods: We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. Results: Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents? hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (?1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. Conclusions: Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome. UR - https://medinform.jmir.org/2021/6/e26463 UR - http://dx.doi.org/10.2196/26463 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945493 ID - info:doi/10.2196/26463 ER - TY - JOUR AU - Juarascio, Adrienne AU - Srivastava, Paakhi AU - Presseller, Emily AU - Clark, Kelsey AU - Manasse, Stephanie AU - Forman, Evan PY - 2021/5/31 TI - A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study JO - JMIR Form Res SP - e18261 VL - 5 IS - 5 KW - eating disorders KW - telemedicine KW - mobile phone KW - smartphone KW - technology KW - cognitive behavioral therapy N2 - Background: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. Objective: In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. Methods: A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. Results: Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. Conclusions: CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed. UR - https://formative.jmir.org/2021/5/e18261 UR - http://dx.doi.org/10.2196/18261 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057416 ID - info:doi/10.2196/18261 ER - TY - JOUR AU - Solans, Oscar AU - Vidal-Alaball, Josep AU - Roig Cabo, Pasqual AU - Mora, Núria AU - Coma, Ermengol AU - Bonet Simó, Maria Josep AU - Hermosilla Pérez, Eduardo AU - Saigí-Rubió, Francesc AU - Olmos Domínguez, Carmen AU - Piera-Jiménez, Jordi AU - Abizanda González, Mercè AU - López Seguí, Francesc PY - 2021/5/27 TI - Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study JO - J Med Internet Res SP - e28629 VL - 23 IS - 5 KW - teleconsultation KW - primary care KW - remote consultation KW - telehealth KW - COVID-19 KW - e-consultation N2 - Background: eConsulta?that is, asynchronous, two-way teleconsultation in primary care?is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective: This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods: A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results: During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions: The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity. UR - https://www.jmir.org/2021/5/e28629 UR - http://dx.doi.org/10.2196/28629 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970867 ID - info:doi/10.2196/28629 ER - TY - JOUR AU - Fonner, A. Virginia AU - Kennedy, Samuel AU - Desai, Rohan AU - Eichberg, Christie AU - Martin, Lisa AU - Meissner, G. Eric PY - 2021/5/27 TI - Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study JO - JMIR Form Res SP - e22513 VL - 5 IS - 5 KW - HIV KW - mHealth KW - text messaging KW - video calling KW - implementation science KW - mobile phone N2 - Background: Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective: The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods: We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results: Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions: Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients? needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health?based communication, especially as implementation requires active participation from providers and patients. UR - https://formative.jmir.org/2021/5/e22513 UR - http://dx.doi.org/10.2196/22513 UR - http://www.ncbi.nlm.nih.gov/pubmed/34042596 ID - info:doi/10.2196/22513 ER - TY - JOUR AU - Ali, Zarqa AU - Joergensen, Melbardis Kristina AU - Andersen, Daniel Anders AU - Chiriac, Andrei AU - Bjerre-Christensen, Theis AU - Manole, Ionela AU - Dutei, Ana-Maria AU - Deaconescu, Irina AU - Suru, Alina AU - Serban, Adina AU - Isberg, Pall Ari AU - Dahiya, Priyanka AU - Thomsen, Francis Simon AU - Zibert, Robert John PY - 2021/5/25 TI - Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: Proof-of-Concept and Reliability Evaluation JO - JMIR Form Res SP - e24766 VL - 5 IS - 5 KW - atopic dermatitis KW - eczema KW - remote assessment KW - photo KW - photographs KW - EASI KW - SCORAD KW - severity KW - assessment KW - agreement N2 - Background: Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground. Objective: We aimed to investigate whether photographs taken by a smartphone are of adequate quality to allow severity assessments to be made and to explore the usefulness of an established atopic dermatitis severity assessment instrument on photograph evaluation. Methods: During scheduled visits in a previously published study, the investigating doctor evaluated the severity of atopic dermatitis using the Scoring AD (SCORAD) index and took photographs of the most representative lesions (target lesions) with both a smartphone and a digital single-lens reflex camera (DSLR). The photographs were then assessed by 5 dermatologists using the intensity items of the SCORAD (iSCORAD), which consists of erythema, oedema/papulation, excoriations, lichenification, oozing/crusts, and dryness (scale 0-3, maximum score 18). The mean iSCORAD of the photographs was calculated and compared with in-person assessments using Pearson correlation and Bland-Altman plots. Intraclass correlation coefficients were used for interrater reliability. Results: A total of 942 photographs from 95 patients were assessed. The iSCORAD based on smartphone photographs correlated strongly with the evaluations performed in person (iSCORAD: r=0.78, P<.001; objective SCORAD: r=0.81, P<.001; and total SCORAD: r=0.78, P<.001). For iSCORAD specifically, a Bland-Altman plot showed a difference in mean score of 1.31 for in-person and remote iSCORAD. In addition, the interrater agreement between the 5 rating dermatologists was 0.93 (95% CI 0.911-0.939). A total of 170 lesions were photographed, and the difference in mean scores was 1.32, 1.13, and 1.43 between in-person and remote evaluations based on photographs taken by a DSLR camera, a smartphone without flash, and a smartphone with flash, respectively. Conclusions: In terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low. UR - https://formative.jmir.org/2021/5/e24766 UR - http://dx.doi.org/10.2196/24766 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032580 ID - info:doi/10.2196/24766 ER - TY - JOUR AU - Brown, I. Nashira AU - Powell, Anne Mary AU - Baskin, Monica AU - Oster, Robert AU - Demark-Wahnefried, Wendy AU - Hardy, Claudia AU - Pisu, Maria AU - Thirumalai, Mohanraj AU - Townsend, Sh'Nese AU - Neal, N. Whitney AU - Rogers, Q. Laura AU - Pekmezi, Dori PY - 2021/5/25 TI - Design and Rationale for the Deep South Interactive Voice Response System?Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e29245 VL - 10 IS - 5 KW - exercise KW - health disparities KW - interactive voice response system KW - physical activity KW - rural health KW - telehealth N2 - Background: The rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region?s lower rates of literacy and internet access, interactive voice response (IVR) system?automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System?Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties. Objective: This paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System?Supported Active Lifestyle intervention. Methods: A two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System?Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity?related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O?Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts. Results: This study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County. Conclusions: IVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region. Trial Registration: ClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874. International Registered Report Identifier (IRRID): DERR1-10.2196/29245 UR - https://www.researchprotocols.org/2021/5/e29245 UR - http://dx.doi.org/10.2196/29245 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032575 ID - info:doi/10.2196/29245 ER - TY - JOUR AU - Steindal, A. Simen AU - Nes, Goncalves Andréa Aparecida AU - Godskesen, E. Tove AU - Lind, Susanne AU - Dhle, Alfhild AU - Winger, Anette AU - Österlind, Jane AU - Pettersen, Solvang Fredrik AU - Holmen, Heidi AU - Klarare, Anna PY - 2021/5/21 TI - Advantages and Challenges in Using Telehealth for Home-Based Palliative Care: Protocol for a Systematic Mixed Studies Review JO - JMIR Res Protoc SP - e22626 VL - 10 IS - 5 KW - eHealth KW - health care technology KW - home-based KW - palliative care KW - review KW - systematic mixed studies review KW - telemedicine N2 - Background: Given the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients? experiences of the advantages and challenges of telehealth for home-based palliative care. Objective: The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients? use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. Methods: This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data, and assess methodological quality. The data will then be analyzed using thematic synthesis. Results: We describe the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. Conclusions: Following the ethos of patient-centered palliative care, this systematic mixed studies review could lead to recommendations for practice and policy, enabling the development and implementation of telehealth applications and services that align with patients? preferences and needs at home. International Registered Report Identifier (IRRID): PRR1-10.2196/22626 UR - https://www.researchprotocols.org/2021/5/e22626 UR - http://dx.doi.org/10.2196/22626 UR - http://www.ncbi.nlm.nih.gov/pubmed/34018964 ID - info:doi/10.2196/22626 ER - TY - JOUR AU - Montazeri, Maryam AU - Multmeier, Jan AU - Novorol, Claire AU - Upadhyay, Shubhanan AU - Wicks, Paul AU - Gilbert, Stephen PY - 2021/5/21 TI - Optimization of Patient Flow in Urgent Care Centers Using a Digital Tool for Recording Patient Symptoms and History: Simulation Study JO - JMIR Form Res SP - e26402 VL - 5 IS - 5 KW - symptom assessment app KW - discrete event simulation KW - health care system KW - patient flow modeling KW - patient flow KW - simulation KW - urgent care KW - waiting times N2 - Background: Crowding can negatively affect patient and staff experience, and consequently the performance of health care facilities. Crowding can potentially be eased through streamlining and the reduction of duplication in patient history-taking through the use of a digital symptom-taking app. Objective: We simulated the introduction of a digital symptom-taking app on patient flow. We hypothesized that waiting times and crowding in an urgent care center (UCC) could be reduced, and that this would be more efficient than simply adding more staff. Methods: A discrete-event approach was used to simulate patient flow in a UCC during a 4-hour time frame. The baseline scenario was a small UCC with 2 triage nurses, 2 doctors, 1 treatment/examination nurse, and 1 discharge administrator in service. We simulated 33 scenarios with different staff numbers or different potential time savings through the app. We explored average queue length, waiting time, idle time, and staff utilization for each scenario. Results: Discrete-event simulation showed that even a few minutes saved through patient app-based self-history recording during triage could result in significantly increased efficiency. A modest estimated time saving per patient of 2.5 minutes decreased the average patient wait time for triage by 26.17%, whereas a time saving of 5 minutes led to a 54.88% reduction in patient wait times. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times. Conclusions: Small time savings in the history-taking process have potential to result in substantial reductions in total patient waiting time for triage nurses, with likely effects of reduced patient anxiety, staff anxiety, and improved patient care. Patient self-history recording could be carried out at home or in the waiting room via a check-in kiosk or a portable tablet computer. This formative simulation study has potential to impact service provision and approaches to digitalization at scale. UR - https://formative.jmir.org/2021/5/e26402 UR - http://dx.doi.org/10.2196/26402 UR - http://www.ncbi.nlm.nih.gov/pubmed/34018963 ID - info:doi/10.2196/26402 ER - TY - JOUR AU - Halabi, Reem AU - Smith, Geoffrey AU - Sylwestrzak, Marc AU - Clay, Brian AU - Longhurst, A. Christopher AU - Lander, Lina PY - 2021/5/19 TI - The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study JO - J Med Internet Res SP - e28845 VL - 23 IS - 5 KW - inpatient telemedicine KW - bedside iPad KW - video visits KW - personal protective equipment KW - COVID-19 KW - virtual visits KW - pandemic KW - telehealth KW - telemedicine KW - digital health UR - https://www.jmir.org/2021/5/e28845 UR - http://dx.doi.org/10.2196/28845 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945494 ID - info:doi/10.2196/28845 ER - TY - JOUR AU - Tian, Min AU - Wang, Bo AU - Xue, Zhao AU - Dong, Dinghui AU - Liu, Xuemin AU - Wu, Rongqian AU - Yu, Liang AU - Xiang, Junxi AU - Zhang, Xiaogang AU - Zhang, Xufeng AU - Lv, Yi PY - 2021/5/17 TI - Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study JO - JMIR Med Inform SP - e27175 VL - 9 IS - 5 KW - liver transplantation KW - optimal clinical outcomes KW - telemedicine KW - telemedical follow-up management system KW - telerobotics KW - rapid recovery KW - health-related quality of life KW - remote health monitoring KW - telehealth KW - cohort KW - mortality KW - morbidity N2 - Background: Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. Objective: We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. Methods: To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. Results: No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age (P=.17), the model for end-stage liver disease score (MELD, P=.14), operation time (P=.51), blood loss (P=.07), and transfusion volume (P=.13). The length and expenses of the initial hospitalization (P=.03 and P=.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ?30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group (P=.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% (P=.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups (P=.50). Conclusions: Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post?liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients? health-related quality of life and facilitates achieving optimal clinical outcomes in post?liver transplantation. UR - https://medinform.jmir.org/2021/5/e27175 UR - http://dx.doi.org/10.2196/27175 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999008 ID - info:doi/10.2196/27175 ER - TY - JOUR AU - Wang, Zheyu AU - An, Jiye AU - Lin, Hui AU - Zhou, Jiaqiang AU - Liu, Fang AU - Chen, Juan AU - Duan, Huilong AU - Deng, Ning PY - 2021/5/17 TI - Pathway-Driven Coordinated Telehealth System for Management of Patients With Single or Multiple Chronic Diseases in China: System Development and Retrospective Study JO - JMIR Med Inform SP - e27228 VL - 9 IS - 5 KW - chronic disease KW - telehealth system KW - integrated care KW - pathway KW - ontology N2 - Background: Integrated care enhanced with information technology has emerged as a means to transform health services to meet the long-term care needs of patients with chronic diseases. However, the feasibility of applying integrated care to the emerging ?three-manager? mode in China remains to be explored. Moreover, few studies have attempted to integrate multiple types of chronic diseases into a single system. Objective: The aim of this study was to develop a coordinated telehealth system that addresses the existing challenges of the ?three-manager? mode in China while supporting the management of single or multiple chronic diseases. Methods: The system was designed based on a tailored integrated care model. The model was constructed at the individual scale, mainly focusing on specifying the involved roles and responsibilities through a universal care pathway. A custom ontology was developed to represent the knowledge contained in the model. The system consists of a service engine for data storage and decision support, as well as different forms of clients for care providers and patients. Currently, the system supports management of three single chronic diseases (hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease) and one type of multiple chronic conditions (hypertension with type 2 diabetes mellitus). A retrospective study was performed based on the long-term observational data extracted from the database to evaluate system usability, treatment effect, and quality of care. Results: The retrospective analysis involved 6964 patients with chronic diseases and 249 care providers who have registered in our system since its deployment in 2015. A total of 519,598 self-monitoring records have been submitted by the patients. The engine could generate different types of records regularly based on the specific care pathway. Results of the comparison tests and causal inference showed that a part of patient outcomes improved after receiving management through the system, especially the systolic blood pressure of patients with hypertension (P<.001 in all comparison tests and an approximately 5 mmHg decrease after intervention via causal inference). A regional case study showed that the work efficiency of care providers differed among individuals. Conclusions: Our system has potential to provide effective management support for single or multiple chronic conditions simultaneously. The tailored closed-loop care pathway was feasible and effective under the ?three-manager? mode in China. One direction for future work is to introduce advanced artificial intelligence techniques to construct a more personalized care pathway. UR - https://medinform.jmir.org/2021/5/e27228 UR - http://dx.doi.org/10.2196/27228 UR - http://www.ncbi.nlm.nih.gov/pubmed/33998999 ID - info:doi/10.2196/27228 ER - TY - JOUR AU - Bristowe, Kristina Sean AU - Ghosh, Monty Sumantra AU - Trew, Michael AU - AU - Rittenbach, Katherine PY - 2021/5/12 TI - Virtual Overdose Response for People Who Use Opioids Alone: Protocol for a Feasibility and Clinical Trial Study JO - JMIR Res Protoc SP - e20183 VL - 10 IS - 5 KW - harm reduction KW - opioid crisis KW - overdose response KW - people with lived experience KW - peers N2 - Background: A recent quarterly report released by Alberta Health reports that on average 2.5 Albertans die every day from accidental overdose deaths, and that between April 1, 2020, and June 30, 2020, the province lost a total of 301 people. In Canada, between January 2016 and March 2020, a total of 16,364 people died due to opioid-related overdose. The World Health Organization reports that 70% of the 0.5 million deaths worldwide caused by drugs are related to opioid overdose. Although supervised consumption sites or safe injection sites have been shown to be effective in reducing the harms associated with the use of illicit substances and increasing uptake of addiction treatment and other health services, there is still significant stigma associated with them, and it is unlikely that all of the people who would benefit from supervised consumption service will ever access a site. Objective: To help prevent deaths in populations that cannot or will not access physical safer consumption services in Alberta, we propose to provide virtual (telephone-based) overdose response services, staffed by people with lived experience.The primary outcome for this study is uptake of the service as measured by the number of calls to the service. Secondary outcomes will include patterns of use of the phone line (days of the week and time of calls) and outcomes from the calls (number of emergency medical services dispatches for overdoses from the service and the results of those dispatches). Methods: This phase 1 clinical study is set to officially launch in early May 2020. The service will be available to up to 15 participants who self-disclose as using opioids unobserved and have given informed consent for both data collection and interviews. This group will have access to a toll-free telephone number and be invited to call when they plan to use opioids alone. Results: The analysis will include mixed methods. To improve the design of the service and ensure safety of all involved, quantitative data will be collected on phone calls and participant health care usage, while qualitative data will be collected from both participants and virtual overdose response operators Conclusions: This clinical trial aims to test the feasibility of a service that provides virtual overdose response in order to help prevent deaths in populations that cannot or will not access physical supervised consumption services in Alberta. Trial Registration: ClinicalTrials.gov NCT04391192; https://www.clinicaltrials.gov/ct2/show/NCT04391192 International Registered Report Identifier (IRRID): DERR1-10.2196/20183 UR - https://www.researchprotocols.org/2021/5/e20183 UR - http://dx.doi.org/10.2196/20183 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978598 ID - info:doi/10.2196/20183 ER - TY - JOUR AU - Kooij, Laura AU - Vos, JE Petra AU - Dijkstra, Antoon AU - Roovers, A. Elisabeth AU - van Harten, H. Wim PY - 2021/5/11 TI - Video Consultation as an Adequate Alternative to Face-to-Face Consultation in Continuous Positive Airway Pressure Use for Newly Diagnosed Patients With Obstructive Sleep Apnea: Randomized Controlled Trial JO - JMIR Form Res SP - e20779 VL - 5 IS - 5 KW - video consultation KW - eHealth KW - obstructive sleep apnea KW - continuous positive airway pressure KW - randomized controlled trial N2 - Background: The effectiveness of continuous positive airway pressure (CPAP) is dependent on the degree of use, so adherence is essential. Cognitive components (eg, self-efficacy) and support during treatment have been found to be important in CPAP use. Video consultation may be useful to support patients during treatment. So far, video consultation has rarely been evaluated in thorough controlled research, with only a limited number of outcomes assessed. Objective: The aim of the study was to evaluate the superiority of video consultation over face-to-face consultation for patients with obstructive sleep apnea (OSA) on CPAP use (minutes per night), adherence, self-efficacy, risk outcomes, outcome expectancies, expectations and experiences with video consultation, and satisfaction of patients and nurses. Methods: A randomized controlled trial was conducted with an intervention (video consultation) and a usual care group (face-to-face consultation). Patients with confirmed OSA (apnea-hypopnea index >15), requiring CPAP treatment, no history of CPAP treatment, having access to a tablet or smartphone, and proficient in the Dutch language were recruited from a large teaching hospital. CPAP use was monitored remotely, with short-term (weeks 1 to 4) and long-term (week 4, week 12, and week 24) assessments. Questionnaires were completed at baseline and after 4 weeks on self-efficacy, risk perception, outcome expectancies (Self-Efficacy Measure for Sleep Apnea), expectations and experiences with video consultation (covering constructs of the unified theory of acceptance and use of technology), and satisfaction. Nurse satisfaction was evaluated using questionnaires. Results: A total of 140 patients were randomized (1:1 allocation). The use of video consultation for OSA patients does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. A significant difference in change over time was found between groups for short-term (P-interaction=.008) but not long-term (P-interaction=.68) CPAP use. CPAP use decreased in the long term (P=.008), but no significant difference was found between groups (P=.09). Change over time for adherence was not significantly different in the short term (P-interaction=.17) or long term (P-interaction=.51). A relation was found between CPAP use and self-efficacy (P=.001), regardless of the intervention arm (P=.25). No significant difference between groups was found for outcome expectancies (P=.64), self-efficacy (P=.41), and risk perception (P=.30). The experiences were positive, and 95% (60/63) intended to keep using video consultation. Patients in both groups rated the consultations on average with an 8.4. Overall, nurses (n=3) were satisfied with the video consultation system. Conclusions: Support of OSA patients with video consultation does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. The findings of this research suggest that self-efficacy is an important factor in improving CPAP use and that video consultation may be a feasible way to support patients starting CPAP. Future research should focus on blended care approaches in which self-efficacy receives greater emphasis. Trial Registration: Clinicaltrials.gov NCT04563169; https://clinicaltrials.gov/show/NCT04563169 UR - https://formative.jmir.org/2021/5/e20779 UR - http://dx.doi.org/10.2196/20779 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973866 ID - info:doi/10.2196/20779 ER - TY - JOUR AU - Nguyen, T. Oliver AU - Alishahi Tabriz, Amir AU - Huo, Jinhai AU - Hanna, Karim AU - Shea, M. Christopher AU - Turner, Kea PY - 2021/5/5 TI - Impact of Asynchronous Electronic Communication?Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review JO - J Med Internet Res SP - e27531 VL - 23 IS - 5 KW - telemedicine KW - telehealth KW - e-visits KW - electronic visits KW - digital care KW - outcome KW - delivery KW - review KW - access KW - utilization KW - cost KW - patient portal KW - eHealth N2 - Background: Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. Objective: To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. Methods: We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits? impacts on clinical and health care delivery outcomes. Results: Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. Conclusions: Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits. UR - https://www.jmir.org/2021/5/e27531 UR - http://dx.doi.org/10.2196/27531 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843592 ID - info:doi/10.2196/27531 ER - TY - JOUR AU - Haque, Naim Saira AU - DeStefano, Sydney AU - Banger, Alison AU - Rutledge, Regina AU - Romaire, Melissa PY - 2021/5/5 TI - Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study JO - JMIR Form Res SP - e24118 VL - 5 IS - 5 KW - telehealth KW - rural health KW - health IT KW - telemedicine KW - virtual care N2 - Background: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. Objective: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Methods: This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services?funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Results: Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Conclusions: Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing. UR - https://formative.jmir.org/2021/5/e24118 UR - http://dx.doi.org/10.2196/24118 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949958 ID - info:doi/10.2196/24118 ER - TY - JOUR AU - Mahoney, Christopher Martin AU - Park, Eunhee AU - Schlienz, J. Nicolas AU - Duerr, CeCe AU - Hawk, W. Larry PY - 2021/4/30 TI - Transitioning to Remote Clinic Visits in a Smoking Cessation Trial During the COVID-19 Pandemic: Mixed Methods Evaluation JO - JMIR Form Res SP - e25541 VL - 5 IS - 4 KW - smoking KW - cessation KW - clinical trial KW - telehealth KW - COVID-19 KW - coronavirus KW - telemedicine KW - conferencing KW - mixed methods KW - experience KW - patient N2 - Background: The pandemic of SARS-CoV-2, which causes COVID-19, has caused disruptions in ongoing clinical trials and is expected to accelerate interest in conducting research studies remotely. Objective: A quasi-experimental, mixed methods approach was used to examine the rates of visit completion as well as the opinions and experiences of participants enrolled in an ongoing clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or telephone conferencing due to the COVID-19 pandemic. Methods: For quantitative comparisons, we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, COVID-19 cohort) to a comparable cohort of participants followed over a similar time period in the calendar years 2018 and 2019 (n=51, pre?COVID-19 cohort) to examine the rates of completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from in-person to remote visits. Results: Participants in the COVID-19 cohort completed an average of 83.6% of remote clinic visits (95% CI 73.1%-91.2%), which was not significantly different than the in-person completion rate of 89.8% in the pre?COVID-19 cohort. Participants in the COVID-19 cohort returned an average of 93.2% (95% CI 83.5%-98.1%) of saliva specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100% in the pre?COVID-19 cohort. Two broad themes emerged from the qualitative data: (1) the benefits of remote visits and (2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most participants expressed a willingness to engage in remote visits in the future. Conclusions: Even in the context of a rapid transition from in-person to remote visits necessitated by the COVID-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes may impact study outcomes. Trial Registration: ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/study/NCT03262662 UR - https://formative.jmir.org/2021/4/e25541 UR - http://dx.doi.org/10.2196/25541 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878020 ID - info:doi/10.2196/25541 ER - TY - JOUR AU - Legler, Sean AU - Diehl, Matthew AU - Hilliard, Brian AU - Olson, Andrew AU - Markowitz, Rebecca AU - Tignanelli, Christopher AU - Melton, B. Genevieve AU - Broccard, Alain AU - Kirsch, Jonathan AU - Usher, Michael PY - 2021/4/29 TI - Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study JO - J Med Internet Res SP - e25987 VL - 23 IS - 4 KW - telemedicine KW - hospital medicine KW - COVID-19 KW - telehealth KW - hospital KW - mixed methods KW - evaluation KW - impact KW - exposure KW - risk KW - communication N2 - Background: The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective: The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods: We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results: Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions: In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction. UR - https://www.jmir.org/2021/4/e25987 UR - http://dx.doi.org/10.2196/25987 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872187 ID - info:doi/10.2196/25987 ER - TY - JOUR AU - Vranceanu, Ana-Maria AU - Bakhshaie, Jafar AU - Reichman, Mira AU - Doorley, James AU - Elwy, Rani A. AU - Jacobs, Cale AU - Chen, Neal AU - Esposito, John AU - Laverty, David AU - Matuszewski, E. Paul AU - Fatehi, Amirreza AU - Bowers, C. Lucy AU - Harris, Mitchel AU - Ring, David PY - 2021/4/28 TI - A Live Video Program to Prevent Chronic Pain and Disability in At-Risk Adults With Acute Orthopedic Injuries (Toolkit for Optimal Recovery): Protocol for a Multisite Feasibility Study JO - JMIR Res Protoc SP - e28155 VL - 10 IS - 4 KW - orthopedic KW - musculoskeletal KW - prevention KW - chronic pain KW - disability KW - intervention KW - video KW - telehealth KW - mobile phone N2 - Background: Despite the pivotal role of psychosocial factors in pain and disability after orthopedic injury, there are no evidence-based preventive interventions targeting psychosocial factors in patients with acute orthopedic injuries. We developed the first mind-body intervention focused on optimizing recovery and improving pain and disability in patients with acute orthopedic injuries who exhibit high levels of catastrophic thinking about pain and/or pain anxiety (Toolkit for Optimal Recovery [TOR] after orthopedic injury). In a pilot single-site randomized controlled trial (RCT), the TOR met a priori set benchmarks for feasibility, acceptability, and satisfaction. The next step in developing TOR is to conduct a multisite feasibility RCT to set the stage for a scientifically rigorous hybrid efficacy-effectiveness trial. Objective: The objective of this study is to conduct a rigorous multisite feasibility RCT of TOR to determine whether the intervention and study methodology meet a priori set benchmarks necessary for the successful implementation of a future multisite hybrid efficacy-effectiveness trial. In this paper, we describe the study design, manualized treatments, and specific strategies used to conduct this multisite feasibility RCT investigation. Methods: This study will be conducted at 3 geographically diverse level 1 trauma centers, anonymized as sites A, B, and C. We will conduct a multisite feasibility RCT of TOR versus the minimally enhanced usual care (MEUC) control (60 patients per site; 30 per arm) targeting a priori set feasibility benchmarks. Adult patients with acute orthopedic injuries who endorse high pain catastrophizing or pain anxiety will be recruited approximately 1-2 months after injury or surgery (baseline). Participants randomized to the TOR will receive a 4-session mind-body treatment delivered via a secure live video by trained clinical psychologists. Participants randomized to the MEUC will receive an educational booklet. Primary outcomes include feasibility of recruitment, appropriateness, feasibility of data collection, acceptability of TOR (adherence to sessions), and treatment satisfaction across all sites. We will also collect data on secondary implementation outcomes, as well as pain severity, physical and emotional function, coping skills, and adverse events. Outcomes will be assessed at baseline, posttreatment, and at the 3-month follow-up. Results: Enrollment for the RCT is estimated to begin in June 2021. The target date of completion of the feasibility RCT is April 2024. The institutional review board approval has been obtained (January 2020). Conclusions: This investigation examines the multisite feasibility of TOR administered via live videoconferencing in adult patients with acute orthopedic injuries. If feasible, the next step is a multisite, hybrid efficacy-effectiveness trial of TOR versus MEUC. Preventive psychosocial interventions can provide a new way to improve patient and provider satisfaction and decrease suffering and health care costs among patients with orthopedic injuries who are at risk for chronic pain and disability. International Registered Report Identifier (IRRID): PRR1-10.2196/28155 UR - https://www.researchprotocols.org/2021/4/e28155 UR - http://dx.doi.org/10.2196/28155 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908886 ID - info:doi/10.2196/28155 ER - TY - JOUR AU - Whiteside, Ursula AU - Richards, Julie AU - Simon, E. Gregory PY - 2021/4/12 TI - Brief Interventions via Electronic Health Record Messaging for Population-Based Suicide Prevention: Mixed Methods Pilot Study JO - JMIR Form Res SP - e21127 VL - 5 IS - 4 KW - suicide KW - suicide prevention KW - dialectical behavior therapy KW - caring message KW - web-based KW - NowMattersNow.org KW - prevention N2 - Background: New opportunities to create and evaluate population-based selective prevention programs for suicidal behavior are emerging in health care settings. Standard depression severity measures recorded in electronic medical records (EMRs) can be used to identify patients at risk for suicide and suicide attempt, and promising interventions for reducing the risk of suicide attempt in at-risk populations can be adapted for web-based delivery in health care. Objective: This study aims to evaluate a pilot of a psychoeducational program, focused on developing emotion regulation techniques via a web-based dialectical behavior therapy (DBT) skills site, including four DBT skills, and supported by secure message coaching, including elements of caring messages. Methods: Patients were eligible based on the EMR-documented responses to the Patient Health Questionnaire indicating suicidal thoughts. We measured feasibility via the proportion of invitees who opened program invitations, visited the web-based consent form page, and consented; acceptability via qualitative feedback from participants about the DBT program; and engagement via the proportion of invitees who began DBT skills as well as the number of website visits for DBT skills and the degree of site engagement. Results: A total of 60 patients were invited to participate. Overall, 93% (56/60) of the patients opened the invitation and 43% (26/60) consented to participate. DBT skills website users visited the home page on an average of 5.3 times (SD 6.0). Procedures resulted in no complaints and some participant feedback emphasizing the usefulness of DBT skills. Conclusions: This study supports the potential of using responses to patient health questionnaires in EMRs to identify a high-risk population and offer key elements of caring messages and DBT adapted for a low-intensity intervention. A randomized trial evaluating the effectiveness of this program is now underway (ClinicalTrials.gov: NCT02326883). UR - https://formative.jmir.org/2021/4/e21127 UR - http://dx.doi.org/10.2196/21127 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843599 ID - info:doi/10.2196/21127 ER - TY - JOUR AU - Shaw, James AU - Brewer, C. LaPrincess AU - Veinot, Tiffany PY - 2021/4/5 TI - Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review JO - JMIR Form Res SP - e23233 VL - 5 IS - 4 KW - virtual care KW - health equity KW - health disparities KW - health informatics KW - COVID-19 KW - telemedicine KW - telehealth KW - digital health N2 - Background: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post?COVID-19 reality. UR - https://formative.jmir.org/2021/4/e23233 UR - http://dx.doi.org/10.2196/23233 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739931 ID - info:doi/10.2196/23233 ER - TY - JOUR AU - Perrin, B. Paul AU - McDonald, D. Scott AU - Watson, D. Jack AU - Pierce, S. Bradford AU - Elliott, R. Timothy PY - 2021/3/29 TI - Telehealth Transition Assistance Program for Acute Spinal Cord Injury Caregivers: Protocol for a Mixed-Methods, Randomized Controlled Trial JO - JMIR Res Protoc SP - e28256 VL - 10 IS - 3 KW - spinal cord injury KW - telehealth KW - caregiver KW - methodology N2 - Background: While spinal cord injury (SCI) caregiving can be a rewarding experience, caregivers often experience reduced mental and physical health. Objective: This article describes the methodology of a study examining the efficacy of a newly developed telehealth Transition Assistance Program (TAP) for caregivers of individuals with acute SCI. Methods: A mixed-methods, randomized controlled trial is comparing TAP outcomes to that of a standard-of-care control. The study is recruiting for 48 months and incorporating quantitative outcome measures. Results: This study was funded by the Craig H. Neilsen Foundation in April 2017. It was approved by the institutional review boards at Virginia Commonwealth University and the Hunter Holmes McGuire Veterans Affairs Medical Center that same year. Participant recruitment and data collection began in 2018. Conclusions: This study is implementing and testing an SCI caregiver intervention unlike any created before, targeting a critical time period that, until now, other SCI caregiver interventions have overlooked. Research personnel intend to disseminate the intervention and study findings through the publication of manuscripts and presentations at conferences. If the current study shows improvements in caregiver or patient well-being, the TAP for SCI caregivers could become part of the standard of care for acute SCI. Trial Registration: ClinicalTrials.gov NCT03244098; https://www.clinicaltrials.gov/ct2/show/NCT03244098 International Registered Report Identifier (IRRID): DERR1-10.2196/28256 UR - https://www.researchprotocols.org/2021/3/e28256 UR - http://dx.doi.org/10.2196/28256 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779569 ID - info:doi/10.2196/28256 ER - TY - JOUR AU - de Jersey, Susan AU - Meloncelli, Nina AU - Guthrie, Taylor AU - Powlesland, Hilary AU - Callaway, Leonie AU - Chang, T. Angela AU - Wilkinson, Shelley AU - Comans, Tracy AU - Eakin, Elizabeth PY - 2021/3/18 TI - Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study JO - JMIR Res Protoc SP - e27196 VL - 10 IS - 3 KW - implementation study KW - pregnancy KW - weight KW - nutrition KW - lifestyle intervention KW - physical activity N2 - Background: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective: This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods: Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ?16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks? gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results: Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions: This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID): DERR1-10.2196/27196 UR - https://www.researchprotocols.org/2021/3/e27196 UR - http://dx.doi.org/10.2196/27196 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734093 ID - info:doi/10.2196/27196 ER - TY - JOUR AU - Entezarjou, Artin AU - Calling, Susanna AU - Bhattacharyya, Tapomita AU - Milos Nymberg, Veronica AU - Vigren, Lina AU - Labaf, Ashkan AU - Jakobsson, Ulf AU - Midlöv, Patrik PY - 2021/3/15 TI - Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study JO - JMIR Med Inform SP - e25473 VL - 9 IS - 3 KW - telemedicine KW - antibiotics KW - streptococcal tonsillitis KW - cystitis KW - respiratory tract infection KW - virtual visit KW - virtual KW - eVisit N2 - Background: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking. Objective: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits. Methods: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated. Results: Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively. Conclusions: The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits. Trial Registration: ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887 UR - https://medinform.jmir.org/2021/3/e25473 UR - http://dx.doi.org/10.2196/25473 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720032 ID - info:doi/10.2196/25473 ER - TY - JOUR AU - Silsand, Line AU - Severinsen, Gro-Hilde AU - Berntsen, Gro PY - 2021/3/5 TI - Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team JO - JMIR Form Res SP - e25220 VL - 5 IS - 3 KW - person-centered care KW - rapid digitalization KW - health care KW - videoconferencing KW - persons with complex, long-term needs KW - COVID-19 N2 - Background: The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient?s response to ?What matters to you?? drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care. Objective: The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions. Methods: This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders. Results: The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination. Conclusions: The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios. UR - https://formative.jmir.org/2021/3/e25220 UR - http://dx.doi.org/10.2196/25220 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646965 ID - info:doi/10.2196/25220 ER - TY - JOUR AU - Stanimirovic, Aleksandra AU - Francis, Troy AU - Cooper Reed, Anna AU - Meerai, Sonia AU - Sutakovic, Olivera AU - Merritt, Rebecca AU - Brent, Michael AU - Rac, Valeria PY - 2021/3/5 TI - Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study JO - JMIR Res Protoc SP - e23492 VL - 10 IS - 3 KW - gender KW - screening KW - diabetes KW - diabetic retinopathy KW - blindness KW - technology KW - tele-retina screening KW - health equity KW - intersectionality theory N2 - Background: By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender. Objective: We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019. Methods: Using a convergent mixed methods design, we want to understand patients?, providers?, administrators?, and decision makers? perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina. Results: For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021. Conclusions: In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. International Registered Report Identifier (IRRID): PRR1-10.2196/23492 UR - https://www.researchprotocols.org/2021/3/e23492 UR - http://dx.doi.org/10.2196/23492 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666559 ID - info:doi/10.2196/23492 ER - TY - JOUR AU - Husain, Amna AU - Cohen, Eyal AU - Dubrowski, Raluca AU - Jamieson, Trevor AU - Kurahashi, Miyoshi Allison AU - Lokuge, Bhadra AU - Rapoport, Adam AU - Saunders, Stephanie AU - Stasiulis, Elaine AU - Stinson, Jennifer AU - Subramaniam, Saranjah AU - Wegier, Pete AU - Barwick, Melanie PY - 2021/3/3 TI - A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study JO - J Med Internet Res SP - e25505 VL - 23 IS - 3 KW - coordination of care KW - complexity KW - internet communication technology KW - collaborative care KW - implementation science KW - theory of behavior KW - interprofessional team KW - patient engagement KW - social networking technology KW - user-centered design KW - Consolidated Framework for Implementation Research KW - Quality Improvement Framework KW - Implementation Outcome Taxonomy N2 - Background: Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. Objective: The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. Methods: The study was a hybrid type II mixed methods design to simultaneously evaluate Loop?s clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. Results: We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop?s potential value for engaging the patient and caregiver, and for improving communication within the patient?s circle of care, Loop?s relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. Conclusions: Fundamental structural and implementation challenges persist toward realizing Loop?s potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication. UR - https://www.jmir.org/2021/3/e25505 UR - http://dx.doi.org/10.2196/25505 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656445 ID - info:doi/10.2196/25505 ER - TY - JOUR AU - Anyanwu, C. Emeka AU - Ward, Parker R. AU - Shah, Atman AU - Arora, Vineet AU - Umscheid, A. Craig PY - 2021/2/23 TI - A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience JO - JMIR Mhealth Uhealth SP - e24452 VL - 9 IS - 2 KW - adoption KW - communication KW - COVID-19 KW - hospital KW - inpatient KW - mHealth KW - mobile app KW - telemedicine N2 - Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number?related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team?s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. UR - https://mhealth.jmir.org/2021/2/e24452 UR - http://dx.doi.org/10.2196/24452 UR - http://www.ncbi.nlm.nih.gov/pubmed/33513562 ID - info:doi/10.2196/24452 ER - TY - JOUR AU - Tian, Jaminal Peter George AU - Harris, Richard Jeffrey AU - Seikaly, Hadi AU - Chambers, Thane AU - Alvarado, Sara AU - Eurich, Dean PY - 2021/2/23 TI - Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan JO - JMIR Form Res SP - e17672 VL - 5 IS - 2 KW - telephone consultations KW - teleconsultations KW - remote consultations KW - telemedicine KW - eHealth KW - environmental scan N2 - Background: Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective: As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods: We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results: The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions: Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.? UR - https://formative.jmir.org/2021/2/e17672 UR - http://dx.doi.org/10.2196/17672 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620325 ID - info:doi/10.2196/17672 ER - TY - JOUR AU - Donald, Maoliosa AU - Beanlands, Heather AU - Straus, E. Sharon AU - Smekal, Michelle AU - Gil, Sarah AU - Elliott, J. Meghan AU - Herrington, Gwen AU - Harwood, Lori AU - Waldvogel, Blair AU - Delgado, Maria AU - Sparkes, Dwight AU - Tong, Allison AU - Grill, Allan AU - Novak, Marta AU - James, Thomas Matthew AU - Brimble, Scott K. AU - Samuel, Susan AU - Tu, Karen AU - Farragher, Janine AU - Hemmelgarn, R. Brenda PY - 2021/2/9 TI - A Web-Based Self-Management Support Prototype for Adults With Chronic Kidney Disease (My Kidneys My Health): Co-Design and Usability Testing JO - JMIR Form Res SP - e22220 VL - 5 IS - 2 KW - chronic kidney disease KW - knowledge-to-action framework KW - integrated knowledge translation KW - patient engagement KW - patient-oriented research KW - self-management KW - web-based intervention N2 - Background: Supporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those who care for them. Self-management has been shown to slow CKD progression and improve the quality of life of individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed, web-based tool for CKD self-management that can be individualized to a patient?s unique situation, priorities, and preferences. We addressed this gap using an integrated knowledge translation method and patient engagement principles. Objective: The aim of this study is to conduct systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (nondialysis and nontransplant) and their caregivers to enhance self-management support. Methods: A multistep, iterative system development cycle was used to co-design and test the My Kidneys My Health prototype. The 3-step process included creating website features and content using 2 sequential focus groups with patients with CKD and caregivers, heuristic testing using the 10 heuristic principles by Nielsen, and usability testing through in-person 60-minute interviews with patients with CKD and their caregivers. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. Results: In step 1, 18 participants (14 patients and 4 caregivers) attended one of the 2 sequential focus groups. The participants provided specific suggestions for simplifying navigation as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. A total of 5 reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Furthermore, 5 participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean system usability score of 90 out of 100. Conclusions: The My Kidneys My Health prototype is a systematically developed, multifaceted, web-based CKD self-management support tool guided by the theory and preferences of patients with CKD and their caregivers. The website is user friendly and provides features that improve user experience by tailoring the content and resources to their needs. A feasibility study will provide insights into the acceptability of and engagement with the prototype and identify preliminary patient-reported outcomes (eg, self-efficacy) as well as potential factors related to implementation. This work is relevant given the shift to virtual care during the current pandemic times and provides patients with support when in-person care is restricted. UR - https://formative.jmir.org/2021/2/e22220 UR - http://dx.doi.org/10.2196/22220 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560245 ID - info:doi/10.2196/22220 ER - TY - JOUR AU - Hull, D. Thomas AU - Levine, Jacob AU - Bantilan, Niels AU - Desai, N. Angel AU - Majumder, S. Maimuna PY - 2021/2/9 TI - Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages JO - JMIR Form Res SP - e26190 VL - 5 IS - 2 KW - digital phenotyping KW - COVID-19 KW - telehealth KW - digital mental health KW - natural language processing KW - machine learning KW - mental health KW - phenotyping KW - burden KW - treatment KW - symptom N2 - Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients? pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19?related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. UR - http://formative.jmir.org/2021/2/e26190/ UR - http://dx.doi.org/10.2196/26190 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502999 ID - info:doi/10.2196/26190 ER - TY - JOUR AU - Depp, Colin AU - Ehret, Blaire AU - Villa, Jennifer AU - Perivoliotis, Dimitri AU - Granholm, Eric PY - 2021/2/8 TI - A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial JO - JMIR Res Protoc SP - e14378 VL - 10 IS - 2 KW - prevention KW - mental health services KW - psychosis KW - technology N2 - Background: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378 UR - https://www.researchprotocols.org/2021/2/e14378 UR - http://dx.doi.org/10.2196/14378 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555265 ID - info:doi/10.2196/14378 ER - TY - JOUR AU - O'Cathail, Micheal AU - Aznar-Garcia, Luis AU - Sivanandan, Ananth AU - Diver, Claire AU - Patel, Poulam AU - Tang, Pui-Shan AU - Christian, Judith PY - 2021/2/5 TI - Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study JO - JMIR Form Res SP - e15598 VL - 5 IS - 2 KW - telemedicine KW - teleconsultations KW - brain metastases KW - stereotactic radiosurgery KW - mobile phone N2 - Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. UR - http://formative.jmir.org/2021/2/e15598/ UR - http://dx.doi.org/10.2196/15598 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544082 ID - info:doi/10.2196/15598 ER - TY - JOUR AU - Laukka, Elina AU - Pölkki, Tarja AU - Heponiemi, Tarja AU - Kaihlanen, Anu-Marja AU - Kanste, Outi PY - 2021/2/4 TI - Leadership in Digital Health Services: Protocol for a Concept Analysis JO - JMIR Res Protoc SP - e25495 VL - 10 IS - 2 KW - health care KW - leadership KW - health services KW - concept analysis KW - telehealth N2 - Background: Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective: The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods: The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results: An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions: A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. International Registered Report Identifier (IRRID): PRR1-10.2196/25495 UR - http://www.researchprotocols.org/2021/2/e25495/ UR - http://dx.doi.org/10.2196/25495 UR - http://www.ncbi.nlm.nih.gov/pubmed/33538702 ID - info:doi/10.2196/25495 ER - TY - JOUR AU - Sauch Valmaña, Glòria AU - Vidal-Alaball, Josep AU - Garcia Furió, Victoria AU - Testoni, Giorgia AU - Espelt, Albert AU - Exposito, Katarin AU - Saigí-Rubió, Francesc AU - Carré, Núria AU - Sanz, Ikuska AU - Vicens, Victor PY - 2021/2/3 TI - An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study JO - JMIR Res Protoc SP - e25062 VL - 10 IS - 2 KW - mHealth KW - telehealth KW - teenager KW - health promotion and sexual health KW - health promotion KW - sexual health N2 - Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients? safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 UR - https://www.researchprotocols.org/2021/2/e25062 UR - http://dx.doi.org/10.2196/25062 UR - http://www.ncbi.nlm.nih.gov/pubmed/33533729 ID - info:doi/10.2196/25062 ER - TY - JOUR AU - Jalilian Khave, Laya AU - Vahidi, Mohammad AU - Shirini, Dorsa AU - Sanadgol, Ghazal AU - Ashrafi, Farzad AU - Arab-Ahmadi, Mehran AU - Fatemi, Alireza AU - Shabani Barzegar, Minoosh AU - Hassanzadeh, Taha AU - Rezaei, Behandokht AU - Zali, Alireza AU - Ommi, Davood AU - Nohesara, Shabnam AU - Jalili Khoshnood, Reza AU - Abdi, Saeed AU - Pirsalehi, Ali AU - Masarat, Ehsan AU - Shokoohi, Mostafa AU - Karamouzian, Mohammad PY - 2021/2/2 TI - Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study) JO - JMIR Res Protoc SP - e23316 VL - 10 IS - 2 KW - cohort studies KW - COVID-19 KW - health care delivery KW - Iran KW - medical education KW - telemedicine N2 - Background: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients? clinical profiles. Methods: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23316 UR - https://www.researchprotocols.org/2021/2/e23316 UR - http://dx.doi.org/10.2196/23316 UR - http://www.ncbi.nlm.nih.gov/pubmed/33471777 ID - info:doi/10.2196/23316 ER - TY - JOUR AU - Frick, J. Nicholas R. AU - Möllmann, L. Henriette AU - Mirbabaie, Milad AU - Stieglitz, Stefan PY - 2021/2/1 TI - Driving Digital Transformation During a Pandemic: Case Study of Virtual Collaboration in a German Hospital JO - JMIR Med Inform SP - e25183 VL - 9 IS - 2 KW - digital transformation KW - virtual collaboration KW - digital health KW - health care KW - COVID-19 KW - pandemic KW - hospital KW - collaboration KW - virtual heath KW - crisis KW - case study N2 - Background: The COVID-19 pandemic has not only changed the private lives of millions of people but has significantly affected the collaboration of medical specialists throughout health care systems worldwide. Hospitals are making changes to their regular operations to slow the spread of SARS-CoV-2 while ensuring the treatment of emergency patients. These substantial changes affect the typical work setting of clinicians and require the implementation of organizational arrangements. Objective: In this study, we aim to increase our understanding of how digital transformation drives virtual collaboration among clinicians in hospitals in times of crisis, such as the COVID-19 pandemic. Methods: We present the lessons learned from an exploratory case study in which we observed the introduction of an information technology (IT) system for enhancing collaboration among clinicians in a German hospital. The results are based on 16 semistructured interviews with physicians from various departments and disciplines; the interviews were generalized to better understand and interpret the meaning of the statements. Results: Three key lessons and recommendations explain how digital transformation ensures goal-driven collaboration among clinicians. First, we found that implementing a disruptive change requires alignment of the mindsets of the stakeholders. Second, IT-enabled collaboration presupposes behavioral rules that must be followed. Third, transforming antiquated processes demands a suitable technological infrastructure. Conclusions: Digital transformation is being driven by the COVID-19 pandemic. However, the rapid introduction of IT-enabled collaboration reveals grievances concerning the digital dissemination of medical information along the patient treatment path. To avoid being caught unprepared by future crises, digital transformation must be further driven to ensure collaboration, and the diagnostic and therapeutic process must be opened to disruptive strategies. UR - https://medinform.jmir.org/2021/2/e25183 UR - http://dx.doi.org/10.2196/25183 UR - http://www.ncbi.nlm.nih.gov/pubmed/33449905 ID - info:doi/10.2196/25183 ER - TY - JOUR AU - Sandell, Tiffany AU - Schütze, Heike AU - Miller, Andrew PY - 2021/1/19 TI - A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study JO - JMIR Res Protoc SP - e21752 VL - 10 IS - 1 KW - radiation oncology KW - general practice KW - health technology KW - communication KW - cancer KW - shared care KW - follow-up N2 - Background: The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective: The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods: This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results: Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions: Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients? preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID): PRR1-10.2196/21752 UR - http://www.researchprotocols.org/2021/1/e21752/ UR - http://dx.doi.org/10.2196/21752 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464209 ID - info:doi/10.2196/21752 ER - TY - JOUR AU - Rauseo-Ricupero, Natali AU - Torous, John PY - 2021/1/14 TI - Technology Enabled Clinical Care (TECC): Protocol for a Prospective Longitudinal Cohort Study of Smartphone-Augmented Mental Health Treatment JO - JMIR Res Protoc SP - e23771 VL - 10 IS - 1 KW - mental health care KW - access KW - multi-language KW - smartphone KW - app KW - quality improvement KW - protocol KW - mental health KW - treatment KW - acceptability KW - efficacy KW - COVID-19 N2 - Background: Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision?Technology Enabled Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP. Objective: TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design. Methods: The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations. Results: The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction. Conclusions: TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations. International Registered Report Identifier (IRRID): PRR1-10.2196/23771 UR - https://www.researchprotocols.org/2021/1/e23771 UR - http://dx.doi.org/10.2196/23771 UR - http://www.ncbi.nlm.nih.gov/pubmed/33296869 ID - info:doi/10.2196/23771 ER - TY - JOUR AU - Jackowich, A. Robyn AU - Mooney, M. Kayla AU - Hecht, Evelyn AU - Pukall, F. Caroline PY - 2021/1/11 TI - Online Pelvic Floor Group Education Program for Women With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Descriptive Feasibility Study JO - JMIR Form Res SP - e22450 VL - 5 IS - 1 KW - persistent genital arousal disorder KW - genitopelvic dysesthesia KW - online program KW - pelvic floor KW - pilot N2 - Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as ?genital arousal,? which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants? abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms. UR - http://formative.jmir.org/2021/1/e22450/ UR - http://dx.doi.org/10.2196/22450 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427673 ID - info:doi/10.2196/22450 ER - TY - JOUR AU - Aminoff, Hedvig AU - Meijer, Sebastiaan AU - Arnelo, Urban AU - Frennert, Susanne PY - 2021/1/11 TI - Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes JO - JMIR Form Res SP - e20692 VL - 5 IS - 1 KW - telemedicine KW - telementoring KW - teleconsulting KW - technology acceptance model KW - professional users KW - specialties, surgical/education KW - attitude KW - clinical staff KW - surgery KW - framework KW - surgeon KW - user-centered KW - interview KW - survey N2 - Background: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective: Our objective was to gain a deeper understanding of ERCP practitioners? attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons? beliefs about teleguidance?s contribution to performance and factors that might interact with implementation. Results: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard ?Ease of Use? items for ?Compatibility and Implementation Climate.? In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05). Conclusions: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes. UR - https://formative.jmir.org/2021/1/e20692 UR - http://dx.doi.org/10.2196/20692 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427670 ID - info:doi/10.2196/20692 ER - TY - JOUR AU - An, Ho Min AU - You, Chan Seng AU - Park, Woong Rae AU - Lee, Seongwon PY - 2021/1/8 TI - Using an Extended Technology Acceptance Model to Understand the Factors Influencing Telehealth Utilization After Flattening the COVID-19 Curve in South Korea: Cross-sectional Survey Study JO - JMIR Med Inform SP - e25435 VL - 9 IS - 1 KW - telemedicine KW - telehealth KW - COVID-19 KW - pandemic KW - model KW - South Korea KW - acceptance KW - anxiety KW - cross-sectional N2 - Background: Although telehealth is considered a key component in combating the worldwide crisis caused by COVID-19, the factors that influence its acceptance by the general population after the flattening of the COVID-19 curve remain unclear. Objective: We aimed to identify factors affecting telehealth acceptance, including anxiety related to COVID-19, after the initial rapid spread of the disease in South Korea. Methods: We proposed an extended technology acceptance model (TAM) and performed a cross-sectional survey of individuals aged ?30 years. In total, 471 usable responses were collected. Confirmatory factor analysis was used to examine the validity of measurements, and the partial least squares (PLS) method was used to investigate factors influencing telehealth acceptance and the impacts of COVID-19. Results: PLS analysis showed that increased accessibility, enhanced care, and ease of telehealth use had positive effects on its perceived usefulness (P=.002, P<.001, and P<.001, respectively). Furthermore, perceived usefulness, ease, and privacy/discomfort significantly impacted the acceptance of telehealth (P<.001, P<.001, and P<.001, respectively). However, anxiety toward COVID-19 was not associated with telehealth acceptance (P=.112), and this insignificant relationship was consistent in the cluster (n=216, 46%) of respondents with chronic diseases (P=.185). Conclusions: Increased accessibility, enhanced care, usefulness, ease of use, and privacy/discomfort are decisive variables affecting telehealth acceptance in the Korean general population, whereas anxiety about COVID-19 is not. This study may lead to a tailored promotion of telehealth after the pandemic subsides. UR - http://medinform.jmir.org/2021/1/e25435/ UR - http://dx.doi.org/10.2196/25435 UR - http://www.ncbi.nlm.nih.gov/pubmed/33395397 ID - info:doi/10.2196/25435 ER - TY - JOUR AU - Eldh, Catrine Ann AU - Sverker, Annette AU - Bendtsen, Preben AU - Nilsson, Evalill PY - 2020/12/14 TI - Health Care Professionals? Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study JO - JMIR Hum Factors SP - e21698 VL - 7 IS - 4 KW - communication KW - content analysis KW - eHealth KW - telemedicine KW - digital technology KW - interviews KW - primary health care KW - qualitative research N2 - Background: Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care. Objective: The objective of our study was to describe health care staff?s experience with a digital communication system intended for patient-staff encounters via a digital route in primary care. Methods: In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis. Results: While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient?s voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service?at least for a while?if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers. Conclusions: A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation. UR - http://humanfactors.jmir.org/2020/4/e21698/ UR - http://dx.doi.org/10.2196/21698 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315014 ID - info:doi/10.2196/21698 ER - TY - JOUR AU - te Pas, E. Mariska AU - Rutten, M. Werner G. M. AU - Bouwman, Arthur R. AU - Buise, P. Marc PY - 2020/12/7 TI - User Experience of a Chatbot Questionnaire Versus a Regular Computer Questionnaire: Prospective Comparative Study JO - JMIR Med Inform SP - e21982 VL - 8 IS - 12 KW - chatbot KW - user experience KW - questionnaires KW - response rates KW - value-based health care N2 - Background: Respondent engagement of questionnaires in health care is fundamental to ensure adequate response rates for the evaluation of services and quality of care. Conventional survey designs are often perceived as dull and unengaging, resulting in negative respondent behavior. It is necessary to make completing a questionnaire attractive and motivating. Objective: The aim of this study is to compare the user experience of a chatbot questionnaire, which mimics intelligent conversation, with a regular computer questionnaire. Methods: The research took place at the preoperative outpatient clinic. Patients completed both the standard computer questionnaire and the new chatbot questionnaire. Afterward, patients gave their feedback on both questionnaires by the User Experience Questionnaire, which consists of 26 terms to score. Results: The mean age of the 40 included patients (25 [63%] women) was 49 (SD 18-79) years; 46.73% (486/1040) of all terms were scored positive for the chatbot. Patients preferred the computer for 7.98% (83/1040) of the terms and for 47.88% (498/1040) of the terms there were no differences. Completion (mean time) of the computer questionnaire took 9.00 minutes by men (SD 2.72) and 7.72 minutes by women (SD 2.60; P=.148). For the chatbot, completion by men took 8.33 minutes (SD 2.99) and by women 7.36 minutes (SD 2.61; P=.287). Conclusions: Patients preferred the chatbot questionnaire over the computer questionnaire. Time to completion of both questionnaires did not differ, though the chatbot questionnaire on a tablet felt more rapid compared to the computer questionnaire. This is an important finding because it could lead to higher response rates and to qualitatively better responses in future questionnaires. UR - http://medinform.jmir.org/2020/12/e21982/ UR - http://dx.doi.org/10.2196/21982 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284125 ID - info:doi/10.2196/21982 ER - TY - JOUR AU - Baines, Rebecca AU - Tredinnick-Rowe, John AU - Jones, Ray AU - Chatterjee, Arunangsu PY - 2020/11/12 TI - Barriers and Enablers in Implementing Electronic Consultations in Primary Care: Scoping Review JO - J Med Internet Res SP - e19375 VL - 22 IS - 11 KW - remote consultation KW - COVID-19 KW - implementation science KW - primary health care KW - patient participation KW - referral and consultation N2 - Background: Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. Objective: With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. Methods: In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). Results: In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. Conclusions: This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care. UR - https://www.jmir.org/2020/11/e19375 UR - http://dx.doi.org/10.2196/19375 UR - http://www.ncbi.nlm.nih.gov/pubmed/33035177 ID - info:doi/10.2196/19375 ER - TY - JOUR AU - Cui, Fangfang AU - Ma, Qianqian AU - He, Xianying AU - Zhai, Yunkai AU - Zhao, Jie AU - Chen, Baozhan AU - Sun, Dongxu AU - Shi, Jinming AU - Cao, Mingbo AU - Wang, Zhenbo PY - 2020/10/23 TI - Implementation and Application of Telemedicine in China: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e18426 VL - 8 IS - 10 KW - telemedicine KW - Chinese hospital KW - implementation KW - application KW - influencing factors N2 - Background: Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine. Objective: The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future. Methods: The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect. Results: Approximately 93.8% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3% (139/161), 57.1% (92/161), 49.7% (80/161), 37.9% (61/161), and 33.5% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education. Conclusions: A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished. UR - http://mhealth.jmir.org/2020/10/e18426/ UR - http://dx.doi.org/10.2196/18426 UR - http://www.ncbi.nlm.nih.gov/pubmed/33095175 ID - info:doi/10.2196/18426 ER - TY - JOUR AU - Cha, Dongchul AU - Shin, Ho Seung AU - Kim, Jungghi AU - Eo, Seong Tae AU - Na, Gina AU - Bae, Seonghoon AU - Jung, Jinsei AU - Kim, Huhn Sung AU - Moon, Seok In AU - Choi, Jaeyoung AU - Park, Rang Yu PY - 2020/10/19 TI - Feasibility of Asynchronous and Automated Telemedicine in Otolaryngology: Prospective Cross-Sectional Study JO - JMIR Med Inform SP - e23680 VL - 8 IS - 10 KW - telemedicine KW - otolaryngology KW - otology KW - automated diagnosis KW - asynchronous KW - COVID-19 KW - diagnosis KW - feasibility KW - cross-sectional N2 - Background: COVID-19 often causes respiratory symptoms, making otolaryngology offices one of the most susceptible places for community transmission of the virus. Thus, telemedicine may benefit both patients and physicians. Objective: This study aims to explore the feasibility of telemedicine for the diagnosis of all otologic disease types. Methods: A total of 177 patients were prospectively enrolled, and the patient?s clinical manifestations with otoendoscopic images were written in the electrical medical records. Asynchronous diagnoses were made for each patient to assess Top-1 and Top-2 accuracy, and we selected 20 cases to conduct a survey among four different otolaryngologists to assess the accuracy, interrater agreement, and diagnostic speed. We also constructed an experimental automated diagnosis system and assessed Top-1 accuracy and diagnostic speed. Results: Asynchronous diagnosis showed Top-1 and Top-2 accuracies of 77.40% and 86.44%, respectively. In the selected 20 cases, the Top-2 accuracy of the four otolaryngologists was on average 91.25% (SD 7.50%), with an almost perfect agreement between them (Cohen kappa=0.91). The automated diagnostic model system showed 69.50% Top-1 accuracy. Otolaryngologists could diagnose an average of 1.55 (SD 0.48) patients per minute, while the machine learning model was capable of diagnosing on average 667.90 (SD 8.3) patients per minute. Conclusions: Asynchronous telemedicine in otology is feasible owing to the reasonable Top-2 accuracy when assessed by experienced otolaryngologists. Moreover, enhanced diagnostic speed while sustaining the accuracy shows the possibility of optimizing medical resources to provide expertise in areas short of physicians. UR - http://medinform.jmir.org/2020/10/e23680/ UR - http://dx.doi.org/10.2196/23680 UR - http://www.ncbi.nlm.nih.gov/pubmed/33027033 ID - info:doi/10.2196/23680 ER - TY - JOUR AU - Snoswell, L. Centaine AU - Taylor, L. Monica AU - Comans, A. Tracy AU - Smith, C. Anthony AU - Gray, C. Leonard AU - Caffery, J. Liam PY - 2020/10/19 TI - Determining if Telehealth Can Reduce Health System Costs: Scoping Review JO - J Med Internet Res SP - e17298 VL - 22 IS - 10 KW - cost-benefit analysis KW - telemedicine KW - review N2 - Background: Telehealth represents an opportunity for Australia to harness the power of technology to redesign the way health care is delivered. The potential benefits of telehealth include increased accessibility to care, productivity gains for health providers and patients through reduced travel, potential for cost savings, and an opportunity to develop culturally appropriate services that are more sensitive to the needs of special populations. The uptake of telehealth has been hindered at times by clinician reluctance and policies that preclude metropolitan populations from accessing telehealth services. Objective: This study aims to investigate if telehealth reduces health system costs compared with traditional service models and to identify the scenarios in which cost savings can be realized. Methods: A scoping review was undertaken to meet the study aims. Initially, literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature in telehealth. The investigators then conducted an expert focus group to identify domains where telehealth could reduce health system costs, followed by targeted literature searches for corresponding evidence. Results: The cost analyses reviewed provided evidence that telehealth reduced costs when health system?funded travel was prevented and when telehealth mitigated the need for expensive procedural or specialist follow-up by providing competent care in a more efficient way. The expert focus group identified 4 areas of potential savings from telehealth: productivity gains, reductions in secondary care, alternate funding models, and telementoring. Telehealth demonstrated great potential for productivity gains arising from health system redesign; however, under the Australian activity-based funding, it is unlikely that these gains will result in cost savings. Secondary care use mitigation is an area of promise for telehealth; however, many studies have not demonstrated overall cost savings due to the cost of administering and monitoring telehealth systems. Alternate funding models from telehealth systems have the potential to save the health system money in situations where the consumers pay out of pocket to receive services. Telementoring has had minimal economic evaluation; however, in the long term it is likely to result in inadvertent cost savings through the upskilling of generalist and allied health clinicians. Conclusions: Health services considering implementing telehealth should be motivated by benefits other than cost reduction. The available evidence has indicated that although telehealth provides overwhelmingly positive patient benefits and increases productivity for many services, current evidence suggests that it does not routinely reduce the cost of care delivery for the health system. UR - http://www.jmir.org/2020/10/e17298/ UR - http://dx.doi.org/10.2196/17298 UR - http://www.ncbi.nlm.nih.gov/pubmed/33074157 ID - info:doi/10.2196/17298 ER - TY - JOUR AU - Piera-Jiménez, Jordi AU - Daugbjerg, Signe AU - Stafylas, Panagiotis AU - Meyer, Ingo AU - Müller, Sonja AU - Lewis, Leo AU - da Col, Paolo AU - Folkvord, Frans AU - Lupiáñez-Villanueva, Francisco PY - 2020/10/6 TI - BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments JO - JMIR Med Inform SP - e20938 VL - 8 IS - 10 KW - integrated care KW - telemedicine KW - telecare KW - digital health KW - cost-effectiveness KW - clinical effectiveness KW - chronic disease N2 - Background: Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce. Objective: The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain. Methods: A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology?enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months. Results: The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI ?4.51 to 4.78; P=.95) but decreased in the comparator group (mean change ?3.23, 95% CI ?5.34 to ?1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of ?0.23 (95% CI ?0.44 to ?0.02; P=.03) and ?0.33 (95% CI ?0.46 to ?0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI ?0.44 to 1.01, P=.44; comparator: mean change ?0.29, 95% CI ?0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio ?6505.52, approximately US $7582). Conclusions: The information and communication technology?enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved. Trial Registration: ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004 UR - https://medinform.jmir.org/2020/10/e20938 UR - http://dx.doi.org/10.2196/20938 UR - http://www.ncbi.nlm.nih.gov/pubmed/33021490 ID - info:doi/10.2196/20938 ER - TY - JOUR AU - Waqas, Ahmed AU - Teoh, Huat Soo AU - Lapão, Velez Luís AU - Messina, Ary Luiz AU - Correia, César Jorge PY - 2020/10/2 TI - Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis JO - J Med Internet Res SP - e18835 VL - 22 IS - 10 KW - telemedicine KW - scientometric analysis KW - evidence synthesis KW - health information technology KW - research KW - theme N2 - Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. UR - https://www.jmir.org/2020/10/e18835 UR - http://dx.doi.org/10.2196/18835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006571 ID - info:doi/10.2196/18835 ER - TY - JOUR AU - Novak, Lovett Laurie AU - Simpson, L. Christopher AU - Coco, Joseph AU - McNaughton, D. Candace AU - Ehrenfeld, M. Jesse AU - Bloos, M. Sean AU - Fabbri, Daniel PY - 2020/9/25 TI - Understanding the Information Needs and Context of Trauma Handoffs to Design Automated Sensing Clinical Documentation Technologies: Qualitative Mixed-Method Study of Military and Civilian Cases JO - J Med Internet Res SP - e17978 VL - 22 IS - 9 KW - trauma handoffs KW - military field medicine KW - documentation KW - trauma KW - health records KW - hospital KW - emergency N2 - Background: Current methods of communication between the point of injury and receiving medical facilities rely on verbal communication, supported by brief notes and the memory of the field medic. This communication can be made more complete and reliable with technologies that automatically document the actions of field medics. However, designing state-of-the-art technology for military field personnel and civilian first responders is challenging due to the barriers researchers face in accessing the environment and understanding situated actions and cognitive models employed in the field. Objective: To identify design insights for an automated sensing clinical documentation (ASCD) system, we sought to understand what information is transferred in trauma cases between prehospital and hospital personnel, and what contextual factors influence the collection, management, and handover of information in trauma cases, in both military and civilian cases. Methods: Using a multi-method approach including video review and focus groups, we developed an understanding of the information needs of trauma handoffs and the context of field documentation to inform the design of an automated sensing documentation system that uses wearables, cameras, and environmental sensors to passively infer clinical activity and automatically produce documentation. Results: Comparing military and civilian trauma documentation and handoff, we found similarities in the types of data collected and the prioritization of information. We found that military environments involved many more contextual factors that have implications for design, such as the physical environment (eg, heat, lack of lighting, lack of power) and the potential for active combat and triage, creating additional complexity. Conclusions: An ineffectiveness of communication is evident in both the civilian and military worlds. We used multiple methods of inquiry to study the information needs of trauma care and handoff, and the context of medical work in the field. Our findings informed the design and evaluation of an automated documentation tool. The data illustrated the need for more accurate recordkeeping, specifically temporal aspects, during transportation, and characterized the environment in which field testing of the developed tool will take place. The employment of a systems perspective in this project produced design insights that our team would not have identified otherwise. These insights created exciting and interesting challenges for the technical team to resolve. UR - http://www.jmir.org/2020/9/e17978/ UR - http://dx.doi.org/10.2196/17978 UR - http://www.ncbi.nlm.nih.gov/pubmed/32975522 ID - info:doi/10.2196/17978 ER - TY - JOUR AU - Khana, Rajes AU - Mahinderjit Singh, Manmeet AU - Damanhoori, Faten AU - Mustaffa, Norlia PY - 2020/9/23 TI - Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study JO - JMIR Med Inform SP - e21584 VL - 8 IS - 9 KW - trust KW - trustworthiness KW - multifaceted trust KW - breast self-examination KW - breast cancer KW - health care system KW - social media N2 - Background: Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient?s personal medical data excessively with colleagues or the public. Such an act would reduce the physician?s trustworthiness from the patient?s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening. Objective: The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians. Methods: We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum. Results: Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions. Conclusions: Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient?s recommendation regarding the physician?s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty. UR - https://medinform.jmir.org/2020/9/e21584 UR - http://dx.doi.org/10.2196/21584 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965225 ID - info:doi/10.2196/21584 ER - TY - JOUR AU - Ramaswamy, Ashwin AU - Yu, Miko AU - Drangsholt, Siri AU - Ng, Eric AU - Culligan, J. Patrick AU - Schlegel, N. Peter AU - Hu, C. Jim PY - 2020/9/9 TI - Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study JO - J Med Internet Res SP - e20786 VL - 22 IS - 9 KW - telemedicine KW - medicine KW - pandemics KW - patient satisfaction KW - remote consultation KW - disruptive technology KW - medical informatics KW - health care delivery KW - practice patterns KW - physicians KW - health policy KW - health services research KW - health care reform KW - COVID-19 N2 - Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre?COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE ?2.05; 95% CI ?2.66 to ?1.22), female gender (PE ?0.73; 95% CI ?0.96 to ?0.50), and new visit type (PE ?0.75; 95% CI ?1.00 to ?0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. UR - http://www.jmir.org/2020/9/e20786/ UR - http://dx.doi.org/10.2196/20786 UR - http://www.ncbi.nlm.nih.gov/pubmed/32810841 ID - info:doi/10.2196/20786 ER - TY - JOUR AU - Dhala, Atiya AU - Sasangohar, Farzan AU - Kash, Bita AU - Ahmadi, Nima AU - Masud, Faisal PY - 2020/9/3 TI - Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study JO - J Med Internet Res SP - e20143 VL - 22 IS - 9 KW - intensive care units KW - critical care KW - pandemics KW - SARS-CoV-2 KW - telemedicine KW - infection control KW - COVID-19 N2 - Background: The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective: The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients? families during the pandemic. Methods: The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non?COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non?COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results: Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions: Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients. UR - http://www.jmir.org/2020/9/e20143/ UR - http://dx.doi.org/10.2196/20143 UR - http://www.ncbi.nlm.nih.gov/pubmed/32795997 ID - info:doi/10.2196/20143 ER - TY - JOUR AU - Pawa?owski, Piotr AU - Mazurek, Cezary AU - Leszczuk, Miko?aj AU - Moureaux, Jean-Marie AU - Chaabouni, Amine PY - 2020/7/29 TI - Video Cloud Services for Hospitals: Designing an End-to-End Cloud Service Platform for Medical Video Storage and Secure Access JO - JMIR Biomed Eng SP - e18139 VL - 5 IS - 1 KW - medical video KW - telemedicine KW - medical cloud platforms UR - https://biomedeng.jmir.org/2020/1/e18139 UR - http://dx.doi.org/10.2196/18139 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/18139 ER - TY - JOUR AU - North, Frederick AU - Luhman, E. Kristine AU - Mallmann, A. Eric AU - Mallmann, J. Toby AU - Tulledge-Scheitel, M. Sidna AU - North, J. Emily AU - Pecina, L. Jennifer PY - 2020/7/8 TI - A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? JO - JMIR Med Inform SP - e16521 VL - 8 IS - 7 KW - patient messages KW - secure messages KW - patient portal KW - provider messages KW - electronic health records KW - electronic mail KW - communication KW - patients KW - physicians KW - physician assistants KW - nurse practitioners KW - nurses N2 - Background: Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. Objective: This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. Methods: We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). Results: Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. Conclusions: Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume. UR - https://medinform.jmir.org/2020/7/e16521 UR - http://dx.doi.org/10.2196/16521 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673238 ID - info:doi/10.2196/16521 ER - TY - JOUR AU - Gunasekeran, Visva Dinesh AU - Liu, Zhenghong AU - Tan, Jim Win AU - Koh, Joshua AU - Cheong, Peng Chiu AU - Tan, Hong Lay AU - Lau, Siang Chee AU - Phuah, Kheng Gaik AU - Manuel, A. Newsie Donnah AU - Chia, Chong Che AU - Seng, Siang Gek AU - Tong, Nancy AU - Huin, Hang May AU - Dulce, Villaluna Suzette AU - Yap, Susan AU - Ponampalam, Kishanti AU - Ying, Hao AU - Ong, Hock Marcus Eng AU - Ponampalam, R. PY - 2020/6/15 TI - Evaluating Safety and Efficacy of Follow-up for Patients With Abdominal Pain Using Video Consultation (SAVED Study): Randomized Controlled Trial JO - J Med Internet Res SP - e17417 VL - 22 IS - 6 KW - digital health KW - teleconsultation KW - video consultation KW - telereview KW - abdominal pain KW - primary care KW - emergency department N2 - Background: The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. Objective: The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. Methods: The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). Results: A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups. Conclusions: The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. Trial Registration: ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556. UR - https://www.jmir.org/2020/6/e17417 UR - http://dx.doi.org/10.2196/17417 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459637 ID - info:doi/10.2196/17417 ER - TY - JOUR AU - Schinköthe, Timo AU - Gabri, Rolando Mariano AU - Mitterer, Manfred AU - Gouveia, Pedro AU - Heinemann, Volker AU - Harbeck, Nadia AU - Subklewe, Marion PY - 2020/6/1 TI - A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development JO - JMIR Public Health Surveill SP - e19033 VL - 6 IS - 2 KW - COVID-19 KW - eHealth KW - connected care KW - telecare KW - cloud solution KW - telehealth KW - public health KW - infectious disease KW - pandemic KW - outbreak N2 - Background: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. Objective: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. Methods: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. Results: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. Conclusions: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19. UR - http://publichealth.jmir.org/2020/2/e19033/ UR - http://dx.doi.org/10.2196/19033 UR - http://www.ncbi.nlm.nih.gov/pubmed/32406855 ID - info:doi/10.2196/19033 ER - TY - JOUR AU - Sule, Ashutosh Anupam AU - Caputo, Dean AU - Gohal, Jaskaren AU - Dascenzo, Doug PY - 2020/5/22 TI - Desirable Features of an Interdisciplinary Handoff JO - JMIR Nursing SP - e18914 VL - 3 IS - 1 KW - handoff KW - transition KW - sign-out KW - electronic KW - interdisciplinary KW - interprofessional KW - communication KW - patient safety UR - https://nursing.jmir.org/2020/1/e18914/ UR - http://dx.doi.org/10.2196/18914 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345786 ID - info:doi/10.2196/18914 ER - TY - JOUR AU - Snoswell, L. Centaine AU - North, B. John AU - Caffery, J. Liam PY - 2020/5/21 TI - Economic Advantages of Telehealth and Virtual Health Practitioners: Return on Investment Analysis JO - JMIR Perioper Med SP - e15688 VL - 3 IS - 1 KW - clinical services KW - e-health KW - health economics KW - health funding and financing KW - rural and remote health KW - workforce N2 - Background: Telehealth is a disruptive modality that challenges the traditional model of having a clinician or patient physically present for an appointment. The benefit is that it offers the opportunity to redesign the way services are offered. For instance, a virtual health practitioner can provide videoconference consultations while being located anywhere in the world that has internet. A virtual health practitioner also obviates the issues of attracting a specialist medical workforce to rural areas, and allows the rural health service to control the specialist services that they offer. Objective: The aim of this research was to evaluate the economic effects of 3 different models of care on rural and metropolitan hospital sites. The models of care examined were patient travel, telehealth using videoconferencing, and employment of a virtual health practitioner by a rural site. Methods: Using retrospective activity data for 3 years, a return on investment (ROI) analysis was undertaken from the perspective of a rural site and metropolitan partner site using a telehealth orthopedic fracture clinic as an example. Further analysis was conducted to calculate the number of patients that would be required to attend the clinic in each model of care for the sites to break even. Results: The only service model that resulted in a positive ROI for the rural site over the 3-year period was the virtual health practitioner model. The breakeven analysis demonstrated that the rural site required the lowest number of patients to recoup costs in the virtual health practitioner model of care. The rural site was unable to recoup its costs within the travel model due to the lack of opportunity for reimbursement for services and the requirement to cover the cost of travel for patients. Conclusions: Our model demonstrated that rural health care providers can increase their ROI by employing a virtual health practitioner. UR - http://periop.jmir.org/2020/1/e15688/ UR - http://dx.doi.org/10.2196/15688 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393922 ID - info:doi/10.2196/15688 ER - TY - JOUR AU - Shaw, E. Sara AU - Seuren, Martinus Lucas AU - Wherton, Joseph AU - Cameron, Deborah AU - A'Court, Christine AU - Vijayaraghavan, Shanti AU - Morris, Joanne AU - Bhattacharya, Satyajit AU - Greenhalgh, Trisha PY - 2020/5/11 TI - Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction JO - J Med Internet Res SP - e18378 VL - 22 IS - 5 KW - delivery of health care KW - physical examination KW - remote consultation KW - telemedicine KW - health communication KW - language KW - nonverbal communication KW - mobile phone N2 - Background: Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. Objective: Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. Methods: We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). Results: Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. Conclusions: A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. International Registered Report Identifier (IRRID): RR2-10.2196/10913 UR - http://www.jmir.org/2020/5/e18378/ UR - http://dx.doi.org/10.2196/18378 UR - http://www.ncbi.nlm.nih.gov/pubmed/32391799 ID - info:doi/10.2196/18378 ER - TY - JOUR AU - Hong, Zhen AU - Li, Nian AU - Li, Dajiang AU - Li, Junhua AU - Li, Bing AU - Xiong, Weixi AU - Lu, Lu AU - Li, Weimin AU - Zhou, Dong PY - 2020/5/8 TI - Telemedicine During the COVID-19 Pandemic: Experiences From Western China JO - J Med Internet Res SP - e19577 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus disease KW - medical education KW - pandemics KW - teleteaching KW - tele-education KW - telemedicine UR - http://www.jmir.org/2020/5/e19577/ UR - http://dx.doi.org/10.2196/19577 UR - http://www.ncbi.nlm.nih.gov/pubmed/32349962 ID - info:doi/10.2196/19577 ER - TY - JOUR AU - Pérez Sust, Pol AU - Solans, Oscar AU - Fajardo, Carles Joan AU - Medina Peralta, Manuel AU - Rodenas, Pepi AU - Gabaldà, Jordi AU - Garcia Eroles, Luis AU - Comella, Adrià AU - Velasco Muñoz, César AU - Sallent Ribes, Josuè AU - Roma Monfa, Rosa AU - Piera-Jimenez, Jordi PY - 2020/5/4 TI - Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak JO - JMIR Public Health Surveill SP - e19106 VL - 6 IS - 2 KW - digital health KW - eHealth KW - telemedicine KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - public health KW - policymaking UR - http://publichealth.jmir.org/2020/2/e19106/ UR - http://dx.doi.org/10.2196/19106 UR - http://www.ncbi.nlm.nih.gov/pubmed/32339998 ID - info:doi/10.2196/19106 ER - TY - JOUR AU - Chen, Chien-I Sonia AU - Hu, Ridong AU - McAdam, Rodney PY - 2020/4/28 TI - Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study JO - J Med Internet Res SP - e14201 VL - 22 IS - 4 KW - connected health care KW - smart health care KW - health care quality KW - access KW - remote monitoring KW - precision medicine KW - self-management N2 - Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care?s direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. UR - http://www.jmir.org/2020/4/e14201/ UR - http://dx.doi.org/10.2196/14201 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343254 ID - info:doi/10.2196/14201 ER - TY - JOUR AU - Lin, Chun-Cheng AU - Chen, Yu-Pin AU - Chiang, Chao-Ching AU - Chang, Ming-Chau AU - Lee, Kuang-Sheng Oscar PY - 2020/4/22 TI - Real-Time Streaming of Surgery Performance and Intraoperative Imaging Data in the Hybrid Operating Room: Development and Usability Study JO - JMIR Med Inform SP - e18094 VL - 8 IS - 4 KW - hybrid operating room KW - real-time streaming KW - surgical telementoring KW - information technology infrastructure KW - encoder and decoder KW - real-world evidence KW - information technology KW - surgery KW - medical imaging KW - operating room N2 - Background: The trend of quick evolution and increased digital data in today?s operating rooms (ORs) has led to the construction of hybrid ORs. There is often a main control room with monitors for integrating intraoperative data from multiple devices in the hybrid OR. However, there is no adequate solution for communicating the data with people outside the OR. Objective: The objective of this study was to design an intelligent operating room (iOR) system, augmented onto the existing information technology (IT) infrastructure of hybrid ORs, to stream surgery performance and intraoperative imaging data. Methods: In this study, an all-in-one device with synergetic encoder and decoder was used. The device was able to stream multiple sources to one display. The lossless video and images from specific surgical workflows were streamed outside the hybrid OR through network protocols and were further managed by a streaming server and wireless control system. The steps of this study included the following: (1) defining the requirements and feasibility of an iOR system in the hybrid OR, (2) connecting multiple sources, (3) setting up equipment across the hybrid OR and a conference room, (4) designing a video management system, and (5) real-time streaming under specific surgical workflows. Results: The wired streamed video was shown simultaneously on the display in the hybrid OR and the display in the conference room with near-zero latency. Additionally, an interactive video between the hybrid OR and the conference room was achieved through the bidirectional wireless control system. The functions of recording, archiving, and playback were successfully provided by the streaming server. The readily available hardware components and open-access programming reduced the cost required to construct this streaming system. Conclusions: This flexible and cost-effective iOR system not only provided educational benefits, but also contributed to surgical telementoring. UR - http://medinform.jmir.org/2020/4/e18094/ UR - http://dx.doi.org/10.2196/18094 UR - http://www.ncbi.nlm.nih.gov/pubmed/32209528 ID - info:doi/10.2196/18094 ER - TY - JOUR AU - G Bianchi, Mara AU - Santos, Andre AU - Cordioli, Eduardo PY - 2020/4/21 TI - Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study JO - J Med Internet Res SP - e16700 VL - 22 IS - 4 KW - access to and use of services KW - decision making KW - epidemiology KW - economics KW - health care systems and management (telehealth) KW - management KW - technology KW - teledermatology KW - geriatric population N2 - Background: Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective: Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods: This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results: Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions: Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses. UR - http://www.jmir.org/2020/4/e16700/ UR - http://dx.doi.org/10.2196/16700 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314966 ID - info:doi/10.2196/16700 ER - TY - JOUR AU - Verma, Rhea AU - Krishnamurti, Tamar AU - Ray, N. Kristin PY - 2020/4/9 TI - Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study JO - J Med Internet Res SP - e16954 VL - 22 IS - 4 KW - consultation KW - referral KW - telemedicine KW - telehealth KW - child health KW - child health services N2 - Background: Electronic consultations, which use store-and-forward transfer of clinical information between a primary care physician and a specialist, improve access to specialty care. Adoption of electronic consultations is beginning in pediatric health care systems, but little is known about parent perspectives, informational needs, and preferences for interaction with this new model of care. Objective: This study aimed to examine parent perspectives about electronic consultations, including perceived benefits and risks, anticipated informational needs, and preferences for parent engagement with electronic consultations. Methods: We recruited caregivers of pediatric patients (aged 0-21 years) attending visits at an academic primary care center. Caregivers were eligible if their child had ever been referred for in-person specialty care. Caregivers participated in a semistructured interview about electronic consultations, including general perspectives, desired information, and preferences for parental engagement. Interviews were transcribed and qualitatively analyzed to identify parent perspectives on electronic consultations in general, information parents would like to receive about electronic consultations, and perspectives on opportunities to enhance parent engagement with electronic consultations. Results: Interviewees (n=20) anticipated that electronic consultations would reduce the time burden of specialty care on families and that these had the potential to improve the integrity and availability of clinical information, but interviewees also expressed concern about data confidentiality. The most detailed information desired by interviewees about electronic consultations related to data security, including data confidentiality, availability, and integrity. Interviewees expressed concern that electronic consultations could exclude parents from their child?s health care decisions. Interviewees saw value in the potential ability to track the consultation status or to participate in the consultation dialogue, but they were more ambivalent about the idea of read-only access to consultation documentation. Conclusions: Parents identified the potential risks and benefits of pediatric electronic consultations, with implications for communication with families about electronic consultations and for incorporation of features to enhance parent engagement. UR - https://www.jmir.org/2020/4/e16954 UR - http://dx.doi.org/10.2196/16954 UR - http://www.ncbi.nlm.nih.gov/pubmed/32084626 ID - info:doi/10.2196/16954 ER - TY - JOUR AU - O'Cathail, Micheal AU - Sivanandan, Ananth M. AU - Diver, Claire AU - Patel, Poulam AU - Christian, Judith PY - 2020/3/16 TI - The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review JO - JMIR Med Inform SP - e15380 VL - 8 IS - 3 KW - telehealth KW - telemedicine KW - teleconsultation KW - scoping review N2 - Background: The National Health Service (NHS) Long-Term Plan has set out a vision of enabling patients to access digital interactions with health care professionals within 5 years, including by video link. Objective: This review aimed to examine the extent and nature of the use of patient-facing teleconsultations within a health care setting in the United Kingdom and what outcome measures have been assessed. Methods: We conducted a systematic scoping review of teleconsultation studies following the Joanna Briggs Institute methodology. PubMed, Scopus, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched up to the end of December 2018 for publications that reported on the use of patient-facing teleconsultations in a UK health care setting. Results: The search retrieved 3132 publications, of which 101 were included for a full review. Overall, the studies were heterogeneous in design, in the specialty assessed, and reported outcome measures. The technology used for teleconsultations changed over time with earlier studies employing bespoke, often expensive, solutions. Two-thirds of the studies, conducted between 1995 and 2005, used this method. Later studies transitioned to Web-based commercial solutions such as Skype. There were five outcome measures that were assessed: (1) technical feasibility, (2) user satisfaction, (3) clinical effectiveness, (4) cost, (5) logistical and operational considerations. Due to the changing nature of technology over time, there were differing technical issues across the studies. Generally, teleconsultations were acceptable to patients, but this was less consistent among health care professionals. However, among both groups, face-to-face consultations were still seen as the gold standard. A wide range of clinical scenarios found teleconsultations to be clinically useful but potentially limited to more straightforward clinical interactions. Due to the wide array of study types and changes in technology over time, it is difficult to draw definitive conclusions on the cost involved. However, cost savings for health care providers have been demonstrated by the goal-directed implementation of teleconsultations. The integration of technology into routine practice represents a complex problem with barriers identified in funding and hospital reimbursement, information technologies infrastructure, and integration into clinicians? workflow. Conclusions: Teleconsultations appear to be safe and effective in the correct clinical situations. Where offered, it is likely that patients will be keen to engage, although teleconsultations should only be offered as an option to support traditional care models rather than replace them outright. Health care staff should be encouraged and supported in using teleconsultations to diversify their practice. Health care organizations need to consider developing a digital technology strategy and implementation groups to assist health care staff to integrate digitally enabled care into routine practice. The introduction of new technologies should be assessed after a set period with service evaluations, including feedback from key stakeholders. UR - http://medinform.jmir.org/2020/3/e15380/ UR - http://dx.doi.org/10.2196/15380 UR - http://www.ncbi.nlm.nih.gov/pubmed/32175911 ID - info:doi/10.2196/15380 ER - TY - JOUR AU - Park, Rang Yu AU - Koo, HaYeong AU - Yoon, Young-Kwang AU - Park, Sumi AU - Lim, Young-Suk AU - Baek, Seunghee AU - Kim, Reong Hae AU - Kim, Won Tae PY - 2020/2/27 TI - Expedited Safety Reporting Through an Alert System for Clinical Trial Management at an Academic Medical Center: Retrospective Design Study JO - JMIR Med Inform SP - e14379 VL - 8 IS - 2 KW - clinical trial KW - adverse event KW - early detection KW - patient safety N2 - Background: Early detection or notification of adverse event (AE) occurrences during clinical trials is essential to ensure patient safety. Clinical trials take advantage of innovative strategies, clinical designs, and state-of-the-art technologies to evaluate efficacy and safety, however, early awareness of AE occurrences by investigators still needs to be systematically improved. Objective: This study aimed to build a system to promptly inform investigators when clinical trial participants make unscheduled visits to the emergency room or other departments within the hospital. Methods: We developed the Adverse Event Awareness System (AEAS), which promptly informs investigators and study coordinators of AE occurrences by automatically sending text messages when study participants make unscheduled visits to the emergency department or other clinics at our center. We established the AEAS in July 2015 in the clinical trial management system. We compared the AE reporting timeline data of 305 AE occurrences from 74 clinical trials between the preinitiative period (December 2014-June 2015) and the postinitiative period (July 2015-June 2016) in terms of three AE awareness performance indicators: onset to awareness, awareness to reporting, and onset to reporting. Results: A total of 305 initial AE reports from 74 clinical trials were included. All three AE awareness performance indicators were significantly lower in the postinitiative period. Specifically, the onset-to-reporting times were significantly shorter in the postinitiative period (median 1 day [IQR 0-1], mean rank 140.04 [SD 75.35]) than in the preinitiative period (median 1 day [IQR 0-4], mean rank 173.82 [SD 91.07], P?.001). In the phase subgroup analysis, the awareness-to-reporting and onset-to-reporting indicators of phase 1 studies were significantly lower in the postinitiative than in the preinitiative period (preinitiative: median 1 day, mean rank of awareness to reporting 47.94, vs postinitiative: median 0 days, mean rank of awareness to reporting 35.75, P=.01; and preinitiative: median 1 day, mean rank of onset to reporting 47.4, vs postinitiative: median 1 day, mean rank of onset to reporting 35.99, P=.03). The risk-level subgroup analysis found that the onset-to-reporting time for low- and high-risk studies significantly decreased postinitiative (preinitiative: median 4 days, mean rank of low-risk studies 18.73, vs postinitiative: median 1 day, mean rank of low-risk studies 11.76, P=.02; and preinitiative: median 1 day, mean rank of high-risk studies 117.36, vs postinitiative: median 1 day, mean rank of high-risk studies 97.27, P=.01). In particular, onset to reporting was reduced more in the low-risk trial than in the high-risk trial (low-risk: median 4-0 days, vs high-risk: median 1-1 day). Conclusions: We demonstrated that a real-time automatic alert system can effectively improve safety reporting timelines. The improvements were prominent in phase 1 and in low- and high-risk clinical trials. These findings suggest that an information technology-driven automatic alert system effectively improves safety reporting timelines, which may enhance patient safety. UR - http://medinform.jmir.org/2020/2/e14379/ UR - http://dx.doi.org/10.2196/14379 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/14379 ER - TY - JOUR AU - Jiang, Jinglu AU - Cameron, Ann-Frances AU - Yang, Ming PY - 2020/2/18 TI - Analysis of Massive Online Medical Consultation Service Data to Understand Physicians? Economic Return: Observational Data Mining Study JO - JMIR Med Inform SP - e16765 VL - 8 IS - 2 KW - Web-based health services KW - remote consultation KW - machine learning KW - data mining KW - decision tree KW - patient involvement N2 - Background: Online health care consultation has become increasingly popular and is considered a potential solution to health care resource shortages and inefficient resource distribution. However, many online medical consultation platforms are struggling to attract and retain patients who are willing to pay, and health care providers on the platform have the additional challenge of standing out in a crowd of physicians who can provide comparable services. Objective: This study used machine learning (ML) approaches to mine massive service data to (1) identify the important features that are associated with patient payment, as opposed to free trial?only appointments; (2) explore the relative importance of these features; and (3) understand how these features interact, linearly or nonlinearly, in relation to payment. Methods: The dataset is from the largest China-based online medical consultation platform, which covers 1,582,564 consultation records between patient-physician pairs from 2009 to 2018. ML techniques (ie, hyperparameter tuning, model training, and validation) were applied with four classifiers?logistic regression, decision tree (DT), random forest, and gradient boost?to identify the most important features and their relative importance for predicting paid vs free-only appointments. Results: After applying the ML feature selection procedures, we identified 11 key features on the platform, which are potentially useful to predict payment. For the binary ML classification task (paid vs free services), the 11 features as a whole system achieved very good prediction performance across all four classifiers. DT analysis further identified five distinct subgroups of patients delineated by five top-ranked features: previous offline connection, total dialog, physician response rate, patient privacy concern, and social return. These subgroups interact with the physician differently, resulting in different payment outcomes. Conclusions: The results show that, compared with features related to physician reputation, service-related features, such as service delivery quality (eg, consultation dialog intensity and physician response rate), patient source (eg, online vs offline returning patients), and patient involvement (eg, provide social returns and reveal previous treatment), appear to contribute more to the patient?s payment decision. Promoting multiple timely responses in patient-provider interactions is essential to encourage payment. UR - http://medinform.jmir.org/2020/2/e16765/ UR - http://dx.doi.org/10.2196/16765 UR - http://www.ncbi.nlm.nih.gov/pubmed/32069213 ID - info:doi/10.2196/16765 ER - TY - JOUR AU - Jung, Yul Kwang AU - Kim, SuJin AU - Kim, Kihyung AU - Lee, Ju Eun AU - Kim, Kyunga AU - Lee, Jeanhyoung AU - Choi, Soo Jong AU - Kang, Mira AU - Chang, Kyung Dong AU - Cha, Chul Won PY - 2020/2/14 TI - Frequent Mobile Electronic Medical Records Users Respond More Quickly to Emergency Department Consultation Requests: Retrospective Quantitative Study JO - JMIR Mhealth Uhealth SP - e14487 VL - 8 IS - 2 KW - electronic medical record KW - emergency department KW - mobile health KW - time efficiency N2 - Background: Specialty consultation is a critical aspect of emergency department (ED) practice, and a delay in providing consultation might have a significant clinical effect and worsen ED overcrowding. Although mobile electronic medical records (EMR) are being increasingly used and are known to improve the workflow of health care providers, limited studies have evaluated their effectiveness in real-life clinical scenarios. Objective: For this study, we aimed to determine the association between response duration to an ED specialty consultation request and the frequency of mobile EMR use. Methods: This retrospective study was conducted in an academic ED in Seoul, South Korea. We analyzed EMR and mobile EMR data from May 2018 to December 2018. Timestamps of ED consultation requests were retrieved from a PC-based EMR, and the response interval was calculated. Doctors? log frequencies were obtained from the mobile EMR, and we merged data using doctors? deidentification numbers. Pearson?s product-moment correlation was performed to identify this association. The primary outcome was the relationship between the frequency of mobile EMR usage and the time interval from ED request to consultation completion by specialty doctors. The secondary outcome was the relationship between the frequency of specialty doctors? mobile EMR usage and the response time to consultation requests. Results: A total of 25,454 consultations requests were made for 15,555 patients, and 252 specialty doctors provided ED specialty consultations. Of the 742 doctors who used the mobile EMR, 208 doctors used it for the specialty consultation process. After excluding the cases lacking essential information, 21,885 consultations with 208 doctors were included for analysis. According to the mobile EMR usage pattern, the average usage frequency of all users was 13.3 logs/day, and the average duration of the completion of the specialty consultation was 51.7 minutes. There was a significant inverse relationship between the frequency of mobile EMR usage and time interval from ED request to consultation completion by specialty doctors (coefficient=?0.19; 95% CI ?0.32 to ?0.06; P=.005). Secondary analysis with the response time was done. There was also a significant inverse relationship between the frequency of specialty doctors? mobile EMR usage and the response time to consultation requests (coefficient=?0.18; 95% CI ?0.30 to ?0.04; P=.009). Conclusions: Our findings suggest that frequent mobile EMR usage is associated with quicker response time to ED consultation requests. UR - http://mhealth.jmir.org/2020/2/e14487/ UR - http://dx.doi.org/10.2196/14487 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130157 ID - info:doi/10.2196/14487 ER - TY - JOUR AU - Fernández, Solans Oscar AU - Seguí, López Francesc AU - Vidal-Alaball, Josep AU - Bonet Simo, Maria Josep AU - Vian, Hernandez Oscar AU - Cabo, Roig Pascual AU - Hernandez, Carrasco Marta AU - Dominguez, Olmos Carmen AU - Reig, Alzaga Xavier AU - Rodríguez, Díaz Yesika AU - Peralta, Medina Manuel AU - Hermosilla, Eduardo AU - León, Martínez Nuria AU - Guimferrer, Nuria AU - González, Abizanda Mercedes AU - Cuyàs, García Francesc AU - Sust, Pérez Pol PY - 2020/1/31 TI - Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study JO - JMIR Med Inform SP - e16484 VL - 8 IS - 1 KW - tele-medicine KW - tele-consultation KW - remote consultation KW - primary care KW - general practitioners N2 - Background: eConsulta is a tele-consultation service involving doctors and patients, and is part of Catalonia's public health information technology system. The service has been in operation since the end of 2015 as an adjunct to face-to-face consultations. A key factor in understanding the barriers and facilitators to the acceptance of the tool is understanding the sociodemographic characteristics of general practitioners who determine its use. Objective: This study aimed to analyze the sociodemographic factors that affect the likelihood of doctors using eConsulta. Methods: A retrospective cross-sectional analysis of administrative data was used to perform a multivariate logistic regression analysis on the use of eConsulta in relation to sociodemographic variables. Results: The model shows that the doctors who use eConsulta are 45-54 years of age, score higher than the 80th percentile on the quality of care index, have a high degree of accessibility, are involved in teaching, and work on a health team in a high socioeconomic urban setting. Conclusions: The results suggest that certain sociodemographic characteristics associated with general practitioners determine whether they use eConsulta. These results must be taken into account if its deployment is to be encouraged in the context of a public health system. UR - http://medinform.jmir.org/2020/1/e16484/ UR - http://dx.doi.org/10.2196/16484 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012061 ID - info:doi/10.2196/16484 ER - TY - JOUR AU - Lo, Yu-Sheng AU - Yang, Cheng-Yi AU - Chien, Hsiung-Fei AU - Chang, Shy-Shin AU - Lu, Chung-Ying AU - Chen, Ray-Jade PY - 2019/12/4 TI - Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study JO - J Med Internet Res SP - e13563 VL - 21 IS - 12 KW - medical referral KW - electronic referral system KW - blockchain KW - decentralized application KW - electronic medical records KW - electronic health records KW - interoperability N2 - Background: Medical referral is the transfer of a patient?s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA?s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. Objective: To eliminate the existing restrictions of the NHIA?s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA?s NMR referral data to build an alliance-based medical referral service connecting health care facilities. Methods: We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA?s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients? behavior and investigate the acceptance of our personal authorization-controlled framework. Results: The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. Conclusions: This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption. UR - https://www.jmir.org/2019/12/e13563 UR - http://dx.doi.org/10.2196/13563 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799935 ID - info:doi/10.2196/13563 ER - TY - JOUR AU - Mold, Freda AU - Hendy, Jane AU - Lai, Yi-Ling AU - de Lusignan, Simon PY - 2019/12/3 TI - Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review JO - JMIR Med Inform SP - e13042 VL - 7 IS - 4 KW - referral and consultation KW - health services accessibility KW - primary health care KW - general practice KW - patient access to records KW - patient portals KW - Web-based access N2 - Background: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective: This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods: A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results: This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow. UR - http://medinform.jmir.org/2019/4/e13042/ UR - http://dx.doi.org/10.2196/13042 UR - http://www.ncbi.nlm.nih.gov/pubmed/31793888 ID - info:doi/10.2196/13042 ER - TY - JOUR AU - Hoffmann, Mariell AU - Hartmann, Mechthild AU - Wensing, Michel AU - Friederich, Hans-Christoph AU - Haun, W. Markus PY - 2019/08/19 TI - Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians JO - J Med Internet Res SP - e13382 VL - 21 IS - 8 KW - video consultations KW - videoconferencing KW - integrated behavioral health KW - primary care KW - health services research KW - mental health N2 - Background: Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective: This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods: In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results: Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions: By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487 UR - http://www.jmir.org/2019/8/e13382/ UR - http://dx.doi.org/10.2196/13382 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429419 ID - info:doi/10.2196/13382 ER - TY - JOUR AU - Jewer, Jennifer AU - Parsons, H. Michael AU - Dunne, Cody AU - Smith, Andrew AU - Dubrowski, Adam PY - 2019/8/6 TI - Evaluation of a Mobile Telesimulation Unit to Train Rural and Remote Practitioners on High-Acuity Low-Occurrence Procedures: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e14587 VL - 21 IS - 8 KW - medical education KW - distributed medical education KW - simulation training KW - emergency medicine KW - rural health KW - remote-facilitation KW - assessment KW - chest tubes N2 - Background: The provision of acute medical care in rural and remote areas presents unique challenges for practitioners. Therefore, a tailored approach to training providers would prove beneficial. Although simulation-based medical education (SBME) has been shown to be effective, access to such training can be difficult and costly in rural and remote areas. Objective: The aim of this study was to evaluate the educational efficacy of simulation-based training of an acute care procedure delivered remotely, using a portable, self-contained unit outfitted with off-the-shelf and low-cost telecommunications equipment (mobile telesimulation unit, MTU), versus the traditional face-to-face approach. A conceptual framework based on a combination of Kirkpatrick?s Learning Evaluation Model and Miller?s Clinical Assessment Framework was used. Methods: A written procedural skills test was used to assess Miller?s learning level? knows ?at 3 points in time: preinstruction, immediately postinstruction, and 1 week later. To assess procedural performance (shows how), participants were video recorded performing chest tube insertion before and after hands-on supervised training. A modified Objective Structured Assessment of Technical Skills (OSATS) checklist and a Global Rating Scale (GRS) of operative performance were used by a blinded rater to assess participants? performance. Kirkpatrick?s reaction was measured through subject completion of a survey on satisfaction with the learning experiences and an evaluation of training. Results: A total of 69 medical students participated in the study. Students were randomly assigned to 1 of the following 3 groups: comparison (25/69, 36%), intervention (23/69, 33%), or control (21/69, 31%). For knows, as expected, no significant differences were found between the groups on written knowledge (posttest, P=.13). For shows how, no significant differences were found between the comparison and intervention groups on the procedural skills learning outcomes immediately after the training (OSATS checklist and GRS, P=1.00). However, significant differences were found for the control versus comparison groups (OSATS checklist, P<.001; GRS, P=.02) and the control versus intervention groups (OSATS checklist, P<.001; GRS, P=.01) on the pre- and postprocedural performance. For reaction, there were no statistically significant differences between the intervention and comparison groups on the satisfaction with learning items (P=.65 and P=.79) or the evaluation of the training (P=.79, P=.45, and P=.31). Conclusions: Our results demonstrate that simulation-based training delivered remotely, applying our MTU concept, can be an effective way to teach procedural skills. Participants trained remotely in the MTU had comparable learning outcomes (shows how) to those trained face-to-face. Both groups received statistically significant higher procedural performance scores than those in the control group. Participants in both instruction groups were equally satisfied with their learning and training (reaction). We believe that mobile telesimulation could be an effective way of providing expert mentorship and overcoming a number of barriers to delivering SBME in rural and remote locations. UR - http://www.jmir.org/2019/8/e14587/ UR - http://dx.doi.org/10.2196/14587 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/14587 ER - TY - JOUR AU - Seto, Emily AU - Morita, Pelegrini Plinio AU - Tomkun, Jonathan AU - Lee, M. Theresa AU - Ross, Heather AU - Reid-Haughian, Cheryl AU - Kaboff, Andrew AU - Mulholland, Deb AU - Cafazzo, A. Joseph PY - 2019/07/26 TI - Implementation of a Heart Failure Telemonitoring System in Home Care Nursing: Feasibility Study JO - JMIR Med Inform SP - e11722 VL - 7 IS - 3 KW - patient monitoring KW - home care services KW - heart failure KW - mobile phone KW - feasibility studies N2 - Background: Telemonitoring (TM) of heart failure (HF) patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementing TM through a home care nursing agency. Objective: This study aimed to determine the feasibility of implementing a mobile phone?based TM system through a home care nursing agency and to explore the feasibility of conducting a future effectiveness trial. Methods: A feasibility study was conducted by recruiting, through community cardiologists and family physicians, 10 to 15 HF patients who would use the TM system for 4 months by taking daily measurements of weight and blood pressure and recording symptoms. Home care nurses responded to alerts generated by the TM system through either a phone call and/or a home visit. Patients and their clinicians were interviewed poststudy to determine their perceptions and experiences of using the TM system. Results: Only one community cardiologist was recruited who was willing to refer patients to this study, even after multiple attempts were made to recruit further physicians, including family physicians. The cardiologist referred only 6 patients over a 6-month period, and half of the patients dropped out of the study. The identified barriers to implementing the TM system in home care nursing were numerous and led to the small recruitment in patients and clinicians and large dropout rate. These barriers included challenges in nurses contacting patients and physicians, issues related to retention, and challenges related to integrating the TM system into a complex home care nursing workflow. However, some potential benefits of TM through a home care nursing agency were indicated, including improved patient education, providing nurses with a better understanding of the patient?s health status, and reductions in home visits. Conclusions: Lessons learned included the need to incentivize physicians, to ensure streamlined processes for recruitment and communication, to target appropriate patient populations, and to create a core clinical group. Barriers encountered in this feasibility trial should be considered to determine their applicability when deploying innovations into different service delivery models. UR - http://medinform.jmir.org/2019/3/e11722/ UR - http://dx.doi.org/10.2196/11722 UR - http://www.ncbi.nlm.nih.gov/pubmed/31350841 ID - info:doi/10.2196/11722 ER - TY - JOUR AU - Nabelsi, Véronique AU - Lévesque-Chouinard, Annabelle AU - Liddy, Clare AU - Dumas Pilon, Maxine PY - 2019/07/10 TI - Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study JO - JMIR Med Inform SP - e13354 VL - 7 IS - 3 KW - primary health care KW - referrals KW - physicians KW - specialists KW - health information systems N2 - Background: Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. Objective: The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). Methods: We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. Results: For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. Conclusions: The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority. UR - http://medinform.jmir.org/2019/3/e13354/ UR - http://dx.doi.org/10.2196/13354 UR - http://www.ncbi.nlm.nih.gov/pubmed/31293239 ID - info:doi/10.2196/13354 ER - TY - JOUR AU - Liu, Luwen AU - Duan, Shaobo AU - Zhang, Ye AU - Wu, Yuejin AU - Zhang, Lianzhong PY - 2019/07/08 TI - Initial Experience of the Synchronized, Real-Time, Interactive, Remote Transthoracic Echocardiogram Consultation System in Rural China: Longitudinal Observational Study JO - JMIR Med Inform SP - e14248 VL - 7 IS - 3 KW - three synchronization KW - double-real-time KW - interactive KW - remote consultation on UCG KW - dynamic image decoding KW - synchronization technology N2 - Background: China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. Objective: This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. Methods: By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People?s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. Results: This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. Conclusions: The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability. UR - http://medinform.jmir.org/2019/3/e14248/ UR - http://dx.doi.org/10.2196/14248 UR - http://www.ncbi.nlm.nih.gov/pubmed/31287062 ID - info:doi/10.2196/14248 ER - TY - JOUR AU - Li, Yumei AU - Yan, Xiangbin AU - Song, Xiaolong PY - 2019/06/03 TI - Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website JO - J Med Internet Res SP - e12126 VL - 21 IS - 6 KW - e-consultation KW - medical service KW - fee KW - China N2 - Background: Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services. Objective: This study sought to examine doctors? participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces. Methods: This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group. Results: There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors? charges range from ¥20 to ¥30. Conclusions: Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China. UR - https://www.jmir.org/2019/6/e12126/ UR - http://dx.doi.org/10.2196/12126 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162129 ID - info:doi/10.2196/12126 ER - TY - JOUR AU - Rademacher, James Nicholas AU - Cole, Gai AU - Psoter, J. Kevin AU - Kelen, Gabor AU - Fan, Zhi Jamie Wei AU - Gordon, Dennis AU - Razzak, Junaid PY - 2019/05/08 TI - Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine JO - JMIR Med Inform SP - e11233 VL - 7 IS - 2 KW - telemedicine KW - telehealth KW - screening KW - triage KW - emergency medicine KW - emergency health services KW - emergency medical service KW - left without being seen KW - emergency room KW - emergency department KW - tele-medicine N2 - Background: Early efforts to incorporate telemedicine into Emergency Medicine focused on connecting remote treatment clinics to larger emergency departments (EDs) and providing remote consultation services to EDs with limited resources. Owing to continued ED overcrowding, some EDs have used telemedicine to increase the number of providers during surges of patient visits and offer scheduled ?home? face-to-face, on-screen encounters. In this study, we used remote on-screen telemedicine providers in the ?screening-in-triage? role. Objective: This study aimed to compare the efficiency and patient safety of in-person screening and telescreening. Methods: This cohort study, matched for days and proximate hours, compared the performance of real-time remote telescreening and in-person screening at a single urban academic ED over 22 weeks in the spring and summer of 2016. The study involved 337 standard screening hours and 315 telescreening hours. The primary outcome measure was patients screened per hour. Additional outcomes were rates of patients who left without being seen, rates of analgesia ordered by the screener, and proportion of patients with chest pain receiving or prescribed a standard set of tests and medications. Results: In-person screeners evaluated 1933 patients over 337 hours (5.7 patients per hour), whereas telescreeners evaluated 1497 patients over 315 hours (4.9 patients per hour; difference=0.8; 95% CI 0.5-1.2). Split analysis revealed that for the final 3 weeks of the evaluation, the patient-per-hour rate differential was neither clinically relevant nor statistically discernable (difference=0.2; 95% CI ?0.7 to 1.2). There were fewer patients who left without being seen during in-person screening than during telescreening (2.6% vs 3.8%; difference=?1.2; 95% CI ?2.4 to 0.0). However, compared to prior year-, date-, and time-matched data on weekdays from 1 am to 3 am, a period previously void of provider screening, telescreening decreased the rate of patients LWBS from 25.1% to 4.5% (difference=20.7%; 95% CI 10.1-31.2). Analgesia was ordered more frequently by telescreeners than by in-person screeners (51.2% vs 31.6%; difference=19.6%; 95% CI 12.1-27.1). There was no difference in standard care received by patients with chest pain between telescreening and in-person screening (29.4% vs 22.4%; difference=7.0%; 95% CI ?3.4 to 17.4). Conclusions: Although the efficiency of telescreening, as measured by the rate of patients seen per hour, was lower early in the study period, telescreening achieved the same level of efficiency as in-person screening by the end of the pilot study. Adding telescreening during 1-3 am on weekdays dramatically decreased the number of patients who left without being seen compared to historic data. Telescreening was an effective and safe way for this ED to expand the hours in which patients were screened by a health care provider in triage. UR - http://medinform.jmir.org/2019/2/e11233/ UR - http://dx.doi.org/10.2196/11233 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066698 ID - info:doi/10.2196/11233 ER - TY - JOUR AU - Murray-Torres, Teresa AU - Casarella, Aparna AU - Bollini, Mara AU - Wallace, Frances AU - Avidan, S. Michael AU - Politi, C. Mary PY - 2019/04/23 TI - Anesthesiology Control Tower?Feasibility Assessment to Support Translation (ACTFAST): Mixed-Methods Study of a Novel Telemedicine-Based Support System for the Operating Room JO - JMIR Hum Factors SP - e12155 VL - 6 IS - 2 KW - clinical decision support systems KW - usability KW - anesthesiology KW - telemedicine N2 - Background: Despite efforts to improve patient outcomes, major morbidity and mortality remain common after surgery. Health information technologies that provide decision support for clinicians might improve perioperative and postoperative patient care. Evaluating the usability of these technologies and barriers to their implementation can facilitate their acceptance within health systems. Objective: This manuscript describes usability testing and refinement of an innovative telemedicine-based clinical support system, the Anesthesiology Control Tower (ACT). It also reports stakeholders? perceptions of the barriers and facilitators to implementation of the intervention. Methods: Three phases of testing were conducted in an iterative manner. Phase 1 testing employed a think-aloud protocol analysis to identify surface-level usability problems with individual software components of the ACT and its structure. Phase 2 testing involved an extended qualitative and quantitative real-world usability analysis. Phase 3 sought to identify major barriers and facilitators to implementation of the ACT through semistructured interviews with key stakeholders. Results: Phase 1 and phase 2 usability testing sessions identified numerous usability problems with the software components of the ACT. The ACT platform was revised in seven iterations in response to these usability concerns. Initial satisfaction with the ACT, as measured by standardized instruments, was below commonly accepted cutoffs for these measures. Satisfaction improved to acceptable levels over the course of revision and testing. A number of barriers to implementation were also identified and addressed during the refinement of the ACT intervention. Conclusions: The ACT model can improve the standard of perioperative anesthesia care. Through our thorough and iterative usability testing process and stakeholder assessment of barriers and facilitators, we enhanced the acceptability of this novel technology and improved our ability to implement this innovation into routine practice. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-018-0233-4 UR - http://humanfactors.jmir.org/2019/2/e12155/ UR - http://dx.doi.org/10.2196/12155 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012859 ID - info:doi/10.2196/12155 ER - TY - JOUR AU - Yang, Hualong AU - Zhang, Xiaofei PY - 2019/03/22 TI - Investigating the Effect of Paid and Free Feedback About Physicians' Telemedicine Services on Patients? and Physicians? Behaviors: Panel Data Analysis JO - J Med Internet Res SP - e12156 VL - 21 IS - 3 KW - telemedicine KW - feedback KW - physician rating KW - health care quality KW - decision making KW - physicians? contribution N2 - Background: In recent years, paid online patient-physician interaction has been incorporated into the telemedicine markets. With the development of telemedicine and telemedicine services, online feedback has been widely applied, helping other patients to identify quality services. Recently, in China, a new type of service feedback has been applied to the telemedicine markets, namely, paid feedback. Patients who are satisfied with a physician?s online service can buy a virtual gift or give a tip to the physicians. This paid feedback can improve the reliability of service feedback and reduce the proportion of false information because it increases the cost for feedback providers. Paid online feedback can benefit the physicians, such as by providing them with monetary incentives; however, research on the impacts and value of such paid feedback from the physician perspective in the telemedicine markets is scant. To fill this research gap, this study was designed to understand the role of paid feedback by developing a research model based on the theories of signaling and self-determination. Objective: This study aimed to explore the effects of free and paid feedback on patients? choice and physicians? behaviors as well as to investigate the substitute relationship between these 2 types of feedback in the telemedicine markets. Methods: A JAVA software program was used to collect online patient-doctor interaction data over a 6-month period from a popular telemedicine market in China (Good Physician Online). This study drew on a 2-equation panel model to test the hypotheses. Both fixed and random effect models were used to estimate the combined effects of paid feedback and free feedback on patients? choice and physicians? contribution. Finally, the Hausman test was adopted to investigate which model is better to explain our empirical results. Results: The results of this study show that paid feedback has a stronger effect on patients? choice (a5=0.566; t2192=9.160; P<.001) and physicians? contribution (?4=1.332; t2193=11.067; P<.001) in telemedicine markets than free feedback. Moreover, our research also proves that paid feedback and free feedback have a substitute relationship in determining patients? and physicians? behaviors (a6=?0.304; t2191=?5.805; P<.001 and ?5=?0.823; t2192=?8.136; P<.001). Conclusions: Our findings contribute to the extant literature on service feedback in the telemedicine markets and provide insight for relevant stakeholders into how to design an effective feedback mechanism to improve patients? service experience and physicians? engagement. UR - http://www.jmir.org/2019/3/e12156/ UR - http://dx.doi.org/10.2196/12156 UR - http://www.ncbi.nlm.nih.gov/pubmed/30900997 ID - info:doi/10.2196/12156 ER - TY - JOUR AU - Kruse, Clemens AU - Pesek, Brandon AU - Anderson, Megan AU - Brennan, Kacey AU - Comfort, Hilary PY - 2019/03/20 TI - Telemonitoring to Manage Chronic Obstructive Pulmonary Disease: Systematic Literature Review JO - JMIR Med Inform SP - e11496 VL - 7 IS - 1 KW - telemedicine KW - COPD KW - chronic disease N2 - Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death throughout the world. Telemedicine has been utilized for many diseases and its prevalence is increasing in the United States. Telemonitoring of patients with COPD has the potential to help patients manage disease and predict exacerbations. Objective: The objective of this review is to evaluate the effectiveness of telemonitoring to manage COPD. Researchers want to determine how telemonitoring has been used to observe COPD and we are hoping this will lead to more research in telemonitoring of this disease. Methods: This review was conducted in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Authors performed a systematic review of the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to obtain relevant articles. Articles were then accepted or rejected by group consensus. Each article was read and authors identified barriers and facilitators to effectiveness of telemonitoring of COPD. Results: Results indicate that conflicting information exists for the effectiveness of telemonitoring of patients with COPD. Primarily, 13 out of 29 (45%) articles stated that patient outcomes were improved overall with telemonitoring, while 11 of 29 (38%) indicated no improvement. Authors identified the following facilitators: reduced need for in-person visits, better disease management, and bolstered patient-provider relationship. Important barriers included low-quality data, increased workload for providers, and cost. Conclusions: The high variability between the articles and the ways they provided telemonitoring services created conflicting results from the literature review. Future research should emphasize standardization of telemonitoring services and predictability of exacerbations. UR - http://medinform.jmir.org/2019/1/e11496/ UR - http://dx.doi.org/10.2196/11496 UR - http://www.ncbi.nlm.nih.gov/pubmed/30892276 ID - info:doi/10.2196/11496 ER - TY - JOUR AU - Deisz, Robert AU - Rademacher, Susanne AU - Gilger, Katrin AU - Jegen, Rudolf AU - Sauerzapfe, Barbara AU - Fitzner, Christina AU - Stoppe, Christian AU - Benstoem, Carina AU - Marx, Gernot PY - 2019/01/15 TI - Additional Telemedicine Rounds as a Successful Performance-Improvement Strategy for Sepsis Management: Observational Multicenter Study JO - J Med Internet Res SP - e11161 VL - 21 IS - 1 KW - intensive care KW - outcome improvement KW - sepsis KW - sepsis bundle compliance KW - SSC KW - tele-ICU KW - telemedicine N2 - Background: Sepsis is a major health care problem with high morbidity and mortality rates and affects millions of patients. Telemedicine, defined as the exchange of medical information via electronic communication, improves the outcome of patients with sepsis and decreases the mortality rate and length of stay in the intensive care unit (ICU). Additional telemedicine rounds could be an effective component of performance-improvement programs for sepsis, especially in underserved rural areas and hospitals without ready access to critical care physicians. Objective: Our aim was to evaluate the impact of additional daily telemedicine rounds on adherence to sepsis bundles. We hypothesized that additional telemedicine support may increase adherence to sepsis guidelines and improve the detection rates of sepsis and septic shock. Methods: We conducted a retrospective, observational, multicenter study between January 2014 and July 2015 with one tele-ICU center and three ICUs in Germany. We implemented telemedicine as part of standard care and collected data continuously during the study. During the daily telemedicine rounds, routine screening for sepsis was conducted and adherence to the Surviving Sepsis Campaign?s 3-hour and 6-hour sepsis bundles were evaluated. Results: In total, 1168 patients were included in this study, of which 196 were positive for severe sepsis and septic shock. We found that additional telemedicine rounds improved adherence to the 3-hour (Quarter 1, 35% vs Quarter 6, 76.2%; P=.01) and 6-hour (Quarter 1, 50% vs Quarter 6, 95.2%; P=.001) sepsis bundles. In addition, we noted an increase in adherence to the item ?Administration of fluids when hypotension? (Quarter 1, 80% vs Quarter 6, 100%; P=.049) of the 3-hour bundle and the item ?Remeasurement of lactate? (Quarter 1, 65% vs Quarter 6, 100%, P=.003) of the 6-hour bundle. The ICU length of stay after diagnosis of severe sepsis and septic shock remained unchanged over the observation period. Due to a higher number of patients with sepsis in Quarter 5 (N=60) than in other quarters, we observed stronger effects of the additional rounds on mortality in this quarter (Quarter 1, 50% vs Quarter 5, 23.33%, P=.046). Conclusions: Additional telemedicine rounds are an effective component of and should be included in performance-improvement programs for sepsis management. UR - http://www.jmir.org/2019/1/e11161/ UR - http://dx.doi.org/10.2196/11161 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664476 ID - info:doi/10.2196/11161 ER - TY - JOUR AU - Blosnich, R. John AU - Rodriguez, L. Keri AU - Hruska, L. Kristina AU - Kavalieratos, Dio AU - Gordon, J. Adam AU - Matza, Alexis AU - Mejia, M. Susan AU - Shipherd, C. Jillian AU - Kauth, R. Michael PY - 2019/01/14 TI - Utilization of the Veterans Affairs? Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study JO - JMIR Med Inform SP - e11695 VL - 7 IS - 1 KW - teleconsultation KW - telemedicine KW - transgender persons KW - veterans KW - veteran health N2 - Background: In 2015, the Department of Veterans Affairs (VA) nationally implemented a transgender e-consultation (e-consult) program with expert clinical guidance for providers. Objective: This mixed-methods project aimed to describe providers? program experiences, reasons for nonuse of the program, and ways to improve the program use. Methods: From January to May 2017, 15 urban and rural VA providers who submitted at least one e-consult in the last year participated in semistructured interviews about their program experiences, which were analyzed using content analysis. From November to December 2017, 53 providers who encountered transgender patients but did not utilize the program participated in a brief online survey on the reasons for nonuse of the program and the facilitators encouraging use. Results: Qualitative analysis showed that providers learned of the program through email; colleagues; the electronic health record (EHR) system; and participation in the VA Lesbian, Gay, Bisexual, and Transgender committees or educational trainings. Providers used the program to establish care plans, hormone therapy recommendations, sexual and reproductive health education, surgical treatment education, patient-provider communication guidance, and second opinions. The facilitators of program use included understandable recommendations, ease of use through the EHR system, and status as the only transgender resource for rural providers. Barriers to use included time constraints, communication-related problems with the e-consult, impractical recommendations for underresourced sites, and misunderstanding of the e-consult purpose. Suggestions for improvement included addition of concise or sectioned responses, expansion of program awareness among providers or patients, designation of a follow-up contact person, and increase in provider education about transgender veterans and related care. Quantitative analysis showed that the common reasons for nonuse of the program were no knowledge of the program (54%), no need of the program (32%), and receipt of help from a colleague outside of e-consult (24%). Common suggestions to improve the program use in quantitative analyses included provision of more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. Conclusions: The VA transgender e-consult program is useful for providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing the identified barriers and enhancing the facilitators may improve program use and quality care for transgender veterans. UR - http://medinform.jmir.org/2019/1/e11695/ UR - http://dx.doi.org/10.2196/11695 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344672 ID - info:doi/10.2196/11695 ER - TY - JOUR AU - Joschko, Justin AU - Keely, Erin AU - Grant, Rachel AU - Moroz, Isabella AU - Graveline, Matthew AU - Drimer, Neil AU - Liddy, Clare PY - 2018/12/21 TI - Electronic Consultation Services Worldwide: Environmental Scan JO - J Med Internet Res SP - e11112 VL - 20 IS - 12 KW - electronic consultation KW - interviews KW - primary care KW - referral-consultation process KW - telemedicine KW - quality of care KW - specialist care N2 - Background: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many health care systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists through a secure platform to facilitate discussion of patients? care. Objective: This study aims to examine different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different health care contexts. Methods: We conducted an environmental scan comprising 3 stages as follows: literature review; gray literature search; and targeted, semistructured key informant interviews. We searched MEDLINE and EMBASE (literature review) and Google (gray literature search). Upon completing the search, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, physicians, and decision makers. The maximum variation sampling was used to ensure sufficient breadth of participant experience. In addition, we conducted semistructured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach. Results: A total of 53 services emerged from the published and gray literature. Respondents from 10 services participated in telephonic interviews. The following 4 major themes emerged from the analysis: service structure; benefits of eConsult; implementation challenges; and implementation enablers. Conclusions: eConsult services have emerged in a variety of countries and health system contexts worldwide. Despite differences in structure, platform, and delivery of their services, respondents described similar barriers and enablers to the implementation and growth and reported improved access and high levels of satisfaction. UR - http://www.jmir.org/2018/12/e11112/ UR - http://dx.doi.org/10.2196/11112 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578187 ID - info:doi/10.2196/11112 ER - TY - JOUR AU - Lawes-Wickwar, Sadie AU - McBain, Hayley AU - Mulligan, Kathleen PY - 2018/11/21 TI - Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review JO - JMIR Ment Health SP - e62 VL - 5 IS - 4 KW - severe mental disorders KW - telehealth KW - technology KW - systematic review KW - mobile phone N2 - Background: People with severe mental illness (SMI) must receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly being used to assist in health care delivery using ?telehealth,? which includes telephones and mobile phones, computers, remote sensors, the internet, and other devices, to provide immediate real-time information to service users to improve the management of chronic health conditions. Some initial findings have suggested that technology could improve the quality of life of people with SMI. Objective: In this systematic review, we aimed to identify the various uses and efficacy of telehealth technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Health Technology Assessment, CINAHL Plus, and NHS Economic Evaluations Database) to identify randomized controlled trials evaluating telehealth for adults with SMI published in English. Additional literature was identified through searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: Our search identified 31 articles describing 29 trials as eligible for the review. The included studies evaluated the use of computers to deliver cognitive rehabilitation (15 trials), patient education (3 trials), and Web-based self-management interventions (2 trials) and to support consultations (1 trial). Virtual reality was used to simulate work and social situations (2 trials) and to deliver cognitive training (1 trial). Telephones were used to prompt service users to take medications (3 trials) and to report symptoms to their health care team (1 trial). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective in improving medication adherence and reducing the severity of symptoms and inpatient days. Computer-assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. The results of this review should be taken in the context of varied quality in study design, with only 5 studies demonstrating a low risk of bias. Conclusions: A growing variety of telehealth technologies are being used to support the management of SMI. Specific technology types have been found to be effective for some outcomes (eg, telephone and remote medication monitoring for adherence to treatment), while other types of telehealth technologies (eg, delivery of patient education using computers) had no benefit over traditional nurse-based methods and were less acceptable to patients. Further research is warranted to establish the full potential benefits of telehealth for improving the quality of life in people with SMI, acceptability from the service user perspective, and cost-effectiveness. The findings of this review are limited by the poor quality of many of the studies reviewed. UR - http://mental.jmir.org/2018/4/e62/ UR - http://dx.doi.org/10.2196/mental.8816 UR - http://www.ncbi.nlm.nih.gov/pubmed/30463836 ID - info:doi/10.2196/mental.8816 ER - TY - JOUR AU - Lam, Kin Chee AU - McGinnis Pilote, Kara AU - Haque, Ashraful AU - Burzynski, Joseph AU - Chuck, Christine AU - Macaraig, Michelle PY - 2018/11/20 TI - Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study JO - J Med Internet Res SP - e287 VL - 20 IS - 11 KW - computer-assisted therapy KW - directly observed therapy KW - mobile phone KW - telemedicine KW - videoconferencing N2 - Background: Since January 2013, the New York City (NYC) Health Department Tuberculosis (TB) Program has offered persons diagnosed with latent TB infection (LTBI) the 3-month, once-weekly isoniazid and rifapentine (3HP) treatment regimen. Patients on this treatment are monitored in-person under directly observed therapy (DOT). To address patient and provider barriers to in-person DOT, we piloted the use of a videoconferencing software app to remotely conduct synchronous DOT (video directly observed therapy; VDOT) for patients on 3HP. Objective: The objective of our study was to evaluate the implementation of VDOT for patients on 3HP and to assess whether treatment completion for these patients increased when they were monitored using VDOT compared with that using the standard in-person DOT. Methods: Between February and October 2015, patients diagnosed with LTBI at any of the four NYC Health Department TB clinics who met eligibility criteria for treatment with 3HP under VDOT (V3HP) were followed until 16 weeks after treatment initiation, with treatment completion defined as ingestion of 11 doses within 16 weeks. Treatment completion of patients on V3HP was compared with that of patients on 3HP under clinic-based, in-person DOT who were part of a prior study in 2013. Furthermore, outcomes of video sessions with V3HP patients were collected and analyzed. Results: During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001). A total of 360 video sessions were conducted for V3HP patients with a median of 8 (range: 1-11) sessions per patient and a median time of 4 (range: 1-59) minutes per session. Adherence issues (eg, >15 minutes late) during video sessions occurred 104 times. No major side effects were reported by V3HP patients. Conclusions: The NYC TB program observed higher treatment completion with VDOT than that previously seen with clinic DOT among patients on 3HP. Expanding the use of VDOT may improve treatment completion and corresponding outcomes for patients with LTBI. UR - https://www.jmir.org/2018/11/e287/ UR - http://dx.doi.org/10.2196/jmir.9825 UR - http://www.ncbi.nlm.nih.gov/pubmed/30459146 ID - info:doi/10.2196/jmir.9825 ER - TY - JOUR AU - Kim, Wook Sung AU - Madan, Jason AU - Dritsaki, Melina AU - Bryce, Carol AU - Forjaz, Vera AU - Fraser, Joe AU - Griffiths, Frances AU - Hamilton, Kathryn AU - Huxley, Caroline AU - Sturt, Jackie PY - 2018/10/30 TI - Benefits and Costs of Digital Consulting in Clinics Serving Young People With Long-Term Conditions: Mixed-Methods Approach JO - JMIR Med Inform SP - e48 VL - 6 IS - 4 KW - digital consulting KW - long-term conditions KW - costing analysis KW - young people KW - mental health KW - diabetes N2 - Background: Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. Objective: This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. Methods: This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. Results: When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. Conclusions: Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting. UR - http://medinform.jmir.org/2018/4/e48/ UR - http://dx.doi.org/10.2196/medinform.9577 UR - http://www.ncbi.nlm.nih.gov/pubmed/30377145 ID - info:doi/10.2196/medinform.9577 ER - TY - JOUR AU - Ekeland, Granstrøm Anne AU - Hansen, Helen Anne AU - Bergmo, Strand Trine PY - 2018/10/25 TI - Clinical Videoconferencing as eHealth: A Critical-Realist Review and Qualitative Meta-Synthesis JO - J Med Internet Res SP - e282 VL - 20 IS - 10 KW - videoconferencing KW - clinical practice patterns KW - realist review KW - situated implications KW - eHealth KW - telemedicine N2 - Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted, and those used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of electronic health (eHealth) identified 51 unique definitions. In addition, the ?10 E?s of eHealth? was developed. In 2015, the question ?What Is eHealth: Time for an Update?? was posed. Objective: Considering videoconferencing as eHealth, the objective of the paper is twofold: to demonstrate and cluster (different) clinical videoconferencing practices and their situated implications and to suggest interpretive concepts that apply to all clusters and contribute to generative learning of eHealth by discussing the concepts as add-ons to existing descriptions of eHealth in the ?10 E?s of eHealth.? Methods: We performed a literature search via the National Center for Biotechnology Information, encompassing PubMed and PubMedCentral, for quality reviews and primary studies. We used the terms ?videoconferencing? and ?clinical practices.? The selection process was based upon clearly defined criteria. We used an electronic form to extract data. The analysis was inspired by critical and realist review types, grounded theory, and qualitative meta-synthesis. Results: The search returned 354 reviews and primary studies. This paper considered the primary studies, and 16 were included. We identified the following 4 broad clusters: videoconferencing as a controlled technological intervention within existing health care organizations for expert advice, controlled mixed interventions with experimental organizational arrangements, videoconferencing as an emerging technosocial service involving dialogue and empowerment of patients, and videoconferencing as a controlled intervention to improve administrative efficiency. The analysis across the clusters resulted in a proposal to add the following 4 D?s to the existing 10 E?s: (inter)-dependent, differentiated across services and along temporal lines, dynamic in terms of including novel elements for meeting incremental needs, and demanding in terms of making new challenges and dual results visible and needing fresh resources to meet those challenges. For a normative discussion about what eHealth should be according to authors? conclusions, results suggested ethical, in that users interests should be respected, and not harmful in terms of increasing symptom burden. Conclusions: Services were enacted as dynamic, differentiated concerning content and considerations of quality and adaptive along temporal lines. They were made to work from an ongoing demand for fresh resources, making them interdependent. The 4 D?s?Dynamic, Differentiated, Demanding, and (inter) Dependent?serve as pragmatic add-ons to the ?10 E?s of eHealth.? Questions concerning outcome of specified balances between standardization and customization in clinical settings should be addressed in future research along with the emerging dual character of outcome: services being considered both ?good? and ?bad.? UR - http://www.jmir.org/2018/10/e282/ UR - http://dx.doi.org/10.2196/jmir.8497 UR - http://www.ncbi.nlm.nih.gov/pubmed/30361197 ID - info:doi/10.2196/jmir.8497 ER - TY - JOUR AU - Klingberg, Anders AU - Wallis, Alan Lee AU - Hasselberg, Marie AU - Yen, Po-Yin AU - Fritzell, Caroline Sara PY - 2018/10/19 TI - Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e11076 VL - 6 IS - 10 KW - mobile phone KW - referral and consultation KW - emergency medicine KW - mHealth KW - teleconsultations KW - burns KW - usability evaluation KW - think-aloud KW - video analysis KW - South Africa N2 - Background: The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. Objective: The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. Methods: A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. Results: The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. Conclusions: We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words. UR - http://mhealth.jmir.org/2018/10/e11076/ UR - http://dx.doi.org/10.2196/11076 UR - http://www.ncbi.nlm.nih.gov/pubmed/30341047 ID - info:doi/10.2196/11076 ER - TY - JOUR AU - Mercer, Kathryn AU - Burns, Catherine AU - Guirguis, Lisa AU - Chin, Jessie AU - Dogba, Joyce Maman AU - Dolovich, Lisa AU - Guénette, Line AU - Jenkins, Laurie AU - Légaré, France AU - McKinnon, Annette AU - McMurray, Josephine AU - Waked, Khrystine AU - Grindrod, A. Kelly PY - 2018/9/25 TI - Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study  JO - JMIR Hum Factors SP - e24 VL - 5 IS - 3 KW - shared decision-making KW - electronic health records KW - collaboration KW - interprofessional collaboration KW - medication management N2 - Background: Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective: The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods: This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results: We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions: We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach. UR - http://humanfactors.jmir.org/2018/3/e24/ UR - http://dx.doi.org/10.2196/humanfactors.9891 UR - http://www.ncbi.nlm.nih.gov/pubmed/30274959 ID - info:doi/10.2196/humanfactors.9891 ER - TY - JOUR AU - Newe, Axel AU - Becker, Linda PY - 2018/08/07 TI - Three-Dimensional Portable Document Format (3D PDF) in Clinical Communication and Biomedical Sciences: Systematic Review of Applications, Tools, and Protocols JO - JMIR Med Inform SP - e10295 VL - 6 IS - 3 KW - 3D PDF KW - 3D visualization KW - interactive KW - clinical communication KW - biomedical science KW - tools KW - protocols KW - apps KW - online data sharing KW - scholarly publishing KW - electronic publishing N2 - Background: The Portable Document Format (PDF) is the standard file format for the communication of biomedical information via the internet and for electronic scholarly publishing. Although PDF allows for the embedding of three-dimensional (3D) objects and although this technology has great potential for the communication of such data, it is not broadly used by the scientific community or by clinicians. Objective: The objective of this review was to provide an overview of existing publications that apply 3D PDF technology and the protocols and tools for the creation of model files and 3D PDFs for scholarly purposes to demonstrate the possibilities and the ways to use this technology. Methods: A systematic literature review was performed using PubMed and Google Scholar. Articles searched for were in English, peer-reviewed with biomedical reference, published since 2005 in a journal or presented at a conference or scientific meeting. Ineligible articles were removed after screening. The found literature was categorized into articles that (1) applied 3D PDF for visualization, (2) showed ways to use 3D PDF, and (3) provided tools or protocols for the creation of 3D PDFs or necessary models. Finally, the latter category was analyzed in detail to provide an overview of the state of the art. Results: The search retrieved a total of 902 items. Screening identified 200 in-scope publications, 13 covering the use of 3D PDF for medical purposes. Only one article described a clinical routine use case; all others were pure research articles. The disciplines that were covered beside medicine were many. In most cases, either animal or human anatomies were visualized. A method, protocol, software, library, or other tool for the creation of 3D PDFs or model files was described in 19 articles. Most of these tools required advanced programming skills and/or the installation of further software packages. Only one software application presented an all-in-one solution with a graphical user interface. Conclusions: The use of 3D PDF for visualization purposes in clinical communication and in biomedical publications is still not in common use, although both the necessary technique and suitable tools are available, and there are many arguments in favor of this technique. The potential of 3D PDF usage should be disseminated in the clinical and biomedical community. Furthermore, easy-to-use, standalone, and free-of-charge software tools for the creation of 3D PDFs should be developed. UR - http://medinform.jmir.org/2018/3/e10295/ UR - http://dx.doi.org/10.2196/10295 UR - http://www.ncbi.nlm.nih.gov/pubmed/30087092 ID - info:doi/10.2196/10295 ER - TY - JOUR AU - Shaw, E. Sara AU - Cameron, Deborah AU - Wherton, Joseph AU - Seuren, M. Lucas AU - Vijayaraghavan, Shanti AU - Bhattacharya, Satyajit AU - A?Court, Christine AU - Morris, Joanne AU - Greenhalgh, Trisha PY - 2018/07/31 TI - Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project JO - JMIR Res Protoc SP - e10913 VL - 7 IS - 7 KW - remote consultations, communication, language, linguistics, cancer, diabetes mellitus, heart failure N2 - Background: Remote videoconsulting is promoted by policy makers as a way of delivering health care efficiently to an aging population with rising rates of chronic illness. As a radically new service model, it brings operational and interactional challenges in using digital technologies. In-depth research on this dynamic is needed before remote consultations are introduced more widely. Objective: The objective of this study will be to identify and analyze the communication strategies through which remote consultations are accomplished and to guide patients and clinicians to improve the communicative quality of remote consultations. Methods: In previous research, we collected and analyzed two separate datasets of remote consultations in a National Institute for Health Research?funded study of clinics in East London using Skype and a Wellcome Trust?funded study of specialist community heart failure teams in Oxford using Skype or FaceTime. The Qualitative Analysis of Remote Consultations (QuARC) study will combine datasets and undertake detailed interactional microanalysis of up to 40 remote consultations undertaken by senior and junior doctors and nurse specialists, including consultations with adults with diabetes, women who have diabetes during pregnancy, people consulting for postoperative cancer surgery and community-based patients having routine heart failure reviews along with up to 25 comparable face-to-face consultations. Drawing on established techniques (eg, conversation analysis), analysis will examine the contextual features in remote consultations (eg, restricted visual field) combined with close analysis of different modes of communication (eg, speech, gesture, and gaze). Results: Our findings will address the current gap in knowledge about how technology shapes the fine detail of communication in remote consultations. Alongside academic outputs, findings will inform the coproduction of information and guidance about communication strategies to support successful remote consultations. Conclusions: Identifying the communication strategies through which remote consultations are accomplished and producing guidance for patients and clinicians about how to use this kind of technology successfully in consultations is an important and timely goal because roll out of remote consultations is planned across the National Health Service. Registered Report Identifier: RR1-10.2196/10913 UR - http://www.researchprotocols.org/2018/7/e10913/ UR - http://dx.doi.org/10.2196/10913 UR - http://www.ncbi.nlm.nih.gov/pubmed/30064972 ID - info:doi/10.2196/10913 ER - TY - JOUR AU - Shi, Yong AU - Li, Peijia AU - Yu, Xiaodan AU - Wang, Huadong AU - Niu, Lingfeng PY - 2018/07/18 TI - Evaluating Doctor Performance: Ordinal Regression-Based Approach JO - J Med Internet Res SP - e240 VL - 20 IS - 7 KW - performance evaluation KW - ordinal regression KW - mHealth KW - support vector machines KW - ordinal partitioning N2 - Background: Doctor?s performance evaluation is an important task in mobile health (mHealth), which aims to evaluate the overall quality of online diagnosis and patient outcomes so that customer satisfaction and loyalty can be attained. However, most patients tend not to rate doctors? performance, therefore, it is imperative to develop a model to make doctor?s performance evaluation automatic. When evaluating doctors? performance, we rate it into a score label that is as close as possible to the true one. Objective: This study aims to perform automatic doctor?s performance evaluation from online textual consultations between doctors and patients by way of a novel machine learning method. Methods: We propose a solution that models doctor?s performance evaluation as an ordinal regression problem. In doing so, a support vector machine combined with an ordinal partitioning model (SVMOP), along with an innovative predictive function will be developed to capture the hidden preferences of the ordering labels over doctor?s performance evaluation. When engineering the basic text features, eight customized features (extracted from over 70,000 medical entries) were added and further boosted by the Gradient Boosting Decision Tree algorithm. Results: Real data sets from one of the largest mobile doctor/patient communication platforms in China are used in our study. Statistically, 64% of data on mHealth platforms lack the evaluation labels from patients. Experimental results reveal that our approach can support an automatic doctor performance evaluation. Compared with other auto-evaluation models, SVMOP improves mean absolute error (MAE) by 0.1, mean square error (MSE) by 0.5, pairwise accuracy (PAcc) by 5%; the suggested customized features improve MAE by 0.1, MSE by 0.2, PAcc by 3%. After boosting, performance is further improved. Based on SVMOP, predictive features like politeness and sentiment words can be mined, which can be further applied to guide the development of mHealth platforms. Conclusions: The initial modelling of doctor performance evaluation is an ordinal regression problem. Experiments show that the performance of our proposed model with revised prediction function is better than many other machine learning methods on MAE, MSE, as well as PAcc. With this model, the mHealth platform could not only make an online auto-evaluation of physician performance, but also obtain the most effective features, thereby guiding physician performance and the development of mHealth platforms. UR - http://www.jmir.org/2018/7/e240/ UR - http://dx.doi.org/10.2196/jmir.9300 UR - http://www.ncbi.nlm.nih.gov/pubmed/30021708 ID - info:doi/10.2196/jmir.9300 ER - TY - JOUR AU - Lanham, Jordan Holly AU - Leykum, K. Luci AU - Pugh, A. Jacqueline PY - 2018/07/11 TI - Examining the Complexity of Patient-Outpatient Care Team Secure Message Communication: Qualitative Analysis JO - J Med Internet Res SP - e218 VL - 20 IS - 7 KW - secure messaging KW - patient-physician communication KW - complexity science KW - outpatient care KW - outpatients KW - confidentiality N2 - Background: The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communicating both routine and nonroutine issues, and the implications of these differences in use are less well understood. Objective: The purpose of this study was to examine secure messaging use to extend current knowledge of how this tool is being used in outpatient care settings and generate new research questions to improve our understanding of the role of secure messaging in the patient-provider communication toolbox. Methods: We conducted an in-depth qualitative analysis of secure message threads in 12 US Department of Veterans Affairs outpatient clinics in south Texas. We analyzed 70 secure message threads with a total of 179 unique communications between patients and their outpatient teams for patterns in communication and secure message content. We used theories from information systems and complexity science in organizations to explain our observations. Results: Analysis identified content relating to 3 main themes: (1) information management, (2) uncertainty management, and (3) patient safety and engagement risks and opportunities. Within these themes, we identified 2 subcategories of information management (information exchange and problem solving), 2 subcategories of uncertainty management (relationship building and sensemaking), and 3 subcategories of patient safety and engagement risks and opportunities (unresolved issues, tone mismatch, and urgent medical issues). Secure messages were most often used to communicate routine issues (eg, information exchange and problem solving). However, the presence of subcategories pertaining to nonroutine issues (eg, relationship building, sensemaking, tone mismatch, urgent issues, and unresolved issues) requires attention, particularly for improving opportunities in outpatient care settings using secure messaging. Conclusions: Patients use secure messaging for both routine and nonroutine purposes. Our analysis sheds light on potentially new patient safety concerns, particularly when using secure messaging to address some of the more complex issues patients are communicating with providers. Secure messaging is an asynchronous communication information system operated by patients and providers who are often characterized as having significant differences in knowledge, experience and expectations. As such, justification for its use beyond routine purposes is limited?yet this occurs, presenting a multifaceted dilemma for health care organizations. Secure messaging use in outpatient care settings may be more nuanced, and thus more challenging to understand and manage than previously recognized. New information system designs that acknowledge the use of secure messaging for nonroutine and complex health topics are needed. UR - http://www.jmir.org/2018/7/e218/ UR - http://dx.doi.org/10.2196/jmir.9269 UR - http://www.ncbi.nlm.nih.gov/pubmed/29997107 ID - info:doi/10.2196/jmir.9269 ER - TY - JOUR AU - Dietrich, Damien AU - Dekova, Ralitza AU - Davy, Stephan AU - Fahrni, Guillaume AU - Geissbühler, Antoine PY - 2018/06/27 TI - Applications of Space Technologies to Global Health: Scoping Review JO - J Med Internet Res SP - e230 VL - 20 IS - 6 KW - satellite imagery KW - satellite communications KW - public health KW - remote sensing technology KW - global positioning system KW - geographic information systems KW - telemedicine KW - spaceflight KW - space medicine KW - global health N2 - Background: Space technology has an impact on many domains of activity on earth, including in the field of global health. With the recent adoption of the United Nations? Sustainable Development Goals that highlight the need for strengthening partnerships in different domains, it is useful to better characterize the relationship between space technology and global health. Objective: The aim of this study was to identify the applications of space technologies to global health, the key stakeholders in the field, as well as gaps and challenges. Methods: We used a scoping review methodology, including a literature review and the involvement of stakeholders, via a brief self-administered, open-response questionnaire. A distinct search on several search engines was conducted for each of the four key technological domains that were previously identified by the UN Office for Outer Space Affairs? Expert Group on Space and Global Health (Domain A: remote sensing; Domain B: global navigation satellite systems; Domain C: satellite communication; and Domain D: human space flight). Themes in which space technologies are of benefit to global health were extracted. Key stakeholders, as well as gaps, challenges, and perspectives were identified. Results: A total of 222 sources were included for Domain A, 82 sources for Domain B, 144 sources for Domain C, and 31 sources for Domain D. A total of 3 questionnaires out of 16 sent were answered. Global navigation satellite systems and geographic information systems are used for the study and forecasting of communicable and noncommunicable diseases; satellite communication and global navigation satellite systems for disaster response; satellite communication for telemedicine and tele-education; and global navigation satellite systems for autonomy improvement, access to health care, as well as for safe and efficient transportation. Various health research and technologies developed for inhabited space flights have been adapted for terrestrial use. Conclusions: Although numerous examples of space technology applications to global health exist, improved awareness, training, and collaboration of the research community is needed. UR - http://www.jmir.org/2018/6/e230/ UR - http://dx.doi.org/10.2196/jmir.9458 UR - http://www.ncbi.nlm.nih.gov/pubmed/29950289 ID - info:doi/10.2196/jmir.9458 ER - TY - JOUR AU - Bashir, Ayisha AU - Bastola, R. Dhundy PY - 2018/05/25 TI - Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study JO - JMIR Med Inform SP - e35 VL - 6 IS - 2 KW - telehealth KW - survey KW - telemedicine KW - telenursing N2 - Background: Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. Objective: The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Methods: Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. Results: The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. Conclusions: The responses to the interview questions and data gathered from the survey showed overall satisfaction with TNSQ. The SERVQUAL instrument was a good framework to assess TNSQ. In a nutshell, the study highlighted how the telehealth process provides daily monitoring of patient health, leading to the benefits of immediate feedback for patients, family, and caregivers as well as convenience of scheduling. UR - http://medinform.jmir.org/2018/2/e35/ UR - http://dx.doi.org/10.2196/medinform.9080 UR - http://www.ncbi.nlm.nih.gov/pubmed/29802089 ID - info:doi/10.2196/medinform.9080 ER - TY - JOUR AU - Greenhalgh, Trisha AU - Shaw, Sara AU - Wherton, Joseph AU - Vijayaraghavan, Shanti AU - Morris, Joanne AU - Bhattacharya, Satya AU - Hanson, Philippa AU - Campbell-Richards, Desirée AU - Ramoutar, Seendy AU - Collard, Anna AU - Hodkinson, Isabel PY - 2018/04/17 TI - Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study JO - J Med Internet Res SP - e150 VL - 20 IS - 4 KW - remote consultations KW - diabetes mellitus KW - ethnography KW - interviews KW - organizational case studies KW - health systems N2 - Background: There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. Objective: The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. Methods: A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). Results: When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2% and 22% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Conclusions: Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. UR - http://www.jmir.org/2018/4/e150/ UR - http://dx.doi.org/10.2196/jmir.9897 UR - http://www.ncbi.nlm.nih.gov/pubmed/29625956 ID - info:doi/10.2196/jmir.9897 ER - TY - JOUR AU - Celler, Branko AU - Argha, Ahmadreza AU - Varnfield, Marlien AU - Jayasena, Rajiv PY - 2018/04/09 TI - Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial JO - JMIR Med Inform SP - e15 VL - 6 IS - 2 KW - patient compliance KW - vital signs KW - telehealth KW - telemonitoring KW - clinical trial KW - chronic disease N2 - Background: In a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start. Higher adherence rates have been reported for simple types of monitoring and for shorter periods of intervention. If patients do not follow the intended procedure, poorer results than expected may be achieved. Hence, analyzing factors that can influence patient adherence is of great importance. Objective: The goal of the research was to present findings on patient adherence with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organisation (CSIRO) national trial of home telemonitoring of patients (mean age 70.5 years, SD 9.3 years) with chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) carried out at 5 locations along the east coast of Australia. We investigated the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan over periods exceeding 6 months (302 days, SD 135 days) and explored different levels of adherence for different measurements as a function of age, gender, and supervisory models. Methods: In this study, 113 patients forming the test arm of a Before and After Control Intervention (BACI) home telemonitoring trial were analyzed. Patients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and comorbidities. Vital signs included noninvasive blood pressure, pulse oximetry, spirometry, electrocardiogram (ECG), blood glucose level, body temperature, and body weight. Adherence was calculated as the number of days during which at least 1 measurement was taken over all days where measurements were scheduled. Different levels of adherence for different measurements, as a function of age, gender, and supervisory models, were analyzed using linear regression and analysis of covariance for a period of 1 year after the intervention. Results: Patients were monitored on average for 302 (SD 135) days, although some continued beyond 12 months. The overall adherence rate for all measurements was 64.1% (range 59.4% to 68.8%). The adherence rates of patients monitored in hospital settings relative to those monitored in community settings were significantly higher for spirometry (69.3%, range 60.4% to 78.2%, versus 41.0%, range 33.1% to 49.0%, P<.001), body weight (64.5%, range 55.7% to 73.2%, versus 40.5%, range 32.3% to 48.7%, P<.001), and body temperature (66.8%, range 59.7% to 73.9%, versus 55.2%, range 48.4% to 61.9%, P=.03). Adherence with blood glucose measurements (58.1%, range 46.7% to 69.5%, versus 50.2%, range 42.8% to 57.6%, P=.24) was not significantly different overall. Adherence rates for blood pressure (68.5%, range 62.7% to 74.2%, versus 59.7%, range 52.1% to 67.3%, P=.04), ECG (65.6%, range 59.7% to 71.5%, versus 56.5%, range 48.7% to 64.4%, P=.047), and pulse oximetry (67.0%, range 61.4% to 72.7%, versus 56.4%, range 48.6% to 64.1%, P=.02) were significantly higher in males relative to female subjects. No statistical differences were observed between rates of adherence for the younger patient group (70 years and younger) and older patient group (older than 70 years). Conclusions: Patients with chronic conditions enrolled in the home telemonitoring trial were able to record their vital signs at home at least once every 2 days over prolonged periods of time. Male patients maintained a higher adherence than female patients over time, and patients supervised by hospital-based care coordinators reported higher levels of adherence with their measurement schedule relative to patients supervised in community settings. This was most noticeable for spirometry. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/6xPOU3DpR). UR - http://medinform.jmir.org/2018/2/e15/ UR - http://dx.doi.org/10.2196/medinform.9200 UR - http://www.ncbi.nlm.nih.gov/pubmed/29631991 ID - info:doi/10.2196/medinform.9200 ER - TY - JOUR AU - Hensel, M. Jennifer AU - Yang, Rebecca AU - Rai, Minnie AU - Taylor, H. Valerie PY - 2018/04/06 TI - Optimizing Electronic Consultation Between Primary Care Providers and Psychiatrists: Mixed-Methods Study JO - J Med Internet Res SP - e124 VL - 20 IS - 4 KW - eHealth KW - psychiatry KW - primary care KW - consultation KW - health services N2 - Background: The use of electronic consultation (e-consult) between primary care providers (PCPs) and psychiatrists has potential, given the high prevalence of mental health issues in primary care and problematic access to specialist care. Utilization and uptake, however, appears to be lower than would be expected. Objective: This study aimed to examine actual utilization of e-consult between PCPs and psychiatrists and investigate the perceptions of PCPs about this form of psychiatric advice to inform how to optimize the utility and thereby the uptake of this service. Methods: In this mixed-methods study, we conducted a chart review of psychiatry e-consults (N=37) over 2 platforms during early implementation in Ontario, Canada, as well as 3 group interviews and 1 individual interview with PCPs (N=10) with variable experience levels and from a range of practice settings. The chart review assessed response times and referral content including the type of request, referral attachments, and consultant responses. Interviews explored the perceptions of the PCPs about the uses and barriers of psychiatry e-consult. Thematic content analysis of interview data identified common themes as well as themes unique to different provider profiles (eg, experienced PCPs vs new PCPs and rural vs urban practice). On the basis of interpretation of the quantitative and qualitative findings, we developed recommendations for the optimization of psychiatry e-consultation services. Results: During the study period, psychiatry e-consults comprised 3.66% (49/1339) of all e-consults submitted on the studied platforms. Among the e-consults reviewed, different psychiatric diagnoses were represented: 70% of requests (26/37) queried about medication safety or side effects, whereas 59% (22/37) asked about psychiatric symptom management. Moreover, 81% (30/37) of e-consults were answered within 24 hours, and 65% (24/37) were addressed in a single exchange. Themes from the interview data included psychiatry having a complexity that differentiates it from other specialties and may limit the utility of e-consult, other than for psychopharmacology advice. Variability in awareness exists in the way e-consultation could be used in psychiatry, with new PCPs feeling unsure about the appropriateness of a question. In general, new PCPs and PCPs practicing in rural areas were more receptive to psychiatry e-consult. PCPs viewed e-consult as an opportunity to collaborate and desired that it be integrated with other available services. Recommendations include the need for appropriate specialist staffing to address a wide range of requests, adequate education to referrers regarding the use of psychiatry e-consult, and the need to integrate psychiatry e-consult with other geographically relevant services, given the complexity of psychiatric issues. Conclusions: E-consult is a viable and timely way for PCPs to get much-needed psychiatric advice. For optimizing its utility and uptake, e-consult needs to be integrated into reliable care pathways with adequate referrer and consultant preparation. UR - http://www.jmir.org/2018/4/e124/ UR - http://dx.doi.org/10.2196/jmir.8943 UR - http://www.ncbi.nlm.nih.gov/pubmed/29625949 ID - info:doi/10.2196/jmir.8943 ER - TY - JOUR AU - Daniel, Fady AU - Jabak, Suha AU - Sasso, Roula AU - Chamoun, Yara AU - Tamim, Hani PY - 2018/04/06 TI - Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians? Perceptions and Attitudes JO - JMIR Med Inform SP - e18 VL - 6 IS - 2 KW - social media KW - communication KW - patient-physician communication KW - technology use N2 - Background: The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. Objective: The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. Methods: This was a cross-sectional observational study using an online survey that addressed physicians? perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. Results: A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. Conclusions: The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality. UR - http://medinform.jmir.org/2018/2/e18/ UR - http://dx.doi.org/10.2196/medinform.8895 UR - http://www.ncbi.nlm.nih.gov/pubmed/29625955 ID - info:doi/10.2196/medinform.8895 ER - TY - JOUR AU - Chan, SY Windy AU - Leung, YM Angela PY - 2018/03/28 TI - Use of Social Network Sites for Communication Among Health Professionals: Systematic Review JO - J Med Internet Res SP - e117 VL - 20 IS - 3 KW - social networking KW - social media KW - health communication KW - Facebook KW - WhatsApp KW - professional network KW - health professionals N2 - Background: Although much research has been done investigating the roles of social network sites (SNSs) in linking patients and health professionals, there is a lack of information about their uses, benefits, and limitations in connecting health professions only for professional communication. Objective: This review aimed to examine the utilization of SNSs for communication among health professionals in (1) frontline clinical practice, (2) professional networks, and (3) education and training to identify areas for future health communication research. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A systematic search of the literature published in the last 10 years (January 1, 2007, to March 1, 2017) was performed in March 2017, using the following electronic databases: MEDLINE via OvidSP, EMBASE, CINAHL Complete, and InfoSci-Journals. The searches were conducted using the following defined search terms: ?social media? OR ?social network? OR ?social network site? OR ?Facebook? OR ?Twitter? OR ?Linkedin? OR ?Instagram? OR ?Weibo? OR ?Whatsapp? OR ?Telegram? OR ?WeChat? AND ?health? OR ?health profession.? Results: Of the 6977 papers retrieved, a total of 33 studies were included in this review. They were exploratory in nature, and the majority used surveys (n=25) and interviews (n=6). All retrieved studies stated that SNSs enhanced effective communication and information sharing. SNSs were used for supporting delivering of clinical services, making referrals, and sharing information. They were beneficial to network building and professional collaboration. SNSs were novel tools to enhance educational interactions among peers, students, instructors, and preceptors. The application of SNSs came with restraints in technical knowledge, concerns on data protection, privacy and liability, issues in professionalism, and data protection. Conclusions: SNSs provide platforms facilitating efficient communication, interactions, and connections among health professionals in frontline clinical practice, professional networks, education, and training with limitations identified as technical knowledge, professionalism, and risks of data protection. The evolving use of SNSs necessitates robust research to explore the full potential and the relative effectiveness of SNSs in professional communication. UR - http://www.jmir.org/2018/3/e117/ UR - http://dx.doi.org/10.2196/jmir.8382 UR - http://www.ncbi.nlm.nih.gov/pubmed/29592845 ID - info:doi/10.2196/jmir.8382 ER - TY - JOUR AU - van Kasteren, Yasmin AU - Freyne, Jill AU - Hussain, Sazzad M. PY - 2018/03/20 TI - Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study JO - J Med Internet Res SP - e95 VL - 20 IS - 3 KW - arthroplasty KW - replacement KW - osteoarthritis KW - patient participation KW - consumer health informatics KW - technology KW - telemedicine KW - rehabilitation KW - self-care KW - exercise therapy KW - human computer interaction KW - wearables N2 - Background: The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. Objective: The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. Methods: A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. Conclusions: Digital technology can add value to patients? care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity. UR - http://www.jmir.org/2018/3/e95/ UR - http://dx.doi.org/10.2196/jmir.7541 UR - http://www.ncbi.nlm.nih.gov/pubmed/29559424 ID - info:doi/10.2196/jmir.7541 ER - TY - JOUR AU - Argha, Ahmadreza AU - Savkin, Andrey AU - Liaw, Siaw-Teng AU - Celler, George Branko PY - 2018/03/16 TI - Effect of Seasonal Variation on Clinical Outcome in Patients with Chronic Conditions: Analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial JO - JMIR Med Inform SP - e16 VL - 6 IS - 1 KW - telehealth KW - telemonitoring KW - seasonal variation KW - clinical trial KW - vital signs KW - chronic disease N2 - Background: Seasonal variation has an impact on the hospitalization rate of patients with a range of cardiovascular diseases, including myocardial infarction and angina. This paper presents findings on the influence of seasonal variation on the results of a recently completed national trial of home telemonitoring of patients with chronic conditions, carried out at five locations along the east coast of Australia. Objective: The aim is to evaluate the effect of the seasonal timing of hospital admission and length of stay on clinical outcome of a home telemonitoring trial involving patients (age: mean 72.2, SD 9.4 years) with chronic conditions (chronic obstructive pulmonary disease coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) and to explore methods of minimizing the influence of seasonal variations in the analysis of the effect of at-home telemonitoring on the number of hospital admissions and length of stay (LOS). Methods: Patients were selected from a hospital list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. A total of 114 test patients and 173 control patients were available in this trial. However, of the 287 patients, we only considered patients who had one or more admissions in the years from 2010 to 2012. Three different groups were analyzed separately because of substantially different climates: (1) Queensland, (2) Australian Capital Territory and Victoria, and (3) Tasmania. Time series data were analyzed using linear regression for a period of 3 years before the intervention to obtain an average seasonal variation pattern. A novel method that can reduce the impact of seasonal variation on the rate of hospitalization and LOS was used in the analysis of the outcome variables of the at-home telemonitoring trial. Results: Test patients were monitored for a mean 481 (SD 77) days with 87% (53/61) of patients monitored for more than 12 months. Trends in seasonal variations were obtained from 3 years? of hospitalization data before intervention for the Queensland, Tasmania, and Australian Capital Territory and Victoria subgroups, respectively. The maximum deviation from baseline trends for LOS was 101.7% (SD 42.2%), 60.6% (SD 36.4%), and 158.3% (SD 68.1%). However, by synchronizing outcomes to the start date of intervention, the impact of seasonal variations was minimized to a maximum of 9.5% (SD 7.7%), thus improving the accuracy of the clinical outcomes reported. Conclusions: Seasonal variations have a significant effect on the rate of hospital admission and LOS in patients with chronic conditions. However, the impact of seasonal variation on clinical outcomes (rate of admissions, number of hospital admissions, and LOS) of at-home telemonitoring can be attenuated by synchronizing the analysis of outcomes to the commencement dates for the telemonitoring of vital signs. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/ 6xLPv9QDb) UR - http://medinform.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/medinform.9680 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549068 ID - info:doi/10.2196/medinform.9680 ER - TY - JOUR AU - Pahwa, Parika AU - Lunsford, Sarah AU - Livesley, Nigel PY - 2018/03/01 TI - Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study JO - JMIR Med Inform SP - e13 VL - 6 IS - 1 KW - quality improvement KW - mobile apps KW - communication KW - patient care team N2 - Background: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods: Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings. UR - http://medinform.jmir.org/2018/1/e13/ UR - http://dx.doi.org/10.2196/medinform.8154 UR - http://www.ncbi.nlm.nih.gov/pubmed/29496651 ID - info:doi/10.2196/medinform.8154 ER - TY - JOUR AU - Powell, E. Rhea AU - Stone, Danica AU - Hollander, E. Judd PY - 2018/02/13 TI - Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study JO - JMIR Med Inform SP - e10 VL - 6 IS - 1 KW - telemedicine KW - video visit KW - primary care KW - specialty KW - patient satisfaction N2 - Background: Real-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences. Objective: The objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system. Methods: This is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care. Results: This study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52. Conclusions: A large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences. UR - http://medinform.jmir.org/2018/1/e10/ UR - http://dx.doi.org/10.2196/medinform.8479 UR - http://www.ncbi.nlm.nih.gov/pubmed/29439947 ID - info:doi/10.2196/medinform.8479 ER - TY - JOUR AU - Nikolic, Amanda AU - Wickramasinghe, Nilmini AU - Claydon-Platt, Damian AU - Balakrishnan, Vikram AU - Smart, Philip PY - 2018/02/09 TI - The Use of Communication Apps by Medical Staff in the Australian Health Care System: Survey Study on Prevalence and Use JO - JMIR Med Inform SP - e9 VL - 6 IS - 1 KW - mobile phone KW - information science KW - communications media KW - privacy KW - interdisciplinary communication KW - hospital communication systems KW - communication N2 - Background: The use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor?s attitudes towards them, or what guides clinician choice of app. Objective: The objective of this study was to quantify and qualify the use of communication apps among medical staff in clinical situations, their role in patient care, and knowledge and attitudes towards safety, key benefits, potential disadvantages, and policy implications. Methods: Medical staff in hospitals across Victoria (Australia) were invited to participate in an anonymous 33-question survey. The survey collected data on respondent?s demographics, their use of communication apps in clinical settings, attitudes towards communication apps, perceptions of data ?safety,? and why one communication app was chosen over others. Results: Communication apps in Victorian hospitals are in widespread use from students to consultants, with WhatsApp being the primary app used. The median number of messages shared per day was 12, encompassing a range of patient information. All respondents viewed these apps positively in quickly communicating patient information in a clinical setting; however, all had concerns about the privacy implications arising from sharing patient information in this way. In total, 67% (60/90) considered patient data ?moderately safe? on these apps, and 50% (46/90) were concerned the use of these apps was inconsistent with current legislation and policy. Apps were more likely to be used if they were fast, easy to use, had an easy login process, and were already in widespread use. Conclusions: Communication app use by medical personnel in Victorian hospitals is pervasive. These apps contribute to enhanced communication between medical staff, but their use raises compliance issues, most notably with Australian privacy legislation. Development of privacy-compliant apps such as MedX needs to prioritize a user-friendly interface and market the product as a privacy-compliant comparator to apps previously adapted to health care settings. UR - http://medinform.jmir.org/2018/1/e9/ UR - http://dx.doi.org/10.2196/medinform.9526 UR - http://www.ncbi.nlm.nih.gov/pubmed/29426813 ID - info:doi/10.2196/medinform.9526 ER - TY - JOUR AU - Martínez, Vania AU - Rojas, Graciela AU - Martínez, Pablo AU - Zitko, Pedro AU - Irarrázaval, Matías AU - Luttges, Carolina AU - Araya, Ricardo PY - 2018/01/31 TI - Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial JO - J Med Internet Res SP - e38 VL - 20 IS - 1 KW - primary health care KW - depression KW - adolescents KW - Internet KW - telemedicine KW - medically underserved area N2 - Background: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile?s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results: More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=?4.3, 95% CI ?7.2 to ?1.3). Conclusions: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) UR - https://www.jmir.org/2018/1/e38/ UR - http://dx.doi.org/10.2196/jmir.8021 UR - http://www.ncbi.nlm.nih.gov/pubmed/29386172 ID - info:doi/10.2196/jmir.8021 ER - TY - JOUR AU - Kurahashi, M. Allison AU - Stinson, N. Jennifer AU - van Wyk, Margaret AU - Luca, Stephanie AU - Jamieson, Trevor AU - Weinstein, Peter AU - Cafazzo, A. Joseph AU - Lokuge, Bhadra AU - Cohen, Eyal AU - Rapoport, Adam AU - Husain, Amna PY - 2018/01/09 TI - The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System JO - JMIR Hum Factors SP - e2 VL - 5 IS - 1 KW - patient-centered care KW - patient participation KW - chronic disease KW - communication KW - internet communication tools KW - usability testing KW - interdisciplinary communication KW - health communication KW - continuity of patient care KW - patient care team KW - inventions N2 - Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system?s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users? perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions?composing, posting, and reading messages?with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. UR - http://humanfactors.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.7882 UR - http://www.ncbi.nlm.nih.gov/pubmed/29317386 ID - info:doi/10.2196/humanfactors.7882 ER - TY - JOUR AU - Armoiry, Xavier AU - Sturt, Jackie AU - Phelps, Elizabeth Emma AU - Walker, Clare-Louise AU - Court, Rachel AU - Taggart, Frances AU - Sutcliffe, Paul AU - Griffiths, Frances AU - Atherton, Helen PY - 2018/01/05 TI - Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review JO - J Med Internet Res SP - e5 VL - 20 IS - 1 KW - digital clinical communication KW - professional-family relations KW - family KW - caregivers KW - young adult KW - children KW - child health N2 - Background: The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. Objective: The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. Methods: We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. Results: We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. Conclusions: This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families? and caregivers? involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. Trial Registration: PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU) UR - http://www.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/jmir.7999 UR - http://www.ncbi.nlm.nih.gov/pubmed/29305339 ID - info:doi/10.2196/jmir.7999 ER - TY - JOUR AU - Tates, Kiek AU - Antheunis, L. Marjolijn AU - Kanters, Saskia AU - Nieboer, E. Theodoor AU - Gerritse, BE Maria PY - 2017/12/20 TI - The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients JO - J Med Internet Res SP - e421 VL - 19 IS - 12 KW - teleconsultation KW - communication quality KW - patient satisfaction KW - provider satisfaction KW - information exchange KW - interpersonal relationship building KW - shared decision making N2 - Background: Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. Objective: This study aimed to examine (1) the impact of a consultation medium on doctors? and patients? communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors? and patients? communicative behavior on satisfaction with both types of consultation medium. Methods: Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. Results: With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients? attitude toward Web-based communication (b=?.249, P=.02 and patients? perceived time and attention (b=.271, P=.03) significantly predicted patients? perceived interpersonal relationship building. Patients? perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between perceived information exchange and doctors? satisfaction with the consultation (b=.533, P<.001). Furthermore, doctors? perceived interpersonal relationship building was positively related to doctors? satisfaction with the consultation (b=.331, P=.003). Conclusions: In this study, the quality of doctor-patient communication, as indicated by information exchange, interpersonal relationship building, and shared decision making, did not differ significantly between Web-based and face-to-face consultations. Doctors and simulated patients were equally satisfied with both types of consultation medium, and no differences were found in the manner in which participants perceived communicative behavior during these consultations. The findings suggest that worries about a negative impact of Web-based video consultation on the quality of patient-provider consultations seem unwarranted as they offer the same interaction quality and satisfaction level as regular face-to-face consultations. UR - http://www.jmir.org/2017/12/e421/ UR - http://dx.doi.org/10.2196/jmir.8033 UR - http://www.ncbi.nlm.nih.gov/pubmed/29263017 ID - info:doi/10.2196/jmir.8033 ER - TY - JOUR AU - Deldar, Kolsoum AU - Tara, Fatemeh AU - Bahaadinbeigy, Kambiz AU - Khajedaluee, Mohammad AU - Tara, Mahmood PY - 2017/12/14 TI - A Data Model for Teleconsultation in Managing High-Risk Pregnancies: Design and Preliminary Evaluation JO - JMIR Med Inform SP - e52 VL - 5 IS - 4 KW - remote consultation KW - clinical archetype KW - pregnancy KW - clinical decision-making N2 - Background: Teleconsultation is a guarantor for virtual supervision of clinical professors on clinical decisions made by medical residents in teaching hospitals. Type, format, volume, and quality of exchanged information have a great influence on the quality of remote clinical decisions or tele-decisions. Thus, it is necessary to develop a reliable and standard model for these clinical relationships. Objective: The goal of this study was to design and evaluate a data model for teleconsultation in the management of high-risk pregnancies. Methods: This study was implemented in three phases. In the first phase, a systematic review, a qualitative study, and a Delphi approach were done in selected teaching hospitals. Systematic extraction and localization of diagnostic items to develop the tele-decision clinical archetypes were performed as the second phase. Finally, the developed model was evaluated using predefined consultation scenarios. Results: Our review study has shown that present medical consultations have no specific structure or template for patient information exchange. Furthermore, there are many challenges in the remote medical decision-making process, and some of them are related to the lack of the mentioned structure. The evaluation phase of our research has shown that data quality (P<.001), adequacy (P<.001), organization (P<.001), confidence (P<.001), and convenience (P<.001) had more scores in archetype-based consultation scenarios compared with routine-based ones. Conclusions: Our archetype-based model could acquire better and higher scores in the data quality, adequacy, organization, confidence, and convenience dimensions than ones with routine scenarios. It is probable that the suggested archetype-based teleconsultation model may improve the quality of physician-physician remote medical consultations. UR - http://medinform.jmir.org/2017/4/e52/ UR - http://dx.doi.org/10.2196/medinform.8393 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242181 ID - info:doi/10.2196/medinform.8393 ER - TY - JOUR AU - Valenzuela Espinoza, Alexis AU - Devos, Stefanie AU - van Hooff, Robbert-Jan AU - Fobelets, Maaike AU - Dupont, Alain AU - Moens, Maarten AU - Hubloue, Ives AU - Lauwaert, Door AU - Cornu, Pieter AU - Brouns, Raf AU - Putman, Koen PY - 2017/11/24 TI - Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model JO - JMIR Mhealth Uhealth SP - e175 VL - 5 IS - 11 KW - telemedicine KW - prehospital KW - stroke KW - cost effectiveness N2 - Background: Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine. Objective: We aim to develop a first cost effectiveness model for in-ambulance telemedicine and use this model to estimate the time savings needed before in-ambulance telemedicine becomes cost effective. Methods: Current standard stroke care is compared with current standard stroke care supplemented with in-ambulance telemedicine using a cost-utility model measuring costs and quality-adjusted life-years (QALYs) from a health care perspective. We combine a decision tree with a Markov model. Data from the UZ Brussel Stroke Registry (2282 stroke patients) and linked hospital claims data at individual level are combined with literature data to populate the model. A 2-way sensitivity analysis varying both implementation costs and time gain is performed to map the different cost-effective combinations and identify the time gain needed for cost effectiveness and dominance. For several modeled time gains, the cost-effectiveness acceptability curve is calculated and mapped in 1 figure. Results: Under the base-case scenario (implementation cost of US $159,425) and taking a lifetime horizon into account, in-ambulance telemedicine is a cost-effective strategy compared to standard stroke care alone starting from a time gain of 6 minutes. After 12 minutes, in-ambulance telemedicine becomes dominant, and this results in a mean decrease of costs by US ?$30 (95% CI ?$32 to ?$29) per patient with 0.00456 (95% CI 0.00448 to 0.00463) QALYs on average gained per patient. In over 82% of all probabilistic simulations, in-ambulance telemedicine remains under the cost-effectiveness threshold of US $47,747. Conclusions: Our model suggests that in-ambulance telemedicine can be cost effective starting from a time gain of 6 minutes and becomes a dominant strategy after approximately 15 minutes. This indicates that in-ambulance telemedicine has the potential to become a cost-effective intervention assuming time gains in clinical implementations are realized in the future. UR - http://mhealth.jmir.org/2017/11/e175/ UR - http://dx.doi.org/10.2196/mhealth.8288 UR - http://www.ncbi.nlm.nih.gov/pubmed/29175808 ID - info:doi/10.2196/mhealth.8288 ER - TY - JOUR AU - Pecina, L. Jennifer AU - Wyatt, D. Kirk AU - Comfere, I. Nneka AU - Bernard, E. Matthew AU - North, Frederick PY - 2017/11/08 TI - Uses of Mobile Device Digital Photography of Dermatologic Conditions in Primary Care JO - JMIR Mhealth Uhealth SP - e165 VL - 5 IS - 11 KW - telemedicine KW - teledermatology KW - mobile phone KW - mobile applications KW - primary health care KW - smartphone KW - remote consultation N2 - Background: PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)?based mobile devices. Objective: The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes. Methods: Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant). Results: During the study period, there were 1139 photo sessions on 1059 unique patients. Of the 1139 sessions, 395 (34.68%) sessions documented dermatologist input in the EHR via dermatology curbside consultation, eConsult, and in-person dermatology consult. Clinicians utilized curbside phone consults preferentially over eConsults for TD. By clinician type, nurse practitioners (NPs) and physician assistants (PAs) were more likely to utilize the PhotoExam for TD as compared with physicians. By specialty type, pediatric clinicians were more likely to utilize the PhotoExam for TD as compared with family medicine and internal medicine clinicians. A total of 108 (9.5%) photo sessions had a biopsy performed of the photographed site. Of these, 46 biopsies (42.6%) were performed by a primary care clinician, and 27 (25.0%) biopsies were interpreted as a malignancy. Of the 27 biopsies that revealed malignant findings, 6 (22%) had a TD consultation before biopsy, and 10 (37%) of these biopsies were obtained by primary care clinicians. Conclusions: Clinicians primarily used the PhotoExam for non-TD purposes. Nurse practitioners and PAs utilized the app for TD purposes more than physicians. Primary care clinicians requested curbside dermatology consults more frequently than dermatology eConsults. UR - http://mhealth.jmir.org/2017/11/e165/ UR - http://dx.doi.org/10.2196/mhealth.8257 UR - http://www.ncbi.nlm.nih.gov/pubmed/29117934 ID - info:doi/10.2196/mhealth.8257 ER - TY - JOUR AU - Mileski, Michael AU - Kruse, Scott Clemens AU - Catalani, Justin AU - Haderer, Tara PY - 2017/10/24 TI - Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review JO - JMIR Med Inform SP - e41 VL - 5 IS - 4 KW - hypertension KW - telemedicine KW - eHealth KW - mHealth KW - disease management N2 - Background: Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. Objective: A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Methods: Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results: Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. Conclusions: This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of hypertension. UR - http://medinform.jmir.org/2017/4/e41/ UR - http://dx.doi.org/10.2196/medinform.6603 UR - http://www.ncbi.nlm.nih.gov/pubmed/29066424 ID - info:doi/10.2196/medinform.6603 ER - TY - JOUR AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Huang, Ching-Chang AU - Hung, Yu-Chien AU - Hwang, Juey-Jen AU - Ho, Yi-Lwun PY - 2017/09/26 TI - Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study JO - JMIR Mhealth Uhealth SP - e135 VL - 5 IS - 9 KW - atrial fibrillation KW - screen KW - cloud-computing algorithm KW - electrocardiography N2 - Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician?s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. UR - https://mhealth.jmir.org/2017/9/e135/ UR - http://dx.doi.org/10.2196/mhealth.8290 UR - http://www.ncbi.nlm.nih.gov/pubmed/28951384 ID - info:doi/10.2196/mhealth.8290 ER - TY - JOUR AU - Celler, Branko AU - Varnfield, Marlien AU - Nepal, Surya AU - Sparks, Ross AU - Li, Jane AU - Jayasena, Rajiv PY - 2017/09/08 TI - Impact of At-Home Telemonitoring on Health Services Expenditure and Hospital Admissions in Patients With Chronic Conditions: Before and After Control Intervention Analysis JO - JMIR Med Inform SP - e29 VL - 5 IS - 3 KW - telehealth KW - telemonitoring KW - chronic disease management KW - healthcare outcomes KW - BACI analysis N2 - Background: Telemonitoring is becoming increasingly important for the management of patients with chronic conditions, especially in countries with large distances such as Australia. However, despite large national investments in health information technology, little policy work has been undertaken in Australia in deploying telehealth in the home as a solution to the increasing demands and costs of managing chronic disease. Objective: The objective of this trial was to evaluate the impact of introducing at-home telemonitoring to patients living with chronic conditions on health care expenditure, number of admissions to hospital, and length of stay (LOS). Methods: A before and after control intervention analysis model was adopted whereby at each location patients were selected from a list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. Test patients were supplied with a telehealth vital signs monitor and were remotely managed by a trained clinical care coordinator, while control patients continued to receive usual care. A total of 100 test patients and 137 control patients were analyzed. Primary health care benefits provided to Australian patients were investigated for the trial cohort. Time series data were analyzed using linear regression and analysis of covariance for a period of 3 years before the intervention and 1 year after. Results: There were no significant differences between test and control patients at baseline. Test patients were monitored for an average of 276 days with 75% of patients monitored for more than 6 months. Test patients 1 year after the start of their intervention showed a 46.3% reduction in rate of predicted medical expenditure, a 25.5% reduction in the rate of predicted pharmaceutical expenditure, a 53.2% reduction in the rate of predicted unscheduled admission to hospital, a 67.9% reduction in the predicted rate of LOS when admitted to hospital, and a reduction in mortality of between 41.3% and 44.5% relative to control patients. Control patients did not demonstrate any significant change in their predicted trajectory for any of the above variables. Conclusions: At-home telemonitoring of chronically ill patients showed a statistically robust positive impact increasing over time on health care expenditure, number of admissions to hospital, and LOS as well as a reduction in mortality. Trial Registration: Retrospectively registered with the Australian and New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030 (Archived by WebCite at http://www.webcitation.org/6sxqjkJHW) UR - http://medinform.jmir.org/2017/3/e29/ UR - http://dx.doi.org/10.2196/medinform.7308 UR - http://www.ncbi.nlm.nih.gov/pubmed/28887294 ID - info:doi/10.2196/medinform.7308 ER - TY - JOUR AU - Lowenstein, Margaret AU - Bamgbose, Olusinmi AU - Gleason, Nathaniel AU - Feldman, D. Mitchell PY - 2017/08/04 TI - Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry JO - J Med Internet Res SP - e279 VL - 19 IS - 8 KW - mental health KW - primary care KW - health care delivery KW - teleconsultation KW - telehealth KW - Internet care delivery N2 - Background: Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Objective: Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. Methods: We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Results: Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. Conclusions: For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. UR - http://www.jmir.org/2017/8/e279/ UR - http://dx.doi.org/10.2196/jmir.7921 UR - http://www.ncbi.nlm.nih.gov/pubmed/28778852 ID - info:doi/10.2196/jmir.7921 ER - TY - JOUR AU - Giordano, Vincenzo AU - Koch, Hilton AU - Godoy-Santos, Alexandre AU - Dias Belangero, William AU - Esteves Santos Pires, Robinson AU - Labronici, Pedro PY - 2017/07/21 TI - WhatsApp Messenger as an Adjunctive Tool for Telemedicine: An Overview JO - Interact J Med Res SP - e11 VL - 6 IS - 2 KW - whatsapp KW - telemedicine KW - smartphone KW - mobile application N2 - Background: The advent of telemedicine has allowed physicians to deliver medical treatment to patients from a distance. Mobile apps such as WhatsApp Messenger, an instant messaging service, came as a novel concept in all fields of social life, including medicine. The use of instant messaging services has been shown to improve communication within medical teams by providing means for quick teleconsultation, information sharing, and starting treatment as soon as possible. Objective: The aim of this study was to perform a comprehensive systematic review of present literature on the use of the WhatsApp Messenger app as an adjunctive health care tool for medical doctors. Methods: Searches were performed in PubMed, EMBASE, and the Cochrane Library using the term ?whatsapp*? in articles published before January 2016. A bibliography of all relevant original articles that used the WhatsApp Messenger app was created. The level of evidence of each study was determined according to the Oxford Levels of Evidence ranking system produced by the Oxford Centre for Evidence-Based Medicine. The impact and the indications of WhatsApp Messenger are discussed in order to understand the extent to which this app currently functions as an adjunctive tool for telemedicine. Results: The database search identified a total of 30 studies in which the term ?whatsapp*? was used. Each article?s list of references was evaluated item-by-item. After literature reviews, letters to the editor, and low-quality studies were excluded, a total of 10 studies were found to be eligible for inclusion. Of these studies, 9 had been published in the English language and 1 had been published in Spanish. Five were published by medical doctors. Conclusions: The pooled data presents compelling evidence that the WhatsApp Messenger app is a promising system, whether used as a communication tool between health care professionals, as a means of communication between health care professionals and the general public, or as a learning tool for providing health care information to professionals or to the general population. However, high-quality and properly evaluated research is needed, as are improvements in descriptions of the methodology and the study processes. These improvements will allow WhatsApp Messenger to be categorically defined as an effective telemedicine tool in many different fields of health care. UR - http://www.i-jmr.org/2017/2/e11/ UR - http://dx.doi.org/10.2196/ijmr.6214 UR - http://www.ncbi.nlm.nih.gov/pubmed/28733273 ID - info:doi/10.2196/ijmr.6214 ER - TY - JOUR AU - Voruganti, Teja AU - Grunfeld, Eva AU - Jamieson, Trevor AU - Kurahashi, M. Allison AU - Lokuge, Bhadra AU - Krzyzanowska, K. Monika AU - Mamdani, Muhammad AU - Moineddin, Rahim AU - Husain, Amna PY - 2017/07/18 TI - My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer JO - J Med Internet Res SP - e219 VL - 19 IS - 7 KW - MeSH: Internet KW - professional-patient relations KW - interdisciplinary communication KW - neoplasms KW - adult KW - chronic disease KW - continuity of patient care KW - patient care team KW - communication KW - outcome assessment (health care) N2 - Background: The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. Objective: The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. Methods: We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ?3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. Results: Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. Conclusions: The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. Trial Registration: ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb). UR - http://www.jmir.org/2017/7/e219/ UR - http://dx.doi.org/10.2196/jmir.7421 UR - http://www.ncbi.nlm.nih.gov/pubmed/28720558 ID - info:doi/10.2196/jmir.7421 ER - TY - JOUR AU - Sieck, J. Cynthia AU - Hefner, L. Jennifer AU - Schnierle, Jeanette AU - Florian, Hannah AU - Agarwal, Aradhna AU - Rundell, Kristen AU - McAlearney, Scheck Ann PY - 2017/07/04 TI - The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users JO - JMIR Med Inform SP - e13 VL - 5 IS - 3 KW - patient portals KW - secure messaging KW - patient-provider communication KW - qualitative study N2 - Background: Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective: Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods: This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic?s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results: Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician?s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the ?rules of engagement? at portal sign-up, either in the office or through an online tutorial. Conclusions: As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing ?rules of engagement? for communication via patient portals. UR - http://medinform.jmir.org/2017/3/e13/ UR - http://dx.doi.org/10.2196/medinform.7516 UR - http://www.ncbi.nlm.nih.gov/pubmed/28676467 ID - info:doi/10.2196/medinform.7516 ER - TY - JOUR AU - Woldaregay, Zebene Ashenafi AU - Walderhaug, Ståle AU - Hartvigsen, Gunnar PY - 2017/06/28 TI - Telemedicine Services for the Arctic: A Systematic Review JO - JMIR Med Inform SP - e16 VL - 5 IS - 2 KW - telemedicine KW - telehealth KW - health services accessibility KW - extreme cold KW - arctic regions KW - accidents N2 - Background: Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. Objective: The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. Methods: A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. Results: The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated another 219 papers, leaving 203 relevant papers. After a full-text assessment, 36 articles were left, which were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. Conclusions: Despite the increasing number of fishermen and other seafarers, Arctic and maritime working conditions are mainly characterized by an absence of access to health care facilities. The condition is further aggravated for fishermen and seafarers who are working in the Arctic regions. In spite of the existing barriers and challenges, some telemedicine services have recently been successfully delivered in these areas. These services include teleconsultation (9/37, 24%), teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%), telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37, 27%). However, the use of telemedicine in relation to search and rescue (SAR) services is not yet fully exploited. Therefore, we foresee that these implemented and evaluated telemedicine services will serve as underlying models for the successful implementation of future search and rescue (SAR) services. UR - http://medinform.jmir.org/2017/2/e16/ UR - http://dx.doi.org/10.2196/medinform.6323 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659257 ID - info:doi/10.2196/medinform.6323 ER - TY - JOUR AU - Kooij, Laura AU - Groen, G. Wim AU - van Harten, H. Wim PY - 2017/06/22 TI - The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review JO - J Med Internet Res SP - e221 VL - 19 IS - 6 KW - review KW - integrated healthcare systems KW - health information systems KW - chronic disease N2 - Background: In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective: Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods: PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness?in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes?were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results: The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes?for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs? satisfaction, and confidence. Conclusions: IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods. UR - http://www.jmir.org/2017/6/e221/ UR - http://dx.doi.org/10.2196/jmir.7405 UR - http://www.ncbi.nlm.nih.gov/pubmed/28642218 ID - info:doi/10.2196/jmir.7405 ER - TY - JOUR AU - McGrail, Marie Kimberlyn AU - Ahuja, Alyssa Megan AU - Leaver, Andrew Chad PY - 2017/05/26 TI - Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study JO - J Med Internet Res SP - e177 VL - 19 IS - 5 KW - virtual visits KW - telehealth KW - primary care delivery KW - patient-centered care N2 - Background: Virtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use. Objective: Descriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician. Methods: The study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs. Results: During 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2%) of respondents saying their virtual visit was of high quality and 364 (91.2%) reporting their virtual visit was ?very? or ?somewhat? helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can $4 per quarter (Can ?$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can ?$8.68, P<.001). Conclusions: Virtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems. UR - http://www.jmir.org/2017/5/e177/ UR - http://dx.doi.org/10.2196/jmir.7374 UR - http://www.ncbi.nlm.nih.gov/pubmed/28550006 ID - info:doi/10.2196/jmir.7374 ER - TY - JOUR AU - Kargiannakis, Melissa AU - Fitzsimmons, A. Deborah AU - Bentley, L. Claire AU - Mountain, A. Gail PY - 2017/03/22 TI - Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data JO - JMIR Med Inform SP - e8 VL - 5 IS - 1 KW - information systems KW - telemedicine KW - pulmonary disease KW - chronic obstructive KW - triggers and rules KW - information integration KW - decision support systems KW - information retrieval N2 - Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD. Objective: The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission. Methods: A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts?other than the COPD discharge service?for all participants for the duration of the intervention and 6 months postintervention. Results: Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm. Conclusions: It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 68856013; http://www.isrctn.com/ISRCTN68856013 (Archived by WebCite at http://www.webcitation.org/6ofApNB2e) UR - http://medinform.jmir.org/2017/1/e8/ UR - http://dx.doi.org/10.2196/medinform.6359 UR - http://www.ncbi.nlm.nih.gov/pubmed/28330829 ID - info:doi/10.2196/medinform.6359 ER - TY - JOUR AU - Stutman, Steve PY - 2016/12/29 TI - Enhancing Video Chat Applications for Home Health Care JO - iproc SP - e22 VL - 2 IS - 1 KW - video chat KW - patient-physician interaction KW - age in place N2 - Background: Estimates show that up to 87% of seniors would like to ?age in place.? Often, such people are remote from their families and health care providers. Acquisition and telemetry of data and bio-signals from personal health care instrumentation is of great value, but we feel that this does not tell the complete story, because we are dealing with humans. A brief video chat, via personal computer, can usually provide a great deal of information concerning a person?s well-being. An individual?s mood, physical status, and energy level and the state of their surroundings can frequently be determined in a one-minute video chat. While these evaluations are qualitative, they can be very useful in answering the simple, important question ?Is this person OK?? A video chat can also help build constructive social bonds between patients and providers because the telecommunication is no longer ?faceless.? People who are aging in place are generally not the best computer users. Even if a person is proficient with the use of computers, issues with vision and manual dexterity can present obstacles to the use of video chat applications such as Skype. We have designed and implemented a low-cost system, comprised of a small ?helper? program and a wired keypad, which operates with a personal computer and obviates the difficulties experienced by many less experienced and older users. Very simply, this system makes it easier for many people to communicate with their families and healthcare providers. Objective: Our goal was to simplify the use of video chat applications. A conventional desktop is often visually cluttered or has one application window obscuring another. Navigation with a mouse or other pointing device can be difficult for people with impaired vision and those with tremors, arthritis, or other dexterity limiting factors. We designed and built a ?helper? program that, in conjunction with a dedicated large symbol keypad, lets a user initiate a video chat just by pressing a couple of buttons. Methods: At present we have conducted a small pilot study (N=8) with naïve computer users who want to video chat with family members. Participants in the study were chosen because they had difficulty initiating video chats. We asked this group to use our system and measured time required to initiate a video chat. Results: All subjects were able to initiate video chats in <30 seconds. The users were all able to terminate the chats when desired. In simple terms, the naïve users were able to start and end calls when they wanted to. Users expressed satisfaction at being able to control this aspect of their computers without technical support from others and enjoyed chat interactions. Conclusions: Video chat applications can be made simpler and easier to use, empowering a person who is aging in place to engage with family and healthcare providers. UR - http://www.iproc.org/2016/1/e22/ UR - http://dx.doi.org/10.2196/iproc.6246 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/iproc.6246 ER - TY - JOUR AU - Abraham, Joanna AU - Kannampallil, G. Thomas AU - Patel, L. Vimla AU - Patel, Bela AU - Almoosa, F. Khalid PY - 2016/12/09 TI - Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study JO - JMIR Hum Factors SP - e29 VL - 3 IS - 2 KW - teaching rounds KW - communication KW - intensive care units N2 - Background: Recent research has shown evidence of disproportionate time allocation for patient communication during multidisciplinary rounds (MDRs). Studies have shown that patients discussed later during rounds receive lesser time. Objective: The aim of our study was to investigate whether disproportionate time allocation effects persist with the use of structured rounding tools. Methods: Using audio recordings of rounds (N=82 patients), we compared time allocation and communication breakdowns between a problem-based Subjective, Objective, Assessment, and Plan (SOAP) and a system-based Handoff Intervention Tool (HAND-IT) rounding tools. Results: We found no significant linear dependence of the order of patient presentation on the time spent or on communication breakdowns for both structured tools. However, for the problem-based tool, there was a significant linear relationship between the time spent on discussing a patient and the number of communication breakdowns (P<.05)??with an average of 1.04 additional breakdowns with every 120 seconds in discussion. Conclusions: The use of structured rounding tools potentially mitigates disproportionate time allocation and communication breakdowns during rounds, with the more structured HAND-IT, almost completely eliminating such effects. These results have potential implications for planning, prioritization, and training for time management during MDRs. UR - http://humanfactors.jmir.org/2016/2/e29/ UR - http://dx.doi.org/10.2196/humanfactors.6642 UR - http://www.ncbi.nlm.nih.gov/pubmed/27940423 ID - info:doi/10.2196/humanfactors.6642 ER - TY - JOUR AU - de Jong, C. Catharina AU - Ros, JG Wynand AU - van Leeuwen, Mia AU - Schrijvers, Guus PY - 2016/11/24 TI - How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals JO - J Med Internet Res SP - e304 VL - 18 IS - 11 KW - eHealth KW - primary care KW - elderly KW - email KW - nurses KW - general practitioners KW - medical informatics KW - Internet N2 - Background: Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. Objective: The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. Methods: The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. Results: An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. Conclusions: An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care. UR - http://www.jmir.org/2016/11/e304/ UR - http://dx.doi.org/10.2196/jmir.6332 UR - http://www.ncbi.nlm.nih.gov/pubmed/27884811 ID - info:doi/10.2196/jmir.6332 ER - TY - JOUR AU - Choi, Iee AU - Kim, Kyu Jin AU - Kim, Jun Sun AU - Cho, Chul Soo AU - Kim, Nyeo Il PY - 2016/08/04 TI - Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors JO - JMIR Med Inform SP - e26 VL - 4 IS - 3 KW - social media KW - personal satisfaction KW - information systems KW - patient transfer N2 - Background: The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. Objective: In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. Methods: Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. Results: The number of patients transferred was reported to increase by 65% (26/40) obstetricians and 40% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72% (29/40) obstetricians and 59% (34/57) pediatricians. Satisfaction was indicated by 83% (33/40) obstetricians and 89% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). Conclusions: The users were highly satisfied and different users indicated different factors of satisfaction. This finding implies that users? requirements should be accommodated in future developments of patient transfer information systems. UR - http://medinform.jmir.org/2016/3/e26/ UR - http://dx.doi.org/10.2196/medinform.5984 UR - http://www.ncbi.nlm.nih.gov/pubmed/27492978 ID - info:doi/10.2196/medinform.5984 ER - TY - JOUR AU - Pathipati, S. Akhilesh AU - Azad, D. Tej AU - Jethwani, Kamal PY - 2016/07/12 TI - Telemedical Education: Training Digital Natives in Telemedicine JO - J Med Internet Res SP - e193 VL - 18 IS - 7 KW - telemedicine KW - medical education KW - medical school KW - curriculum reform UR - http://www.jmir.org/2016/7/e193/ UR - http://dx.doi.org/10.2196/jmir.5534 UR - http://www.ncbi.nlm.nih.gov/pubmed/27405323 ID - info:doi/10.2196/jmir.5534 ER - TY - JOUR AU - Bull, Preston Tyler AU - Dewar, Roxanne Alexis AU - Malvey, M. Donna AU - Szalma, Leo James PY - 2016/07/08 TI - Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies JO - JMIR Med Educ SP - e11 VL - 2 IS - 2 KW - telehealth systems KW - younger adults KW - telehealth advantages KW - telehealth disadvantages KW - thematic analysis N2 - Background: While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. Objective: This study aims to examine the perceptions of telehealth systems within a large student sample. Methods: Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. Results: We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. Conclusion: By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems. UR - http://mededu.jmir.org/2016/2/e11/ UR - http://dx.doi.org/10.2196/mededu.5392 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731865 ID - info:doi/10.2196/mededu.5392 ER - TY - JOUR AU - Farrell, Maureen PY - 2016/05/31 TI - Use of iPhones by Nurses in an Acute Care Setting to Improve Communication and Decision-Making Processes: Qualitative Analysis of Nurses? Perspectives on iPhone Use JO - JMIR mHealth uHealth SP - e43 VL - 4 IS - 2 KW - acute care KW - clinical decision making KW - communication KW - iPhones KW - nursing N2 - Background: Smartphones and other mobile devices are having and will continue to have an impact on health care delivery in acute settings in Australia and overseas. Nurses, unlike physicians, have been slow to adopt these technologies and the reasons for this may relate to the status of both these professions within the hospital setting. Objective: To explore nurses? perspectives on iPhone use within an acute care unit. We examined their experiences and views on how this device may improve communication and decision-making processes at the point of care. Methods: Two focus group discussions, using a semistructured interview, were conducted over the trial period. The discussions focused on the nurses? experiences regarding ease of use, features, and capabilities of the device. The focus groups were recorded, transcribed, and analyzed using semistructured interview questions as a guide. Results: The positive findings indicated that the iPhones were accessible and portable at point of care with patients, enhanced communication in the workplace, particularly among the nurses, and that this technology would evolve and be embraced by all nurses in the future. The negatives were the small screen size when undertaking bedside education for the patient and the invasive nature of the device. Another issue was the perception of being viewed as unprofessional when using the device in real time with the patients and their family. Conclusions: The use of iPhones by nurses in acute care settings has the potential to enhance patient care, especially through more effective communication among nurses, and other health care professionals. To ensure that the benefits of this technology is woven into the everyday practice of the nurse, it is important that leaders in these organizations develop the agenda or policy to ensure that this occurs. UR - http://mhealth.jmir.org/2016/2/e43/ UR - http://dx.doi.org/10.2196/mhealth.5071 UR - http://www.ncbi.nlm.nih.gov/pubmed/27246197 ID - info:doi/10.2196/mhealth.5071 ER - TY - JOUR AU - Patel, Bhavesh AU - Johnston, Maximilian AU - Cookson, Natalie AU - King, Dominic AU - Arora, Sonal AU - Darzi, Ara PY - 2016/04/06 TI - Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients JO - J Med Internet Res SP - e79 VL - 18 IS - 4 KW - communication KW - mobile phone KW - pager KW - applications KW - apps KW - escalation of care KW - simulation N2 - Background: Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. Objective: The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. Methods: We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users? satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. Results: We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100?121 versus pager median 77, range 39?104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included ?enhances interprofessional efficiency,? ?results in less disturbance,? ?performed desired functions reliably,? and ?allows me to clearly transfer information.? Conclusions: Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care. UR - http://www.jmir.org/2016/4/e79/ UR - http://dx.doi.org/10.2196/jmir.4854 UR - http://www.ncbi.nlm.nih.gov/pubmed/27052694 ID - info:doi/10.2196/jmir.4854 ER - TY - JOUR AU - Cuba Gyllensten, Illapha AU - Bonomi, G. Alberto AU - Goode, M. Kevin AU - Reiter, Harald AU - Habetha, Joerg AU - Amft, Oliver AU - Cleland, GF John PY - 2016/02/18 TI - Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance JO - JMIR Med Inform SP - e3 VL - 4 IS - 1 KW - Heart failure KW - telemonitoring KW - deterioration detection KW - alert algorithms KW - ambulatory monitoring KW - impedance N2 - Background: Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective: In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods: We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results: Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines. Conclusions: NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation. UR - http://medinform.jmir.org/2016/1/e3/ UR - http://dx.doi.org/10.2196/medinform.4842 UR - http://www.ncbi.nlm.nih.gov/pubmed/26892844 ID - info:doi/10.2196/medinform.4842 ER - TY - JOUR AU - Gupte, Gouri AU - Vimalananda, Varsha AU - Simon, R. Steven AU - DeVito, Katerina AU - Clark, Justice AU - Orlander, D. Jay PY - 2016/02/12 TI - Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System JO - JMIR Med Inform SP - e6 VL - 4 IS - 1 KW - remote consultations KW - clinical communication KW - electronic consultation KW - telehealth KW - clinical information KW - decision making, telemonitoring KW - eHealth infrastructures N2 - Background: Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication. Objective: The aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system. Methods: Data from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults. Results: A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e-consults reflected a request for specialist input to a generalist?s question in diagnosis or management in the ambulatory setting, we identified creative uses of e-consults, including requests for face-to-face appointments and documentation of pre-operative chart reviews; moreover, 7.00% (360/5141) of the e-consults originated from our sub-acute and chronic care inpatient units. In interviews, requesting providers reported high utility and usability. Specialists recognized the value of e-consults but expressed concerns about additional workload. Conclusions: The e-consult mechanism is frequently utilized for its initial intended purpose. It has also been adopted for unexpected clinical and administrative uses, developing into a ?disruptive innovation? and highlighting existing gaps in mechanisms for provider communication. Further investigation is needed to characterize optimal utilization of e-consults within specialty and the medical center, and what features of the e-consult program, other than volume, represent valid measures of access and quality care. UR - http://medinform.jmir.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/medinform.4801 UR - http://www.ncbi.nlm.nih.gov/pubmed/26872820 ID - info:doi/10.2196/medinform.4801 ER - TY - JOUR AU - Prochaska, T. Micah AU - Bird, Amber-Nicole AU - Chadaga, Amar AU - Arora, M. Vineet PY - 2015/11/26 TI - Resident Use of Text Messaging for Patient Care: Ease of Use or Breach of Privacy? JO - JMIR Med Inform SP - e37 VL - 3 IS - 4 KW - in-hospital communication KW - SMS text messaging KW - mobile technology N2 - Background: Short message service (SMS) text messaging is an efficient form of communication and pervasive in health care, but may not securely protect patient information. It is unclear if resident providers are aware of the security concerns of SMS text messaging when communicating about patient care. Objective: We sought to compare residents? preferences for SMS text messaging compared with other forms of in-hospital communication when considering security versus ease of use. Methods: This study was a cross-sectional multi-institutional survey of internal medicine residents. Residents ranked different communication modalities based on efficiency, ease of use, and security using a Likert scale. Communication options included telephone, email, hospital paging, and SMS text messaging. Respondents also reported whether they had received confidential patient identifiers through any of these modalities. Results: SMS text messaging was preferred by 71.7% (94/131) of respondents because of its efficiency and by 79.8% (103/129) of respondents because of its ease of use. For security, 82.5% (104/126) of respondents preferred the hospital paging system, whereas only 20.6% (26/126) of respondents preferred SMS text messaging for secure communication. In all, 70.9% (93/131) of respondents reported having received patient identifiers (first and/or last name), 81.7% (107/131) reported receiving patient initials, and 50.4% (66/131) reported receiving a patient?s medical record number through SMS text messages. Conclusions: Residents prefer in-hospital communication through SMS text messaging because of its ease of use and efficiency. Despite security concerns, the majority of residents reported receiving confidential patient information through SMS text messaging. For providers, it is possible that the benefits of improved in-hospital communication with SMS text messaging and the presumed improvement in the coordination and delivery of patient care outweigh security concerns they may have. The tension between the security and convenience of SMS text messaging may represent an educational opportunity to ensure the compliance of mobile technology in the health care setting. UR - http://medinform.jmir.org/2015/4/e37/ UR - http://dx.doi.org/10.2196/medinform.4797 UR - http://www.ncbi.nlm.nih.gov/pubmed/26611620 ID - info:doi/10.2196/medinform.4797 ER - TY - JOUR AU - Manojlovich, Milisa AU - Adler-Milstein, Julia AU - Harrod, Molly AU - Sales, Anne AU - Hofer, P. Timothy AU - Saint, Sanjay AU - Krein, L. Sarah PY - 2015/06/11 TI - The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol JO - JMIR Res Protoc SP - e72 VL - 4 IS - 2 KW - interdisciplinary communication KW - health information technology KW - computer communication networks KW - hospital communication systems N2 - Background: Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. Objective: The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. Methods: This 4-year study uses a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from aim 1 will provide a detailed assessment of health information and communication technologies in use and help identify sites with variation in health information and communication technologies for the qualitative phase of the study. In aim 2, we will conduct telephone interviews with hospital personnel in up to 8 hospitals to gather in-depth information about communication practices and work relationships on medical-surgical units. In aim 3, we will collect data in 4 hospitals (selected from telephone interview results) via observation, shadowing, focus groups, and artifacts to learn how health information and communication technologies, communication practices, and work relationships affect communication. Results: Results from aim 1 will be published in 2016. Results from aims 2 and 3 will be published in subsequent years. Conclusions: As the majority of US hospitals do not yet have HIT fully implemented, results from our study will inform future development and implementation of health information and communication technologies to support effective communication between nurses and physicians. UR - http://www.researchprotocols.org/2015/2/e72/ UR - http://dx.doi.org/10.2196/resprot.4463 UR - http://www.ncbi.nlm.nih.gov/pubmed/26068442 ID - info:doi/10.2196/resprot.4463 ER - TY - JOUR AU - Ho, Te-Wei AU - Huang, Chen-Wei AU - Lin, Ching-Miao AU - Lai, Feipei AU - Ding, Jian-Jiun AU - Ho, Yi-Lwun AU - Hung, Chi-Sheng PY - 2015/05/07 TI - A Telesurveillance System With Automatic Electrocardiogram Interpretation Based on Support Vector Machine and Rule-Based Processing JO - JMIR Med Inform SP - e21 VL - 3 IS - 2 KW - telehealth care KW - telesurveillance system KW - electrocardiogram KW - ECG classification KW - support vector machine N2 - Background: Telehealth care is a global trend affecting clinical practice around the world. To mitigate the workload of health professionals and provide ubiquitous health care, a comprehensive surveillance system with value-added services based on information technologies must be established. Objective: We conducted this study to describe our proposed telesurveillance system designed for monitoring and classifying electrocardiogram (ECG) signals and to evaluate the performance of ECG classification. Methods: We established a telesurveillance system with an automatic ECG interpretation mechanism. The system included: (1) automatic ECG signal transmission via telecommunication, (2) ECG signal processing, including noise elimination, peak estimation, and feature extraction, (3) automatic ECG interpretation based on the support vector machine (SVM) classifier and rule-based processing, and (4) display of ECG signals and their analyzed results. We analyzed 213,420 ECG signals that were diagnosed by cardiologists as the gold standard to verify the classification performance. Results: In the clinical ECG database from the Telehealth Center of the National Taiwan University Hospital (NTUH), the experimental results showed that the ECG classifier yielded a specificity value of 96.66% for normal rhythm detection, a sensitivity value of 98.50% for disease recognition, and an accuracy value of 81.17% for noise detection. For the detection performance of specific diseases, the recognition model mainly generated sensitivity values of 92.70% for atrial fibrillation, 89.10% for pacemaker rhythm, 88.60% for atrial premature contraction, 72.98% for T-wave inversion, 62.21% for atrial flutter, and 62.57% for first-degree atrioventricular block. Conclusions: Through connected telehealth care devices, the telesurveillance system, and the automatic ECG interpretation system, this mechanism was intentionally designed for continuous decision-making support and is reliable enough to reduce the need for face-to-face diagnosis. With this value-added service, the system could widely assist physicians and other health professionals with decision making in clinical practice. The system will be very helpful for the patient who suffers from cardiac disease, but for whom it is inconvenient to go to the hospital very often. UR - http://medinform.jmir.org/2015/2/e21/ UR - http://dx.doi.org/10.2196/medinform.4397 UR - http://www.ncbi.nlm.nih.gov/pubmed/25953306 ID - info:doi/10.2196/medinform.4397 ER - TY - JOUR AU - Kitsiou, Spyros AU - Paré, Guy AU - Jaana, Mirou PY - 2015/03/12 TI - Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews JO - J Med Internet Res SP - e63 VL - 17 IS - 3 KW - home telemonitoring KW - telemedicine KW - telehealth KW - remote monitoring KW - remote consultation KW - heart failure KW - chronic diseases KW - continuity of patient care KW - physiologic monitoring KW - ambulatory monitoring KW - home care services KW - review KW - umbrella review KW - systematic review KW - meta-analysis N2 - Background: Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective: This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods: A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (?28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. UR - http://www.jmir.org/2015/3/e63/ UR - http://dx.doi.org/10.2196/jmir.4174 UR - http://www.ncbi.nlm.nih.gov/pubmed/25768664 ID - info:doi/10.2196/jmir.4174 ER - TY - JOUR AU - Hallet, Julie AU - Wallace, David AU - El-Sedfy, Abraham AU - Hall, NT Trevor AU - Ahmed, Najma AU - Bridge, Jennifer AU - Taggar, Ru AU - Smith, J. Andy AU - Nathens, B. Avery AU - Coburn, G. Natalie AU - Gotlib-Conn, Lesley PY - 2015/03/05 TI - Optimizing Inter-Professional Communications in Surgery: Protocol for a Mixed-Methods Exploratory Study JO - JMIR Res Protoc SP - e8 VL - 4 IS - 1 KW - communication KW - interprofessional KW - pager KW - resident KW - nurse KW - education KW - patient safety N2 - Background: Effective nurse-physician communication is critical to delivering high quality patient care. Interprofessional communication between surgical nurses and surgeons, often through the use of pagers, is currently characterized by information gaps and interprofessional tensions, both sources of workflow interruption, potential medical error, impaired educational experience, and job satisfaction. Objective: This study aims to define current patterns of, and understand enablers and barriers to interprofessional communication in general surgery, in order to optimize the use of communication technologies, teamwork, provider satisfaction, and quality and safety of patient care. Methods: We will use a mixed-methods multiphasic approach. In phase 1, a quantitative and content analysis of alpha-numeric pages (ANP) received by general surgery residents will be conducted to develop a paging taxonomy. Frequency, timing (on-call vs regular duty hours), and interval between pages will be described using a 4-week sample of pages. Results will be compared between pages sent to junior and senior residents. Finally, using an inductive analysis, two independent assessors will classify ANP thematically. In Phase 2, a qualitative constructivist approach will explore stakeholders? experiences with interprofessional communication, including paging, through interviews and shadowing of 40 residents and 40 nurses at two institutions. Finally, a survey will be developed, tested, and administered to all general surgery nurses and residents at the same two institutions, to evaluate their attitudes about the effectiveness and quality of interprofessional communication, and assess their satisfaction. Results: Describing the profile of current pages is the first step towards identifying areas and root causes of IPC inefficiency. This study will identify key contextual barriers to surgical nurse-house staff communication, and existing interprofessional knowledge and practice gaps. Conclusions: Our findings will inform the design of a guideline and tailored intervention to improve IPC in order to ensure high quality patient care, optimal educational experience, and provider satisfaction. UR - http://www.researchprotocols.org/2015/1/e8/ UR - http://dx.doi.org/10.2196/resprot.3623 UR - http://www.ncbi.nlm.nih.gov/pubmed/25745882 ID - info:doi/10.2196/resprot.3623 ER - TY - JOUR AU - Rodriguez, L. Keri AU - Burkitt, H. Kelly AU - Bayliss, K. Nichole AU - Skoko, E. Jennifer AU - Switzer, E. Galen AU - Zickmund, L. Susan AU - Fine, J. Michael AU - Macpherson, S. David PY - 2015/01/14 TI - Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation JO - JMIR Med Inform SP - e5 VL - 3 IS - 1 KW - access KW - rural health KW - referral and consultation KW - patient satisfaction KW - veterans N2 - Background: Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access. Objective: The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceived facilitators and barriers to using the e-consult program. Methods: We conducted semistructured telephone interviews with veteran patients (N=15), Community Based Outpatient Clinic (CBOC) PCPs (N=15), and VA Pittsburgh specialty physicians (N=4) who used the e-consult program between December 2009 to August 2010. Participants answered questions regarding satisfaction in eight domains and identified factors contributing to their responses. Results: Most participants were white (patients=87%; PCPs=80%; specialists=75%) and male (patients=93%; PCPs=67%; specialists=75%). On average, patients had one e-consult (SD 0), PCPs initiated 6 e-consults (SD 6), and VAPHS specialists performed 17 e-consults (SD 11). Patients, PCPs, and specialty physicians were satisfied with e-consults median (range) of 5.0 (4-5) on 1-5 Likert-scale, 4.0 (3-5), and 3.5 (3-5) respectively. The most common reason why patients and specialists reported increased overall satisfaction with e-consults was improved communication, whereas improved timeliness of care was the most common reason for PCPs. Communication was the most reported perceived barrier and facilitator to e-consult use. Conclusions: Veterans and VA health care providers were satisfied with the e-consult process. Our findings suggest that while the reasons for satisfaction with e-consult differ somewhat for patients and physicians, e-consult may be a useful tool to improve VA health care system access for rural patients. UR - http://medinform.jmir.org/2015/1/e5/ UR - http://dx.doi.org/10.2196/medinform.3725 UR - http://www.ncbi.nlm.nih.gov/pubmed/25589233 ID - info:doi/10.2196/medinform.3725 ER -