Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Background: One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up. Objective: To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients. Material and Methods: A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: “hypertension AND older AND primary care AND (COVID-19 OR coronavirus)” and its Spanish equivalent. Results: The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83–0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66–0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78–0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19. Conclusions: Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote–presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and us

Issues facing the application of telemedicine in developing countries: Hashemite Kingdom of Jordan and Syrian Arab Republic

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Telemedicine delivers healthcare between geographically separated locations using medical expertise supported by communication technology. Physicians and specialists from one site can provide diagnosis, treatment and consultation to patients at a remote site. This makes the use of telemedicine particularly affective in rural and remote areas that have limited access to healthcare services. This study identifies the factors that affect the use and adoption of telemedicine in developing countries and rural areas in general, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as cases studies. We have developed two guideline frameworks to be applied to telemedicine projects at the pre- implementation phase. The main purpose of the guideline frameworks is to assess the readiness of the Jordanian and Syrian health care system to use telemedicine and to assist any healthcare provider who is considering implementing a telemedicine project in either of these two countries. The guideline framework can be transferred and applied to any other country for which similar circumstances apply. Our guideline frameworks are based on interviews with key stakeholders including doctors, technicians, engineers, and decision makers, and administering questionnaires to further key stakeholders including patients, ensuring that we gain opinion from people from different backgrounds and with different roles in the healthcare system. Our research has identified specific key issues which inhibit the use of telemedicine: poor technology infrastructure; lack of funding; lack of IT education; insufficient training for clinicians; doctors’ resistance; patients’ resistance; and lack of knowledge about healthcare and technology. This work provides a clear idea of the current readiness in both countries and proposes two guideline frameworks that will aid the use of telemedicine. Their dissemination will create awareness and spread knowledge, which will help the decision makers to appreciate the potential role of telemedicine and help them to facilitate the process of introduction and so spread telemedicine in both Jordan and Syria

Issues of the adoption of HIT related standards at the decision-making stage of six tertiary healthcare organisations in Saudi Arabia

Due to interoperability barriers between clinical information systems, healthcare organisations are facing potential limitations with regard to acquiring the benefits such systems offer; in particular, in terms of reducing the cost of medical services. However, to achieve the level of interoperability required to reduce these problems, a high degree of consensus is required regarding health data standards. Although such standards essentially constitute a solution to the interoperability barriers mentioned above, the level of adoption of these standards remains frustratingly low. One reason for this is that health data standards are an authoritative field in which marketplace mechanisms do not work owing to the fact that health data standards developed for a particular market cannot, in general, be applied in other markets without modification. Many countries have launched national initiatives to develop and promote national health data standards but, although certain authors have mapped the landscape of the standardisation process for health data in some countries, these studies have failed to explain why the healthcare organisations seem unwilling to adopt those standards. In addressing this gap in the literature, a conceptual model of the adoption process of HIT related standards at the decision-making stage in healthcare organisations is proposed in this research. This model was based on two predominant theories regarding IT related standards in the IS field: Rogers paradigm (1995) and the economics of standards theory. In addition, the twenty one constructs of this model resulted from a comprehensive set of factors derived from the related literature; these were then grouped in accordance with the Technology-Organisation Environment (TOE), a well-known taxonomy within innovation adoption studies in the IS field. Moving from a conceptual to an empirical position, an interpretive, exploratory, multiple-case study methodology was conducted in Saudi Arabia to examine the proposed model. The empirical qualitative evidence gained necessitated some revision to be made to the proposed model. One factor was abandoned, four were modified and eight new factors were added. This consistent empirical model makes a novel contribution at two levels. First, with regard to the body of knowledge in the IS area, this model offers an in-depth understanding of the adoption process of HIT related standards which the literature still lacks. It also examines the applicability of IS theories in a new area which allows others to relate their experiences to those reported. Secondly, this model can be used by decision makers in the healthcare sector, particularly those in developing countries, as a guideline while planning for the adoption of health data standards

Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature

AIMS: To identify and synthesize studies reporting modifiable barriers/enablers associated with retinopathy screening attendance in people with Type 1 or Type 2 diabetes, and to identify those most likely to influence attendance. METHODS: We searched MEDLINE, EMBASE, PsycINFO, Cochrane Library and the 'grey literature' for quantitative and qualitative studies to February 2017. Data (i.e. participant quotations, interpretive summaries, survey results) reporting barriers/enablers were extracted and deductively coded into domains from the Theoretical Domains Framework; with domains representing categories of theoretical barriers/enablers proposed to mediate behaviour change. Inductive thematic analysis was conducted within domains to describe the role each domain plays in facilitating or hindering screening attendance. Domains that were more frequently coded and for which more themes were generated were judged more likely to influence attendance. RESULTS: Sixty-nine primary studies were included. We identified six theoretical domains ['environmental context and resources' (75% of included studies), 'social influences' (51%), 'knowledge' (51%), 'memory, attention, decision processes' (50%), 'beliefs about consequences' (38%) and 'emotions' (33%)] as the key mediators of diabetic retinopathy screening attendance. Examples of barriers populating these domains included inaccurate diabetic registers and confusion between routine eye care and retinopathy screening. Recommendations by healthcare professionals and community-level media coverage acted as enablers. CONCLUSIONS: Across a variety of contexts, we found common barriers to and enablers of retinopathy screening that could be targeted in interventions aiming to increase screening attendance

Exploring the potential of using mobile applications in diabetes management

Background Diabetes mellitus is a common chronic disease and a leading cause of morbidity, complications and mortality worldwide. The number of people living with diabetes is projected to rise sharply over the forthcoming decades. Diabetes care is complex and can overburden clinicians and nurses. There is a need for innovative, flexible and cost-effective technologies to enable successful diabetes management. This thesis explores the opportunities and challenges of the mobile application (app) technology as a potential tool to support diabetes care and management. Purpose The purpose was to develop and evaluate a mobile app that supports healthcare professionals (HCPs) in clinical decision-making. Methods A mixed-methods approach was used following the user-centred design (UCD) framework for the design and implementation of all studies. Quantitative and qualitative systematic reviews of studies reporting the use of mobile apps to support diabetes management were undertaken to identify, appraise and summarise available research evidence. An interview study was carried out with diabetes specialist nurses (DSNs), to explore their experiences and views, and to identify user requirements for apps. Lastly, a guidelines-based mobile clinical decision-support app was developed and tested with junior doctors and DSNs in a controlled environment to evaluate its usability and impact on adherence to clinical guidelines, and to explore how participants experienced the app and their suggestions for improvements. Results Both reviews found that the existing evidence base for mobile apps is weak and inadequate to draw conclusions about the impact of their use as interventions in diabetes management. The interview study identified that nurses lack experience in using apps in clinical practice, even though they believed it could facilitate and support their work. ‘Diabetes & CKD’, a simple mobile decision-support app, has been designed and built for the study to assist HCPs in management of patients with diabetes and kidney disease and was tested by 39 junior doctors and 3 DSNs. It had no impact on the accuracy of decisions. Feedback from participants after the pilot session and usability testing indicated a wish to integrate such apps into their clinical practice with a strong willingness to use them in the future. Conclusions Application of UCD methods was efficient as the app was well-accepted by both DSNs and junior doctors. Despite the positive views and the strong willingness to use such apps, they are not widely used. There is a need to regulate the use of medical apps in clinical practice. Further research with rigorous methodology is required upon which policymakers and practitioners can base their decision-making

Infectious diseases management framework for Saudi Arabia (SAIF)

A Thesis Submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor of PhilosopyInfectious disease management system area is considered as an emerging field of modern healthcare in the Gulf region. Significant technical and clinical progress and advanced technologies can be utilized to enhance the performance and ubiquity of such systems. Effective infectious disease management (IDM) can be achieved by analysing the disease management issues from the perspectives of healthcare personnel and patients. Hence, it is necessary to identify the needs and requirements of both healthcare personnel and patients for managing the infectious disease. The basic idea behind the proposed mobile IDM system in this thesis is to improve the healthcare processes in managing infectious diseases more effectively. For this purpose, internet and mobile technologies are integrated with social networking, mapping and IDM applications to improve the processes efficiency. Hence, the patients submit their health related data through their devices remotely using our application to our system database (so-called SAIF). The main objective of this PhD project was the design and development of a novel web based architecture of next-generation infectious disease management system embedding the concept of social networking tailored for Saudi patients. Following a detailed literature review which identifies the current status and potential impact of using infectious diseases management system in KSA, this thesis conducts a feasibility user perspective study for identifying the needs and the requirements of healthcare personnel and the patients for managing infectious diseases. Moreover, this thesis proposes a design and development of a novel architecture of next-generation web based infectious disease management system tailored for Saudi patients (i.e., called SAIF – infectious diseases management framework for Saudi Arabia). Further, this thesis introduces a usability study for the SAIF system to validate the acceptability of using mobile technologies amongst infected patient in KSA and Gulf region. The preliminary results of the study indicated general acceptance of the patients in using the system with higher usability rating in high affected patients. In general, the study concluded that the concept of SAIF system is considered acceptable tool in particularly with infected patients

Issues facing the application of telemedicine in developing countries : Hashemite Kingdom of Jordan and Syrian Arab Republic

Telemedicine delivers healthcare between geographically separated locations using medical expertise supported by communication technology. Physicians and specialists from one site can provide diagnosis, treatment and consultation to patients at a remote site. This makes the use of telemedicine particularly affective in rural and remote areas that have limited access to healthcare services. This study identifies the factors that affect the use and adoption of telemedicine in developing countries and rural areas in general, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as cases studies. We have developed two guideline frameworks to be applied to telemedicine projects at the pre- implementation phase. The main purpose of the guideline frameworks is to assess the readiness of the Jordanian and Syrian health care system to use telemedicine and to assist any healthcare provider who is considering implementing a telemedicine project in either of these two countries. The guideline framework can be transferred and applied to any other country for which similar circumstances apply. Our guideline frameworks are based on interviews with key stakeholders including doctors, technicians, engineers, and decision makers, and administering questionnaires to further key stakeholders including patients, ensuring that we gain opinion from people from different backgrounds and with different roles in the healthcare system. Our research has identified specific key issues which inhibit the use of telemedicine: poor technology infrastructure; lack of funding; lack of IT education; insufficient training for clinicians; doctors’ resistance; patients’ resistance; and lack of knowledge about healthcare and technology. This work provides a clear idea of the current readiness in both countries and proposes two guideline frameworks that will aid the use of telemedicine. Their dissemination will create awareness and spread knowledge, which will help the decision makers to appreciate the potential role of telemedicine and help them to facilitate the process of introduction and so spread telemedicine in both Jordan and Syria.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

eHealth in Chronic Diseases

This book provides a review of the management of chronic diseases (evaluation and treatment) through eHealth. Studies that examine how eHealth can help to prevent, evaluate, or treat chronic diseases and their outcomes are included

Developing a culturally sensitive structured diabetes education programme for people living with type 2 diabetes in Saudi Arabia

Background - Effective self-management plays a role in improving the health and well-being of people living with type 2 diabetes and structured education is vital as a means of preparing people for a lifetime with the disease. However, in recognition of the fact that there is wide diversity in world populations, there is a need for cultural adaptation to ensure relevance in different populations. Aims - The aim of this research was to determine the requirements for developing a culturally sensitive structured diabetes education programme for people living with type 2 diabetes in Saudi Arabia Methodology - A total of four individual studies were carried out to address the aims of the research. First, a systematic review of existing literature to summarise the current status and impact of theory-based, culturally adapted self-management education programmes on type 2 diabetes mellitus. This was followed up by two qualitative research studies involving semi-structured interviews with health care professionals involved in the provision of diabetes care and people living with type 2 diabetes respectively in Saudi Arabia. Finally, a secondary analysis of existing datasets from a hospital in Saudi Arabia highlights the diagnosis and care for people living with type 2 diabetes. Results - Type 2 diabetes self-management education programmes result in significant improvements in people well-being demonstrated by objective measures such as blood glucose and glycated haemoglobin levels. Education served to prepare individuals to embark on the life-long task of lifestyle improvement as a means of improving their glycaemic control and therefore reducing their risk of short-, medium- and long-term complications. Targeted programmes therefore facilitate the achievement of these goals. Culturally relevant self-management education programmes are best provided with dedicated professionals that are familiar with the target culture and who adopt a person-centred approach to the process. The interviews with health professionals and people living with type 2 diabetes in Saudi Arabia demonstrated that while these participants recognised the benefits of self-management for people with type 2 diabetes, they emphasized the importance of tailoring the approach to the needs of people living with type 2 diabetes. Information should be delivered in the native language of the participants and also recognize and respect elements of culture such as religious beliefs, value systems and customs. Tailoring information and support in such a manner can produce positive effects on dietary and physical activity patterns as well as illness and health-related beliefs. This was of particular importance since many people living with type 2 diabetes felt that it was difficult to identify self-management measures that were suited to the Saudi Arabian context. Conclusion - Successful behaviour change in people living with type 2 diabetes is greatly facilitated by well-designed, self-management education programmes. The research demonstrated that there is a need for well-developed, structured self-management education programmes to improve the management of type 2 diabetes in Saudi Arabia. Many of the existing programmes do not demonstrate sensitivity to and recognition of cultural and religious nuances that could have an impact on adherence in the target population. The unique characteristics of Saudi society highlight the need for targeted culturally sensitive education programmes for people living with type 2 diabetes. This highlights the increased tendency to adhere to guidelines and measures that are in line with the social, cultural and religious beliefs of the targeted populations. This is of particular significance in view of the fact that culturally adapted type 2 diabetes self-management education programmes have been shown to be effective in improving short-, medium- and long-term outcomes in minority populations