Telemedicine: Bridging the Gap between Refugee Health and Health Services Accessibility in Hamilton, Ontario

Refugees face considerable challenges upon seeking asylum in Canada, and accessing health care services remains a prominent issue. Recurrent themes in the literature outlining barriers to health-services accessibility include geographic, economic, and cultural barriers. Drawing on the experiences of service providers in Hamilton, Ontario, we explored the efficacy of telemedicine services in bridging the gap between refugee health and health services accessibility. Research methodology included structured interviews with clinicians who provide health-care services to refugees, complemented by a scoping literature review. The results of this exploratory study demonstrate the efficacy of telemedicine in encouraging dialogue and policy change in the greater health-care setting, and its potential to increase access to specialist health-care services.Les réfugiés doivent faire face à des défis considérables lors du processus de demande d’asile au Canada, et l’accès aux services de santé demeure un enjeu important. Parmi les préoccupations qui reviennent fréquemment dans la documentation portant sur l’accessibilité aux services de santé sont les obstacles de nature géographique, économique, et culturelle. En nous basant sur l’expérience vécue des fournisseurs de service établis à Hamilton, en Ontario, nous étudions l’efficacité des services de télémédecine à combler l’écart entre les besoins en matière de santé des réfugiés et l’accessibilité aux services de santé. La méthodologiede recherche comportait des entrevues structurées avec le personnel traitant chargé de fournir des services de santé aux réfugiés, accompagnée d’une revue exploratoire de la documentation sur le sujet. Les résultats de cette étude exploratoire ont démontré l’efficacité de la télémédecine à stimuler le dialogue et le changement en matière de politique dans le contexte général des services de santé, ainsi que sa capacité à accroître l’accès aux services de santé spécialisés

Evaluating the feasibility and impact of a synchronous health technology innovation in the provision of pediatric health care in a University Hospital.

La prestation de soins critiques et d'orthophonie en milieu pédiatrique nécessite beaucoup de travail pour atteindre le niveau de soins souhaité. Plusieurs facteurs contribuent à ce problème, parmi lesquels la pénurie de ressources, les besoins pressants et l’augmentation du nombre d’enfants malades. Parmi les solutions proposées, beaucoup pensent que la télémédecine synchrone peut être utile en donnant un accès virtuel immédiat aux compétences à distance. Ainsi, l'expertise pourrait être instantanément disponible via une plateforme permettant une communication efficace et capable de soutenir les soins pédiatriques. La télémédecine s’est beaucoup développée dans la prestation des soins critiques et de réadaptation pédiatriques, et ce aux plans diagnostique et thérapeutique. Pourtant, peu d’études ont examiné la faisabilité et évalué l’impact de la télémédecine sur la qualité des soins critiques et de réadaptation pédiatrique. L'objectif principal de cette thèse était d'évaluer la faisabilité de la télémédecine synchrone dans deux contextes pédiatriques, critique et réadaptation, et d'évaluer son influence sur le processus de prestation de soins pédiatriques. Le premier article présente les résultats d'une revue systématique qui synthétisait des études évaluant l'impact des modèles de télémédecine synchrone sur les résultats cliniques dans les établissements de soins de courte durée en pédiatrie. Les résultats ont révélé que l’utilisation de la télémédecine synchrone avait pour effet d’améliorer la qualité des soins, de diminuer le taux de transfert, de réduire de la durée du séjour, de modifier ou renforcer le plan de soins médicaux, de réduire les complications et la gravité de la maladie, et de diminuer le taux de mortalité hospitalière et standardisé. Cependant, la revue de l’état de connaissances a révélé que la qualité des études incluses était faible et que des preuves de haute qualité étaient nécessaires. Le deuxième article, fondé sur un devis pré/post, évalue la faisabilité de la télémédecine à domicile en orthophonie et son impact sur la satisfaction des enfants et orthophonistes, le coût économique, et les performances vocales. Cette étude a montré que la télémédecine en orthophonie était faisable et que les enfants et les orthophonistes étaient satisfaits du service. En outre, l'utilisation de la télémédecine en orthophonie a permis d'améliorer la voix et de faire économiser de l'argent aux parents. Le troisième article évalue la faisabilité de la mise en place d’une plate-forme de télémédecine synchrone dans l’unité des soins intensifs pédiatriques (USIP). Pour qu'une solution de télémédecine synchrone à l’USIP soit faisable, elle nécessite une bonne préparation préalable à la mise en œuvre de la plate-forme de télémédecine synchrone pour être réellement utile. Avec des médecins résidents compétents et autonomes, l’utilité d’une plate-forme de télémédecine synchrone reliant les intensivistes pédiatriques hors site et les médecins résidents sur site à l’USIP est faible. Cette étude a ajouté qu'un tel service pourrait être plus bénéfique que le modèle traditionnel des soins (face à face) pour les communications avec d'autres établissements de soins de santé éloignés, où le besoin d'expertise d'un intensiviste en soins intensifs pédiatriques est plus important. Ces trois études permettent de conclure que la télémédecine synchrone est réalisable et peut avoir un impact sur la qualité des soins intensifs et de réadaptation pédiatrique. On peut déduire de cette thèse qu'il est important de prendre en compte le contexte dans lequel la technologie sera mise en œuvre. Traiter le contexte de l’USIP et celui de réadaptation de la même manière n'aboutit pas aux mêmes résultats et une innovation technologique pourrait réussir dans un contexte et échouer dans un autre.Delivering critical and speech-language pathology care in pediatric settings requires much hard work to reach the desired level of care for children. Several factors contribute to this problem, including resources shortage, pressing needs, and the growing number of ill children. Among the proposed solutions, many believe that synchronous telemedicine can play a role by providing virtual and immediate access to remote skills, with expertise could be made instantly available through a platform that allows efficient communication and is able to support pediatric care. Telemedicine has developed significantly in the provision of critical care and pediatric rehabilitation in terms of diagnosis and therapy. Yet, few studies have examined the feasibility and evaluated the impact of telemedicine on the quality of pediatric critical care and rehabilitation. The main objective of this dissertation was to assess the feasibility of synchronous telemedicine in two pediatric settings—critical care and rehabilitation—and to evaluate its influence on the process of providing pediatric care. The first article presented the results of a systematic review that synthesized studies evaluating the impacts of synchronous telemedicine models on clinical outcomes in pediatric acute care settings. The findings revealed that the use of synchronous telemedicine improved quality of care and resulted in a lower transfer rate, a shorter length of stay, a change in or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital standardized mortality rate. However, the review of the state of knowledge revealed that the quality of the included studies was weak, so more high-quality evidences is needed. The second article, which used a pre/post design, assesses the feasibility assessed the feasibility of home-based telepractice in speech-language pathology (TSLP) and its impact on satisfaction among the children and speech-language pathologists, economic cost, and voice performance. This study showed that TSLP is feasible and that both the children and the speech-language pathologists were satisfied with the service. In addition, the use of TSLP demonstrated more voice improvement at less cost to the parents. The third article evaluated the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). For a STEP-PICU to be feasible and truly helpful, it needs good preparation for the implementation of the telemedicine solution. With competent and autonomous fellows (a fellow is a physician who has completed their residency and elects to complete further training in a subspecialty), the usefulness of an synchronous telemedicine (STM) platform linking off-site pediatric intensivists and on-site fellows in a PICU is limited. This study added that such a service could be more beneficial than the traditional model of care (face to face) for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist. These three studies allow us to conclude that STM is feasible and can have an impact on the quality of pediatric intensive care and rehabilitation. This thesis underscores the importance of taking into consideration the context in which the technology will be implemented. Treating the PICU and the rehabilitation contexts in the same way does not lead to the same results, and a technological innovation that succeeds in one setting may fail in another

Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens

Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

: Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens

Telehealth Utilization in Response to the COVID-19 Pandemic: Current State of Medical Provider Training

Background: The COVID-19 pandemic accelerated the development of telehealth services and thus the need for telehealth education and training to support rapid implementation at scale. A national survey evaluating the current state of the telehealth landscape was deployed to organizational representatives, and included questions related to education and training. Materials and Methods: In the summer of 2020, 71 survey participants (31.8%) completed an online survey seeking to determine the utilization of telehealth services across institutional types and locations. This included data collected to specifically compare the rates and types of formal telehealth education provided before and during the pandemic. Results: Thirty percent of organizations reported no telehealth training before COVID-19, with those in suburban/rural settings significantly less likely to provide any training (55% vs. 82%) compared with urban. Pandemic-related training changes applied to 78% of organizations, with more change happening to those without any training before COVID-19 (95%). Generally, organizations offering training before the pandemic reported deploying COVID-19-related telehealth services, while a higher percentage of those without any training beforehand reported that they either did not plan on providing these services or were in the early planning stages. Discussion: Telehealth education is moving from elective to essential based on the need to prepare and certify the workforce to support high-quality telehealth services. Conclusions: As telehealth continues to evolve to meet the future health care service needs of patients and providers, education and training will advance to meet the needs of everyday clinical encounters and broader public health initiatives

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

Pediatric Asthma Telemonitoring: Literature, Theory, and Application to Practice

Asthma is one of the most prevalent and costly chronic diseases faced by Americans today. It is marked by inflammation and hyperresponsiveness of the airways which fluctuates, often unpredictably, in response to triggers. As such, it causes particular challenges symptom management, especially on the part of the patient who is tasked with dealing with these frequent fluctuations for months at a time between regularly scheduled health care appointments. This is further complicated when the patient is a child, and symptoms must be interpreted and managed second-hand by a caregiver. Uncertainty about how to manage symptoms, as well as minimization of symptoms, contributes to delays in seeking treatment, leading to higher acuity visits, increased costs, and poorer outcomes. Meanwhile the field of telemonitoring is evolving. New technologies offer patients and providers novel ways of communicating between visits. This is supported by telemonitoring literature and theoretical frameworks, which will be addressed in this manuscript. It is the assertion of this project that asthma symptom telemonitoring holds promise as a way for patients to conveniently and more adequately manage symptom fluctuations from home. The first paper in this manuscript surveys the existing literature on asthma telemonitoring modalities. The second paper examines the problem of symptom minimization and uncertainty through the framework of Symptom Management Theory. Finally, the third paper is a technical report describing a pilot study that used the AsthmaChecker app among children with asthma and their caregivers to assess linkages to Symptom Management Theory and Diffusion of Innovation Theory. This project and these writings offer new insights into the emerging field of telemedicine and its potential usefulness in the context of pediatric asthma management

Primary Care Health Workforce in the United States

Synthesizes findings about trends in the composition, supply, and distribution of the primary care workforce; demand for and pressures on primary care providers; and the impact of technologies, payment policies, market forces, and scope of practice laws

Is Telemedicine The Future Primary Care Physician? An Analysis Of Past, Current, And Future Trends

This thesis offers a new method of analyzing the trends of telemedicine in the past, current, and future states, particularly in relation to primary healthcare settings. This thesis consists of a literature review of various studies, an analysis of current legislation, and suggestions for future improvements of the healthcare system in the United States. The terms surrounding telemedicine will be defined and the history of telemedicine will be explained in order to convey an understanding of the topic and to allow the reader to deduce general conclusions from the thesis. The thesis will focus on the patient perspective, the healthcare provider perspective, and the challenges that these two respective groups of people face in relation to successful implementation of telemedicine. Conclusions from this thesis are applicable in the current age due to the rising cost of healthcare, the healthcare shortage in certain geographic areas, and the increasingly technological presence in the United States and in the world