Evaluation of the Effect of Consultant Characteristics on Telemedicine Diagnosis and Treatment

This study examined teleconsultants' specialty, practice setting, type of employment, years and training in telemedicine to evaluate the effect of these characteristics on diagnoses and treatment. A postuse survey was conducted during 1998–2003 (n = 454 consultations) in the University of Arkansas for Medical Sciences' Rural Hospital, Telehealth Project. There were 61 consultants who conducted the teleconsultations. The teleconsultants established a diagnosis in 121 consultations and reported a change in diagnoses in 29 consultations. The consultants established a treatment plan in 219 consultations and reported a change in the treatment plan in 100 consultations. Dermatologists were significantly more likely to establish (P < .01) and change (P = .005) the diagnosis and to establish a treatment plan (P = .03), when compared to all other specialties. Teleconsultants who were self-employed were significantly more likely to change the treatment plan (P = .012). The findings suggest that teleconsultants' characteristics can affect diagnoses and treatment in telemedicine

Digital health and its application in rural areas: a review of international experience

In recent years, there has been growing interest in research on the application of digital technologies in the delivery of health and social care. These debates have ranged widely, focusing in particular on the development of the technologies and their impacts on the quality and efficiency of health service delivery. As part of this debate, research has considered the extent to which digital technologies can be used to address spatial health inequalities that persist at various scales. While there are important health divides within major cities, there are also persistent differences between urban and rural areas. It is widely recognised, for instance, that rural communities are commonly disadvantaged due to remoteness and low population density that limits the range of specialist healthcare facilities that are made available. In this context, the purpose of this article is to review recent research that examines the application of digital health and the extent to which it can be used to overcome rural disadvantage. It is intended that this review will form a basis of consideration of the potential for digital solutions to health inequalities within the County of Cumbria, in the north-west of England, UK. A systematic search of relevant literature was undertaken in order to identify and collate relevant articles. This was achieved using combinations of search terms including appropriate medical terminology (such as “telemedicine”, “telehealth”, “ehealth” “telecare”) in combination with locational descriptions (primarily “rural areas” or “rural community”). During the process, a decision was taken to include examples from both developed and developing countries. While recognising that there are very significant differences between rural areas in these two contexts, there are some parallels in terms of the barriers created by remoteness and low population density. Also, inclusion of a wide range of socio-economic settings provides opportunities to comment on the role of digital technology in delivering health care at different stages in economic development (Rygh & Hjortdahl, 2007). The impact of rurality varies from developing to developed countries and rurality is often used as a metaphor for remote areas populated by indigenous peoples in developed countries

The Feasibility and Validity of a Remote Pulse Oximetry System for Pulmonary Rehabilitation: A Pilot Study

Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease. However, access to these services is limited especially in rural and remote areas. Telerehabilitation has the potential to deliver pulmonary rehabilitation programs to these communities. The aim of this study was threefold: to establish the technical feasibility of transmitting realtime pulse oximetry data, determine the validity of remote measurements compared to conventional face-to-face measures, and evaluate the participants&apos; perception of the usability of the technology. Thirty-seven healthy individuals participated in a single remote pulmonary rehabilitation exercise session, conducted using the eHAB telerehabilitation system. Validity was assessed by comparing the participant&apos;s oxygen saturation and heart rate with the data set received at the therapist&apos;s remote location. There was an 80% exact agreement between participant and therapist data sets. The mean absolute difference and Bland and Altman&apos;s limits of agreement fell within the minimum clinically important difference for both oxygen saturation and heart rate values. Participants found the system easy to use and felt confident that they would be able to use it at home. Remote measurement of pulse oximetry data for a pulmonary rehabilitation exercise session was feasible and valid when compared to conventional face-toface methods

Nonfinancial Barriers and Access to Care for U.S. Adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90354/1/hesr1308.pd

Specialist to non-specialist teleconsultations in chronic respiratory disease management:A systematic review

BACKGROUND: Chronic respiratory diseases (CRD), are common public health problems with high prevalence, disability and mortality rates worldwide. Further uneven distribution of the health workforce is a major barrier to the effective diagnosis and treatment of CRDs. Teleconsultation between a specialist and non-specialist could possibly bridge the gap in access to health care and decrease CRD burden in remote areas. This review investigates the evidence for the effective use of specialist to non-specialist teleconsultation in the management of CRDs in remote areas and identifies instances of good practice and knowledge gaps. METHODS: We searched for articles till November 2020, which focused on specialist to non-specialist teleconsultations for CRD diagnosis or management. Two independent reviewers conducted the title and abstract screening and extracted data from the selected papers and the quality was assessed by Joanna Briggs Institute’s (JBI) tool. A descriptive and narrative approach was used due to the heterogeneous nature of the selected studies. RESULTS: We found 1715, articles that met the initial search criteria, but after excluding duplicates and non-eligible articles, we included 10 research articles of moderate quality. These articles were from nine different studies, all of which, except one, were conducted in high-income countries. The studies reported results in terms of impact on the patients, and the health care providers including primary care physicians (PCP) and specialists. The teleconsulting systems used in all the selected papers primarily used audio modes in addition to other modes like the audio-video medium. The included studies reported primarily non-clinical outcomes including effectiveness, feasibility, acceptability and usability of the teleconsultation systems and only three described the clinical outcomes. The teleconsultation was predominantly conducted in the PCP’s office with the specialist located remotely. CONCLUSIONS: We found relatively few, papers which explored specialist to non-specialist teleconsultation in management of CRDs, and no controlled trials. Two of the included papers described systems, which were used for other diseases in addition to the CRD. The available literature although not generalisable, encourages the use of specialist to non-specialist teleconsultation for diagnosis and management of CRDs

Exploring the Relationship Between Broadband and Socioeconomic Health: A Case Study in Appalachia

This thesis uses county-level Federal Communications Commission (FCC) Form 477 and Appalachian Regional Commission data to examine factors that affect socioeconomic health, with a particular focus on the impact of household broadband adoption, in rural areas of the Appalachian United States. Outcome variables of interest are percentage of people in poverty, per capita market income (i.e., the income one earns from participating in the economy through wages, investments, business income and the like), and number of excess deaths per 100,000 residents. The first chapter uses two multivariate multiple regression models, one using 2008 data and one using 2016 data, to assess the impact of household fixed broadband connections per thousand residents, education (as measured by high school graduation rate), unemployment rate, and county economic dependency, on income and percent of people under the poverty line in two time periods. The second chapter uses an Ordinary Least Square (OLS) regression to evaluate the relationship between rurality and excess mortality when socioeconomic variables, including broadband adoption, percent of adults with high school degrees, unemployment rate, percent of people in poverty, per capita market income, and county economic dependency, are controlled for. The results for the first two models depict a statistically significant and negative association between low levels of broadband adoption and income in counties, and a statistically significant negative association between low levels of broadband and percent of people in poverty in 2016. There was no significant association between broadband and excess mortality, but these results do suggest that socioeconomic factors play a larger role in contributing to excess mortality than whether a county is rural or urban. In particular, transfer payments (i.e., government aid) were positively and significantly associated with higher levels of excess mortality. Establishing causality remains an important consideration when assessing policy aimed at improving rural quality of life through increased broadband availability and adoption, and should be a central influence on policy and funding decisions going forward. Improving data quality and accuracy should also be a priority going forward, as this is necessary for determining whether funding programs are producing tangible benefits

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140284/1/tmj.2014.9981.pd

The Barriers Encountered in Telemedicine Implementation by Health Care Practitioners

Patients in rural areas in the United States do not have adequate health care facilities for illnesses and injuries not serious enough for emergency care, but telemedicine could have a positive impact both economically and medically to control rapidly rising health care costs, which is a significant percentage of the gross national product. The purpose of this case study was to explore the barriers physicians encountered in telemedicine implementation. Participants included 4 physicians who took part in face-to-face interviews in a clinical setting in Ohio to explore strategies used in implementing telemedicine. The results of these interviews, coupled with observations and document reviews, were analyzed. Complex adaptive systems theory was used to conceptualize the existing association between individual behavioral patterns and the social system in which the patterns take place. Significant themes showed (a) how physicians utilize the technology and (b) how the application allows physicians to build relationships with patients. The characterization strategies aimed to mitigate barriers in adopting telemedicine technology in rural markets were consistent with the study findings and the literature review. The results of this research study might contribute to positive social change through economic and health benefits to rural inhabitants by reducing the distance barrier to physicians\u27 offices and increasing timely and effective patient diagnosis in the selected location

The association of medical student debt on choice of primary care specialty and rural practice location.

A shortage of primary care physicians (PCP) is present nationally and within Kentucky. The shortage is expected to worsen, unless a dramatic increase occurs in the generation of additional primary care clinicians. Geographical maldistributions of PCP also exist. Whereas 20% of the US population resides in rural areas, only 10% of physicians practice in these areas. This study explores factors that influence medical students’ decisions to select primary care residency training programs, and to practice in rural areas. Specifically, the levels of debt among 1391 graduates from University of Louisville School of Medicine (ULSOM) during 2001-2010 were examined in association with their selection of categories of residency training programs. Similarly, levels of debt among 1180 ULSOM graduates during 2001-2008 were examined in association with rural practice locations. Statistical methods included evaluations of receiver-operating curves (ROC) and multiple logistic regression analyses. The ROC analyses showed no association was present for any level of debt with either selection of primary care residency programs or rural practice sites. Multiple logistic regression analyses showed a statistically significant, positive association was present between the two extreme quintiles of medical students’ debt, whereby medical students in the lower quintile of debt were more likely select a primary care residency, compared to those students within the highest quintile. No statistically significant association was found for students’ debt with rural practice location. Multiple policy options to increase the primary care workforce were examined, including raising physicians’ reimbursements, shortening time for medical training, and altering how medical schools finance medical education. Policy makers may also consider the affinity model, whereby increasing medical school admissions among applicants from rural areas may result in greater numbers of PCP that are more likely to return to practice in rural areas. Similarly, programs to better support rural pipeline programs may be considered. Other policy solutions may include allowing nurse practitioners and other clinical personnel to work at the full scope of their training as well as a fuller utilization of health information technology. Addressing population health through the Triple Aim may provide novel solutions