Access and Disparities in the Use of Telemedicine Among Patients with Chronic Conditions in Saudi Arabia: A Cross-Sectional Study

Ziyad S Almalki,1 Mohammad T Imam,1 Nada F Abou Chahin,2 Naheda S ALSammak,2 Shahad M Entabli,2 Shatha K Alhammad,2 Ghuyudh F Alanazi,2 Rama A Kharsa,2 Layla A Alonazi,2 Rasha A Mandil,2 Ahmed A Albassam,1 Ahmed M Alshehri,1 Abdullah K Alahmari,1 Ghada M Alem,1 Abdullah A Alalwan,1 Ahmad Alamer1 1Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 2Collage of Pharmacy, Almaarefa University, Riyadh, Saudi ArabiaCorrespondence: Ziyad S Almalki, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia, Tel +966 11 588 7315, Email [email protected]: This study investigated the access to and disparities in telemedicine use among patients with chronic conditions in Riyadh, Saudi Arabia.Patients and Methods: A cross-sectional study of randomly selected primary healthcare centers was conducted to ensure that each of the 17 municipalities in Riyadh were represented. Three hundred and forty-two participants who completed the questionnaire were interviewed using a standardized questionnaire. The relationship between demographic and socioeconomic factors and telemedicine utilization was evaluated using the chi-square test and multivariable mixed-effects logistic regression model.Results: Among the 342 participants, the study revealed that 25.73% of the patients utilized telemedicine. Older participants had lower odds of telemedicine use than did those aged ≤ 30 years [adjusted odds ratio (AOR) = 0.112, 95% confidence interval (CI) = 0.045– 0.279 for 50– 59 years; AOR = 0.19, 95% CI = 0.076– 0.474 for 60– 69 years; AOR = 0.223, 95% CI = 0.092– 0.542 for ≥ 70 years]. Female sex (AOR = 2.519, 95% CI = 1.44– 4.408), having a higher education level (AOR = 3.434, 95% CI = 1.037– 7.041 for secondary education and AOR = 5.87, 95% CI = 2.761– 8.235 for higher education), and living in urban areas (AOR = 2.721, 95% CI = 1.184– 6.256) were associated with higher odds of telemedicine use. Among socioeconomic factors, employed participants had higher odds of telemedicine use (AOR = 4.336, 95% CI = 2.3– 8.174). Furthermore, compared to those with the highest socioeconomic status (SES) index, those with the lowest SES were less likely to use telemedicine than those with the highest SES index (AOR = 0.193, 95% CI = 0.055– 0.683 for the lower bottom (poorest).Conclusion: This study highlights a significant disparity in the utilization of telemedicine services across different populations, primarily due to demographic and socioeconomic factors.Keywords: healthcare system, socioeconomic, digital health, inequitie

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumour types. Despite the favourable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PDL-1 and anti-CTLA-4 treatment, and include myositis, myasthenia gravis and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment. Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multidisciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange and other immune-modulating treatments should be considered in more severe cases. Consideration of rechallenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs. This article is protected by copyright. All rights reserved