Journal of telemedicine and telecare
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E-consultations are being offered within clinic walls as an option for specialist advice without a face-to-face consultation appointment. In a six month time frame, nearly 100% of primary care internists and family medicine providers in a multispecialty practice had used an e-consultation at least once. Specialists also used e-consultations for advice from other specialists. ⋯ Although e-consultations were offered as an alternative to face-to-face specialty consultations, 1,111 of 5,334 e-consultations eventually did receive face-to-face appointments in the same specialty. Within 30 days of the e-consultation 11.5% had a specialty face-to-face visit and 17.7% had seen a specialist face-to-face within 90 days of the e-consultation. The conversions of e-consultations to face-to-face consultations depended on the specialty providing the e-consultation (fewer for gastroenterology and infectious disease), patient distance from the clinic (fewer for international patients and those living greater than 800 kilometers from the clinic), and experience of specialist responding to the e-consultation (lower conversions for specialists providing 15 or more e-consultations).
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Randomized Controlled Trial
A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD.
We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease (COPD). A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Ireland. Patients had at least two of: emergency department admissions, hospital admissions or emergency general practitioner (GP) contacts in the 12 months before the study. ⋯ There were no significant between group differences in EQ-5D scores, HADS depression scores, GP activity, emergency department visits, hospital admissions or exacerbations. The total cost to the health service of the intervention over the 6-month study period was £2039, giving an estimated ICER of £203,900. In selected patients with COPD, telemonitoring was effective in improving health-related quality of life and anxiety, but was not a cost-effective intervention.
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Meta Analysis
A meta-analysis of the use of electronic reminders for patient adherence to medication in chronic disease care.
We conducted a meta-analysis of randomized controlled trials (RCTs) up to January 2014 which evaluated the effects of electronic reminders on patient adherence to medication in chronic disease care. A random-effects model was used to pool the outcome data. Subgroup analyses were performed to examine a set of moderators. ⋯ The frequency and type of electronic reminders appeared to have no moderating effect on medication adherence. The use of electronic reminders seems to be a simple and potentially effective way of improving patient adherence to chronic medication. Future research should concern the optimum strategies for the design and implementation of electronic reminders, with which the effectiveness of the reminders is likely to be augmented.
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Randomized Controlled Trial
The accuracy of mobile teleradiology in the evaluation of chest X-rays.
We assessed the diagnostic accuracy of digital photographs of plain film chest X-rays (CXRs) obtained using a mobile phone. The study was a randomized, non-inferiority trial, in which physical plain film CXRs viewed on a light box were compared with digital photographs of plain film CXRs. CXRs were selected from a database of radiology studies to show common pathologies found in Botswana associated with pneumonia, lung carcinoma, tuberculosis, pneumothorax and interstitial disease, as well as normal findings. ⋯ The difference in diagnostic accuracy was -5.7% (95% CI: -10.8% to -0.5%), which confirmed non-inferiority (P<0.001) for the primary outcome of diagnostic accuracy. A subgroup analysis demonstrated non-inferiority for lung carcinoma and pneumonia images, although non-inferiority was not achieved for pneumothorax, tuberculosis, interstitial disease or normal images. The study demonstrates that digital photographs of CXRs obtained via a mobile phone equipped with a digital camera are non-inferior to plain film CXRs.
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We evaluated the feasibility and the patient acceptability of integrating a kiosk into routine emergency department (ED) practice for offering HIV testing. The work was conducted in four phases: phase 1 was a baseline, in which external testing staff offered testing at the bedside; phase 2 was a pilot assessment of a prototype kiosk; phase 3 was a pilot implementation and phase 4 was the full implementation with automated login. Feasibility was assessed by the proportion of offering HIV tests, acceptance, completion and result reporting. ⋯ There were slightly higher prevalences of newly diagnosed HIV with kiosk versus bedside testing (phase 1, 0%; phase 3, 0.2%; phase 4, 0.5%). Compared to patients tested at the bedside, patients tested via the kiosk were significantly younger, more likely to be female, to be black, and to report high risk behaviours. ED-based HIV screening via a registration-based kiosk was feasible, yielded similar proportions of testing, and increased the proportion of engagement of higher-risk patients in testing.