Quality indicators of telemedical care offshore—a scoping review

Background Offshore industries operate all around the world in diverse and remote environments. The use of telemedicine to ensure up-to-date medical care for thousands of people offshore has been common practice for decades. Thus, in this setting, extensive experiences with this type of health care delivery have already been gathered, while in other settings this is just beginning. However, the quality of telemedical care on offshore installations is rarely reported yet. The objective of this review was to explore published literature with regards to the following questions: Have any Quality Indicators (QIs) been published for measuring the quality of telemedical care on offshore installations or are there identifiable items that could be used as such QIs? Methods We conducted a comprehensive Scoping Review (PRISMA-ScR) of the published literature using the databases MEDLINE, Cochrane Library, Web of Science (Core Collection), and Google Scholar. Search results were read and QIs or findings from which QIs could be derived were classified according to the dimensions of quality established by Donabedian (structure, process, or outcome QIs). Results The search returned 10,236 non-recurring articles, 45 of which were full-text screened and 15 of which were included in this review. Types of publications were heterogenous. No QIs for the quality of telemedical care offshore have been published yet. Findings that could be the basis for QIs focused on structure quality (11 QIs) followed by process quality (11 QIs), while outcome quality was less common (1 QI). Conclusion Currently, although years of experience with telemedical care on offshore installations exist, there is a paucity of research on a solid data base regarding the quality of telemedical care offshore. The authors derived a list of 24 possible QIs from the findings of the publications for further validation. This could be the basis for implementation and definition of QIs in this and in similar remote settings.

Setting-Sensitive Conceptualization and Assessment of Quality of Life in Telemedical Care—Study Protocol of the Tele-QoL Project

Quality of life (QoL) is a core patient-reported outcome in healthcare research, alongside primary clinical outcomes. A conceptual, operational, and psychometric elaboration of QoL in the context of TM is needed, because standardized instruments to assess QoL do not sufficiently represent essential aspects of intended outcomes of telemedical applications (TM). The overall aim is to develop an instrument that can adequately capture QoL in TM. For that purpose, an extended working model of QoL will be derived. Subsequently, an instrument will be developed and validated that captures those aspects of QoL that are influenced by TM. The initial exploratory study section includes (a) a systematic literature review, (b) a qualitative survey for concept elicitation, and (c) pre-testings using cognitive debriefings with patients and an expert workshop. The second quantitative section consists of an online expert survey and two patient surveys for piloting and validation of the newly developed instrument. The resulting questionnaire will assess central experiences of patients regarding telemedical applications and its impact on QoL more sensitively. Its use as adjunct instrument will lead to a more appropriate evaluation of TM and contribute to the improvement of care tailored to patients’ individual needs.

Optimizing telemedical care in neurological outpatients by characterizing the patients’ needs in the physician–patient relationship—content analysis of guideline-based interviews

Background The use of new concepts in patient care, such as video-consultations, reminder systems, and online evaluation portals, is becoming increasingly important in the physician–patient relationship and outpatient care. This study examines the acceptance of these approaches in a neurological setting and determines the patients’ preferences. Methods We analyzed 16 guideline-based qualitative interviews with neurological patients using qualitative content analysis (inductive category formation). Results The patients commented on the benefits and challenges of integrating new concepts of medical care. They identified advantages of telemedical care, including time savings (7 of 16; 43,8%) for both the patient and the physician, the prospect of more intensive (4 of 16; 25%) care, and the possibility for a quick response in case of urgent needs (3 of 16; 18.8%). Several challenges were reported, such as the limitations for patients with psychiatric (2 of 16; 12.5%) or complex diseases (4 of 16; 25%) and limited options for diagnostic procedures (such as physical examination (4 of 16; 25%)). For individual neurological patients' needs, telemedical and telecommunication structures could be discussed, which support the patients' specific requirements, such as answering questions while having a recall (2 of 16; 12.5%) and avoiding the journey (8 of 16; 50%). Also, patients are rejecting evaluation portals and are skeptical of telecare in the treatment of neurological diseases. Discussion The perception of telemedical care and the successful integration of new medical care concepts depend on fulfilling the individual patient’s needs. Regardless of the preferred nature of physician–patient interactions, there are specific instruments that can intensify the relationship. These individual needs of the patients must be inquired about and accommodated for. Conclusions For the first time, we could characterize the properties of optimal telemedical care for neurological patients. Interviews like the ones we conducted should be repeated during and after the pandemic, referring to our results and compare.

Same same-but different: using qualitative studies to inform concept elicitation for quality of life assessment in telemedical care: a request for an extended working model

Background Although telemedical applications are increasingly used in the area of both mental and physical illness, there is no quality of life (QoL) instrument that takes into account the specific context of the healthcare setting. Therefore, the aim of this study was to determine a concept of quality of life in telemedical care to inform the development of a setting-sensitive patient-reported outcome measure. Methods Overall, 63 semi-structured single interviews and 15 focus groups with 68 participants have been conducted to determine the impact of telemedical care on QoL. Participants were patients with chronic physical or mental illnesses, with or without telemedicine supported healthcare as well as telemedical professionals. Mayring's content analysis approach was used to encode the qualitative data using MAXQDA software. Results The majority of aspects that influence the QoL of patients dealing with chronic conditions or mental illnesses could be assigned to an established working model of QoL. However, some aspects that were considered important (e. g. perceived safety) were not covered by the pre-existing domains. For that reason, we re-conceptualized the working model of QoL and added a sixth domain, referred to as healthcare-related domain. Conclusion Interviewing patients and healthcare professionals brought forth specific aspects of QoL evolving in telemedical contexts. These results reinforce the assumption that existing QoL measurements lack sensitivity to assess the intended outcomes of telemedical applications. We will address this deficiency by a telemedicine-related re-conceptualization of the assessment of QoL and the development of a suitable add-on instrument based on the resulting category system of this study.

Telemedical care and quality of life in patients with schizophrenia and bipolar disorder: results of a randomized controlled trial

Background Schizophrenia and bipolar disorder are serious psychiatric disorders with a high disease burden, a high number of years of life lived with disability and a high risk for relapses and re-hospitalizations. Besides, both diseases are often accompanied with a reduced quality of life (QoL). A low level of quality of life is one predictor for relapses. This study examines whether a telemedical care program can improve QoL. Methods Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) is a prospective controlled randomized intervention trial to implement and evaluate a telemedical care concept for patients with schizophrenia and bipolar disorder. Participants were randomized to an intervention or a control group. The intervention group received telemedical care including regular, individualized telephone calls and SMS-messages. QoL was measured with the German version of the WHOQOL-BREF. Effects of telemedicine on QoL after 6 months and treatment*time interactions were calculated using linear regressions (GLM and linear mixed models). Results One hundred eighteen participants were recruited, thereof 57.6% men (n = 68). Participants were on average 43 years old (SD 13). The treatment*time interaction was not significant. Hence, treatment had no significant effect either. Instead, gender is an influencing factor. Further analysis showed that social support, the GAF-level and QoL-values at baselines were significant determinants for the improvement of QoL. Conclusion The telemedicine care concept Tecla was not significant for QoL in patients with severe psychiatric disorders. More important for the QoL is the general social support and the level of global functioning of the patients. Trial registration German Clinical Trials Register, DRKS00008548, registered 21 May 2015 – retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do

Optimizing Telemedical Care in Neurological Outpatients by Characterizing the Patients’ Needs in Physician-Patient Relationship - Content Analysis of Guideline-Based Interviews

BackgroundThe use of new concepts in patient care, such as video-consultation, reminder systems and online-evaluation portals is becoming increasingly important in the physician-patient relation and in the care of outpatients. This study examines the acceptance of these approaches in a neurological setting and characterizes the patients’ preferences.MethodsWe analyzed 16 guideline-based qualitative interviews with neurological patients using qualitative content analysis (inductive category formation). ResultsThe patients commented on benefits and challenges of integrating new concepts of medical care. They identified advantages of telemedical care, including time savings for both the patient and the physician, the prospect of more intensive care and the possibility of quick response in case of urgent needs. Several challenges were reported, such as the limitations for patients with chronic or complex diseases and limited options for diagnostic procedures (such as physical examination)For individual neurological patient’s needs, telemedical and telecommunication structures could be discussed which support the respective requirements of the patients such as answering questions while having a recall, avoiding of the journey and time-savings. Also, they are rejecting evaluation portals and are skeptical about telecare in the treatment of neurological diseases.Discussion/ConclusionsThe neurological patients can be characterized as individuals with different ideas of an optimal physician-patient relationship. A successful integration of new concepts in medical care depends on fulfilling the individual patient’s needs. Regardless of the preferred form of the physician-patient relationship, there are specific instruments that can intensify the relationship. These individual needs of the patients must be inquired about and implemented.

A Bronx Tale: Disparities in Access to Neurologic Telemedicine During the COVID-19 Pandemic

Objective:To determine whether there is a disparity in access to telemedical care that may be a function of socioeconomic status, language, or other demographic factors during the peak of the COVID-19 pandemic at a highly impacted urban center (Montefiore Medical Center) in Bronx, NY.Methods:We retrospectively investigated potential patient characteristics that might be associated with an increased likelihood of receiving a telephone visit as opposed to a televideo visit for patients followed in the pediatric neurology, adult epilepsy and general neurology practices at Montefiore Medical Center during the 30-day period starting April 2, 2020, at the peak of COVID-19 pandemic in New York.Results:We found that patients who had telephone encounters, as opposed to televideo encounters, were overall older, less likely to have commercial insurance, and more likely to have Medicaid. Among pediatric patients, a preferred language other than English was also associated with a higher proportion of telephone encounters. New patients in both the adult and pediatric groups were more likely to have televideo visits.Conclusions:Our findings identify demographic factors, including age, insurance type, and language preference, which may play a role in access to televideo encounters among neurology patients in an urban center during the COVID-19 pandemic. We suggest several potential practice, institution, and community-based interventions which might further expand access to televideo care for neurology patients.

Telemedical care improves quality of life in patients with schizophrenia and bipolar disorder. Results of a randomized controlled trial

Background: Schizophrenia and bipolar disorder are serious psychiatric disorders with a high disease burden, a high number of years of life lived with disability and a high risk for relapses and re-hospitalizations. Besides, both diseases are often accompanied with a reduced quality of life. A low level of quality of life is one predictor for relapses. This study examines whether a telemedical care program can improve quality of life.Methods: Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) is a prospective controlled randomized intervention trial to implement and evaluate a telemedical care concept for patients with schizophrenia and bipolar disorder. Participants were randomized to an intervention or a control group. The intervention group received telemedical care including regular, individualized telephone calls and SMS-messages. The quality of life was measured with the German version of the WHOQOL-BREF. Effects of telemedicine on quality of life after 6 months were analyzed using t-tests to compare the intervention with the control group. Participants also evaluated the telemedical care program based on a short standardized interview.Results: 118 participants were recruited, thereof 57.6 % men (n = 68). Participants were on average 43 years old (SD) 13). Linear mixed model revealed that affiliation to patient group (0 = CG, 1 = IG), gender (0 = female, 1 = male), increasing social support and higher GAF-level are positive significant influence factors for the WHOQOL total quality of life, physical, psychological, environmental and global domain. An increasing education often showed significantly decreasing quality of life values. Age as an influencing factor, showed different results on the sum score and the individual domains.Conclusion: The Tecla telemedical care concept has improved the quality of life in patients with severe psychiatric disorders. It provides for a low-threshold and well suitable component in psychiatric treatment.Trial registration: German Clinical Trials Register, DRKS00008548, registered 21 May 2015 – retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do