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      Telemedicine and Infectious Diseases Practice: A Leap Forward or a Step Back?

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      Author(s): ,
      Publication date (Electronic):
      Journal: Open Forum Infectious Diseases
      Publisher: Oxford University Press

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          Abstract

          Infectious Diseases (ID) specialists pride themselves on performing a thorough history and physical exam, and developing a comprehensive diagnosis and management plan. A timely question is whether this tradition is at risk from the coming wave of telemedicine in clinical practice? It would not be if ID specialists embrace the changes ahead and leverage new technologies to enhance the efficiency and reach of their clinical practices. In this report, we highlight the opportunities and challenges offered by telemedicine for ID practice ( Table 1).

          Abstract

          The critical shortage of infectious diseases specialists limits access to vital expertise for clinical care, antimicrobial stewardship and infection prevention, particularly in sparsely populated regions. Telemedicine services have emerged as a practical solution to expand access, but infectious diseases practitioners must embrace this major change in clinical practice. This invited perspective provides insights into the progress and challenges of extending the reach of infectious diseases expertise through telemedicine

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          Use of Telemedicine Technologies in the Management of Infectious Diseases: A Review

          Parmvir Parmar, David M. Mackie, Sunil Varghese … (2015)
          Telemedicine technologies are rapidly being integrated into infectious diseases programs with the aim of increasing access to infectious diseases specialty care for isolated populations and reducing costs. We summarize the utility and effectiveness of telemedicine in the evaluation and treatment of infectious diseases patients. The use of telemedicine in the management of acute infectious diseases, chronic hepatitis C, human immunodeficiency virus, and active pulmonary tuberculosis is considered. We recapitulate and evaluate the advantages of telemedicine described in other studies, present challenges to adopting telemedicine, and identify future opportunities for the use of telemedicine within the realm of clinical infectious diseases.
          Article 0 comments Cited 30 times – based on 0 reviews     Review now
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            Improved virologic suppression with HIV subspecialty care in a large prison system using telemedicine: an observational study with historical controls.

            Jeremy Young, Rajeshvari Mahesh Patel, Melissa Badowski … (2014)
            Correctional populations have an elevated human immunodeficiency virus (HIV) prevalence, yet many individuals lack access to subspecialty care. Our study showed that HIV-infected inmates had significantly greater virologic suppression and higher CD4 T-lymphocyte counts when managed by a multidisciplinary team of subspecialists conducting clinics via telemedicine. In other studies, these outcomes have been associated with reductions on HIV-related morbidity and mortality, as well as HIV transmission.
            Article 0 comments Cited 27 times – based on 0 reviews     Review now
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              Bundle in the Bronx: Impact of a Transition-of-Care Outpatient Parenteral Antibiotic Therapy Bundle on All-Cause 30-Day Hospital Readmissions

              Theresa Madaline, Priya Nori, Wenzhu Mowrey … (2017)
              Abstract Background. A streamlined transition from inpatient to outpatient care can decrease 30-day readmissions. Outpatient parenteral antibiotic therapy (OPAT) programs have not reduced readmissions; an OPAT bundle has been suggested to improve outcomes. We implemented a transition-of-care (TOC) OPAT bundle and assessed the effects on all-cause, 30-day hospital readmission. Methods. Retrospectively, patients receiving postdischarge intravenous antibiotics were evaluated before and after implementation of a TOC-OPAT program in Bronx, New York, between July, 2015 and February, 2016. Pearson’s χ2 test was used to compare 30-day readmissions between groups, and logistic regression was used to adjust for covariates. Time from discharge to readmission was analyzed to assess readmission risk, using log-rank test to compare survival curves and Cox proportional hazards model to adjust for covariates. Secondary outcomes, 30-day emergency department (ED) visits, and mortality were analyzed similarly. Results. Compared with previous standard care (n = 184), the TOC-OPAT group (n = 146) had significantly lower 30-day readmissions before (13.0% vs 26.1%, P < .01) and after adjustment for covariates (odds ratio [OR] = 0.51; 95% confidence interval [CI], 0.27–0.94; P = .03). In time-dependent analyses, TOC-OPAT patients were at significantly lower risk for readmission (log-rank test, P < .01; hazard ratio = 0.56; 95% CI, 0.32–0.97; P = .04). Propensity-matched sensitivity analysis showed lower readmissions in the TOC-OPAT group (13.6% vs 24.6%, P = .04), which was attenuated after adjustment (OR = 0.51; 95% CI, 0.25–1.05; P = .07). Mortality and ED visits were similar in both groups. Conclusions. Our TOC-OPAT patients had reduced 30-day readmissions compared with the previous standard of care. An effective TOC-OPAT bundle can successfully improve patient outcomes in an economically disadvantaged area.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Forum Infect Dis
                Journal ID (iso-abbrev): Open Forum Infect Dis
                Journal ID (publisher-id): ofid
                Title: Open Forum Infectious Diseases
                Publisher: Oxford University Press (US )
                ISSN (Electronic): 2328-8957
                Publication date Collection: May 2019
                Publication date (Electronic): 20 April 2019
                Publication date PMC-release: 20 April 2019
                Volume: 6
                Issue: 5
                Electronic Location Identifier: ofz196
                Affiliations
                Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
                Author notes
                Correspondence: R. C. Abdel-Massih, MD, Division of Infectious Diseases; University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 2nd Floor, Pittsburgh, PA 15213 ( abdelmassihr@ 123456upmc.edu ).
                Article
                Publisher ID: ofz196
                DOI: 10.1093/ofid/ofz196
                PMC ID: 6527083
                SO-VID: 4e9965df-09d6-45de-8d69-5d03d280ead1
                Copyright © © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 March 2019
                Date accepted : 19 April 2019
                Page count
                Pages: 3
                Funding
                Funded by: University of Pittsburgh Physicians
                Categories
                Subject: Perspectives
                Subject: Editor's Choice

                Data availability:

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