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      Patient Preference and Adherence (submit here)

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      Patient Preference and Satisfaction with the Use of Telemedicine for Glycemic Control in Patients with Type 2 Diabetes: A Review

      review-article
      1 , 2 , 3
      Patient preference and adherence
      Dove
      type 2 diabetes, satisfaction, preference, telemedicine, mHealth, review

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          Abstract

          Background

          Telemedicine has the potential to improve patient care and management for various chronic diseases such as type 2 diabetes. To ensure the success of any telemedicine program, there is a need to understand the patients’ satisfaction and their preferences. This review aims to collate and provide evidence related to practices that may influence the performance of telemedicine for patients with type 2 diabetes.

          Methods

          We searched three electronic databases for studies examining patients’ satisfaction and preferences for using telemedicine in type 2 diabetes. An evaluation matrix was developed to collect the data from the included articles. A total of 20 articles were identified and data on the key outcomes identified were narratively synthesized.

          Results

          Patients were generally satisfied with the use of telemedicine for management of type 2 diabetes. Users reported that telemedicine was beneficial as it provided constant monitoring, improved access to healthcare providers, and reduced waiting time. When adopting a telemedicine platform, most patients expressed preference for mobile health (mHealth) as the telemedicine modality, especially if it has been endorsed by their physician. To improve usability and sustainability, patients suggested that modules related to diabetes education be enhanced, together with sufficient technical and physician support when adopting telemedicine. Patients also expressed the importance of having a sufficiently flexible platform that could be adapted to their needs.

          Conclusion

          Personalized telemedicine strategies coupled with appropriate physician endorsement greatly influences a patient’s decision to undertake telemedicine. Future work should focus on improving telemedicine infrastructure and increasing physician’s involvement, especially during the implementation phase.

          Most cited references53

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          Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

          Summary Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5–74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9–19·6), and injuries 8·0% (7·7–8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5–23·9), representing an additional 7·61 million (7·20–8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0–8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0–24·0) and the death rate by 31·8% (30·1–33·3). Total deaths from injuries increased by 2·3% (0·5–4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2–15·1) to 57·9 deaths (55·9–59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000–289 000) globally in 2007 to 352 000 (334 000–363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8–148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2–40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2–36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990—neonatal disorders, lower respiratory infections, and diarrhoeal diseases—were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Funding Bill & Melinda Gates Foundation.
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            Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020

            In February 2020, CDC issued guidance advising persons and health care providers in areas affected by the coronavirus disease 2019 (COVID-19) pandemic to adopt social distancing practices, specifically recommending that health care facilities and providers offer clinical services through virtual means such as telehealth.* Telehealth is the use of two-way telecommunications technologies to provide clinical health care through a variety of remote methods. † To examine changes in the frequency of use of telehealth services during the early pandemic period, CDC analyzed deidentified encounter (i.e., visit) data from four of the largest U.S. telehealth providers that offer services in all states. § Trends in telehealth encounters during January–March 2020 (surveillance weeks 1–13) were compared with encounters occurring during the same weeks in 2019. During the first quarter of 2020, the number of telehealth visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019. During January–March 2020, most encounters were from patients seeking care for conditions other than COVID-19. However, the proportion of COVID-19–related encounters significantly increased (from 5.5% to 16.2%; p<0.05) during the last 3 weeks of March 2020 (surveillance weeks 11–13). This marked shift in practice patterns has implications for immediate response efforts and longer-term population health. Continuing telehealth policy changes and regulatory waivers might provide increased access to acute, chronic, primary, and specialty care during and after the pandemic. Data for this analysis were provided to CDC from four large national telehealth providers as part of partner engagement to monitor and improve outcomes during the COVID-19 pandemic. Datasets included the date of the telehealth encounter, patient sex, age, county and state of residence, and, for 2020 visits, disposition after the visit (e.g., home or location the provider recommended that the patient seek additional care, if needed, such as in an emergency department [ED] or with a primary care provider), “reason for visit” (text field), and diagnosis defined by one or more International Classification of Diseases, Tenth Revision (ICD-10) codes. ¶ No patient, facility, or provider identifiers were included in the datasets. Date of encounter was categorized by epidemiologic surveillance week. For comparison, total ED visit volume by surveillance week in 2019 and 2020 was analyzed from National Syndromic Surveillance Program (NSSP) data, and percentage change from 2019 to 2020 was calculated by week. The national data in NSSP includes ED visits from a subset of hospitals in 47 states, accounting for approximately 73% of ED visits in the United States. Patient encounters for 2020 were characterized as COVID-19–related or not COVID-19–related. COVID-19–related visits were defined as those with one or more of the following: 1) signs and symptoms in the “reason for visit” field meeting criteria established by CDC in March 2020 for COVID-19–like illness,** 2) ICD-10 codes in the diagnosis field for Z20.828 (contact with and suspected exposure to other viral communicable diseases) or U07.1 (2019-nCoV acute respiratory disease), or 3) the terms “COVID” or “coronavirus” in the “reason for visit” field. COVID-19–like illness was defined as fever plus cough or sore throat or shortness of breath. Patient encounters that did not include one of the described criteria were categorized as not COVID-19–related. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy: [45 C.F.R. part 46.102(l)(2); 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501, et seq.] A Wilcoxon signed-rank test was used to test the difference in the median encounter count by week from 2019 to 2020. Average weekly percent changes in encounter count were calculated using Joinpoint Regression Analysis Software (version 4.8.0.1). †† Pairwise comparisons of proportions of encounters between weeks were calculated with chi-squared tests; p values <0.05 were considered statistically significant. Approximately 2.7 million encounter records were available for analysis. Approximately 1,629,000 telehealth encounters occurred in the first 3 months of 2020 (early pandemic period), compared with approximately 1,084,000 encounters during the same period in 2019 (50% increase overall; p<0.05). During surveillance week 13 in 2020, telehealth visits increased 154% (p<0.05), compared with the same week in 2019 (Figure 1). In contrast, the number of ED visits in the last 3 weeks of March 2020 decreased markedly, compared with the same period in 2019. FIGURE 1 Number of telehealth patient encounters reported by four telehealth providers that offer services in all states and percentage change in telehealth encounters and emergency department (ED) visits — United States, January 1–March 30, 2019 (comparison period) and January 1–March 28, 2020 (early pandemic period)* Abbreviations: CARES Act = Coronavirus Aid, Relief, and Economic Security Act; CMS = Center for Medicare & Medicaid Services; COVID-19 = coronavirus disease 2019. * Unpublished ED visit data obtained from the National Syndromic Surveillance Program. The figure shows the number of telehealth patient encounters reported by four telehealth providers that offer services in all states and the percentage change in telehealth encounters and emergency department (ED) visits from 2019 to 2020. Most telehealth encounters were for adults aged 18–49 years (66% in 2019 and 69% in 2020) and female patients (63% in both 2019 and 2020). During the early pandemic period in 2020, the percentage of telehealth visits for persons aged 18–49 years increased slightly, from 68% during the first week of January 2020 to 73% during the last week of March (p<0.05). There was a slight decrease in the percentage of telehealth encounters for children during the emerging pandemic period, compared with the same period in 2019. An average of 3.5% of encounters were for children aged <5 years in 2020 (compared with 4.0% in 2019), and 8.6% were for those aged 5–17 years in 2020 (compared with 10.0% in 2019). During January–March 2020, most telehealth patients (93%) sought care for conditions other than COVID-19. However, the proportion of COVID-19–related encounters grew (from 5.5% to 16.2%; p<0.05) during the last 3 weeks of March, when an increasing number of visits included mention of COVID-19 in the “reason for visit” field (Figure 2). In addition, 69% of patients who had a telehealth encounter during the early pandemic period in 2020 were managed at home, with 26% advised to seek follow-up from their primary care provider as needed or, if their condition worsened or did not improve, 1.5% were advised to seek care in an ED, and 3% were referred to an urgent care setting. During 2020, referral patterns were consistent during the early pandemic period; the increases or decreases in referral categories between weeks 1–9 and weeks 10–13 were <1%. FIGURE 2 Number of telehealth patient encounters for persons with COVID-19-like symptoms, coronavirus-related ICD-10 codes, or coronavirus-related text string entries reported by four telehealth providers that offer services in all states — United States, January 1–March 28, 2020 Abbreviations: COVID-19 = coronavirus disease 2019; ICD-10 = International Classification of Diseases, Tenth Revision. The figure shows the number of telehealth patient encounters in 2020 for persons with COVID-19-like symptoms, coronavirus-related ICD-10 codes, or coronavirus-related text string entries reported by four telehealth providers that offer services in all U.S. states. Discussion This cross-sectional analysis of telehealth use during the emergence of the COVID-19 pandemic in the United States (January–March 2020) provides information on use patterns of this health care delivery modality for planners and providers. The age and sex of patients who accessed telehealth services in this analysis were similar to those seeking telehealth services in other studies ( 1 ). Substantially more telehealth visits were made during the first 3 months of 2020 than during the same period in 2019; whereas visits to EDs sharply declined. Other researchers have noted a marked overall increase in the use of telehealth services in the latter weeks of March 2020 and sharp declines in the use of EDs ( 2 – 4 ). Overall, an estimated 41%–42% of U.S. adults reported having delayed or avoided seeking care during the pandemic because of concerns about COVID-19, including 12% who reported having avoided seeking urgent or emergency care ( 3 , 4 ). The sharp rise in telehealth encounters might be temporally associated with these declines in in-person visits. The increased number of visits in the latter weeks in March, 2020 might also be related to the March 6, 2020 policy changes and regulatory waivers from Centers for Medicare & Medicaid Services §§ (1,135 waivers) in response to COVID-19 and provisions of the U.S. Coronavirus Aid, Relief, and Economic Security (CARES) Act, effective March 27, 2020. ¶¶ These emergency policies included improved provider payments for telehealth, allowance for providers to serve out-of-state patients, authorization for multiple types of providers to offer telehealth services, reduced or waived cost-sharing for patients, and permission for federally qualified health centers or rural health clinics to offer telehealth services. The waivers also allowed for virtual visits to be conducted from the patient’s home, rather than in a health care setting. Other contributing factors that could have affected utilization of services include state-issued stay-at-home orders ( 5 ), states’ inclusion of telehealth as a Medicaid covered benefit,*** and CDC’s guidance for social distancing and increased use of virtual clinical visits. Telehealth might have multiple benefits for public and individual health during the COVID-19 pandemic. During the latter weeks in March 2020, remote screening and management of persons who needed clinical care for COVID-19 and other conditions might have increased access to care when many outpatient offices were closed or had limited operating hours. The increased availability of telehealth services also might have reduced disease exposure for staff members and patients, preserved scarce supplies of personal protective equipment, and minimized patient surge on facilities ( 6 ). In addition, most patients seeking telehealth in the early pandemic period were managed at home, which might have reduced large volumes of patients seeking care at health care facilities. Access to telehealth services might have been particularly valuable for those patients who were reluctant to seek in-person care, had difficulty accessing in-person care or who had chronic conditions that place them at high risk for severe COVID-19 ( 1 ). Although telehealth is generally well-accepted by patients and clinicians ( 7 ), it is not without challenges. Limited access to the Internet or devices such as smartphones, tablets, or computers, and lack of familiarity with technology might be potential barriers for some patients ( 1 , 8 ). In addition, virtual visits might not be appropriate for some persons based on level of acuity or necessity to conduct an in-person physical examination or diagnostic testing. Although several reports have described concern in the decline of emergency department use during the early pandemic period, a very small proportion of telehealth patients in this analysis were referred to emergency care. Increases in the use of telehealth precipitated by COVID could have long-term benefits for improving appropriate emergency department utilization. The findings in this report are subject to at least two limitations. First, the data in this analysis are from a sample of four large national telehealth providers and do not represent all virtual encounters conducted during the study period. In addition, the symptoms used initially to identify patients with possible COVID-19 were limited, and it was not possible to distinguish them from those with influenza-like illness symptoms or other respiratory conditions; therefore, some patients might have been unidentified or misclassified. Health care delivery has shifted during the COVID-19 pandemic, with telehealth encounters sharply increasing in late March 2020. Telehealth can serve an important role in pandemic planning and response. Continued availability and promotion of telehealth services might play a prominent role in increasing access to services during the public health emergency. The regulatory waivers in place during COVID-19 might have helped increase adoption of telehealth services along with public health guidance encouraging virtual visits and CDC recommendations for use of telehealth services during the COVID-19 pandemic. ††† Data from telehealth encounters can inform public health surveillance systems, especially during the pandemic. With expanded access and improved reimbursement policies in place, as well as ongoing acceptability by patients and health care providers, telehealth might continue to serve as an important modality for delivering care during and after the pandemic. §§§ Summary What is already known about this topic? Use of telehealth (the remote provision of clinical care) early during the COVID-19 pandemic has not been well characterized. What is added by this report? The 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019 might have been related to pandemic-related telehealth policy changes and public health guidance. What are the implications for public health practice? Telehealth could have multiple benefits during the pandemic by expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities. Telehealth policy changes might continue to support increased care access during and after the pandemic.
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              Use of Telehealth During the COVID-19 Pandemic: Scoping Review

              Background With over 37.8 million cases and over 1 million deaths worldwide, the COVID-19 pandemic has created a societal and economic upheaval of unparalleled magnitude. A positive transformation has been brought about by innovative solutions in the health care sector that aim to mitigate the impact of COVID-19 on human health. For instance, the use of telehealth has been on the rise amidst this public health emergency. Objective Given the unprecedented scale of the pandemic with no definitive endpoint, we aimed to scope the existing telehealth-related literature during a defined period of the ongoing pandemic (ie, January to June 2020). Methods Our scoping review was guided by the Joanna Briggs Institute Reviewer Manual. We systematically searched PubMed and Embase databases with specific eligibility criteria. Data extracted from the shortlisted articles included first author and affiliation, journal title, publication type, terminologies used to describe telehealth and their accompanying definitions, health discipline or medical specialties and subspecialties wherein telehealth had been applied, the purpose of telehealth use, and the authors’ overall sentiment on telehealth use. We collated the available information and used descriptive statistics to analyze the synthesized data. Results In all, 543 articles published across 331 different journals were included in this scoping review. The Journal of Medical Internet Research and its sister journals featured the highest number of articles (25/543, 4.6%). Nearly all (533/543, 98.2%) articles were in English. The majority of the articles were opinions, commentaries, and perspectives (333/543, 61.3%). Most authors of the articles reviewed were from high-income countries (470/543, 86.6%), especially from the United States of America (237/543, 43.6%). In all, 39 different definitions were used to describe terms equivalent to telehealth. A small percentage (42/543, 7.7%) of the articles focused on the provision of COVID-19–related care. Moreover, 49.7% (270/543) of the articles primarily focused on the provision of multiple components of clinical care, and 23% (125/543) of the articles focused on various specialties and subspecialties of internal medicine. For a vast majority (461/543, 84.9%) of the articles, the authors expressed a celebratory sentiment about the use of telehealth. Conclusions This review identified considerable emerging literature on telehealth during the first six months of the COVID-19 pandemic, albeit mostly from high-income countries. There is compelling evidence to suggest that telehealth may have a significant effect on advancing health care in the future. However, the feasibility and application of telehealth in resource-limited settings and low- and middle-income countries must be established to avail its potential and transform health care for the world’s population. Given the rapidity with which telehealth is advancing, a global consensus on definitions, boundaries, protocols, monitoring, evaluation, and data privacy is urgently needed.
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                Author and article information

                Journal
                Patient Prefer Adherence
                Patient Prefer Adherence
                ppa
                ppa
                Patient preference and adherence
                Dove
                1177-889X
                10 February 2021
                2021
                : 15
                : 283-298
                Affiliations
                [1 ]School of Pharmacy, Monash University Malaysia , Subang Jaya, Selangor, Malaysia
                [2 ]School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University , Subang Jaya, Selangor, Malaysia
                [3 ]Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia , Bandar Sunway, Selangor, Malaysia
                Author notes
                Correspondence: Shaun Wen Huey Lee School of Pharmacy, Monash University Malaysia , Subang Jaya, Selangor, Malaysia Email shaun.lee@monash.edu
                Author information
                http://orcid.org/0000-0002-5667-9521
                http://orcid.org/0000-0001-7361-6576
                Article
                271449
                10.2147/PPA.S271449
                7882448
                33603347
                59256963-7ae0-47ef-b665-fca10fbe8fb8
                © 2021 Sim and Lee.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 25 November 2020
                : 21 January 2021
                Page count
                Figures: 2, Tables: 3, References: 54, Pages: 16
                Categories
                Review

                Medicine
                type 2 diabetes,satisfaction,preference,telemedicine,mhealth,review
                Medicine
                type 2 diabetes, satisfaction, preference, telemedicine, mhealth, review

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