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      Role of Telemedicine in Follow-up Care of Children with Respiratory Illnesses at a Tertiary Care Hospital — An Ambispective Observational Study

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      , ,

      Indian Journal of Pediatrics

      Springer India

      Children, COVID-19, Respiratory, Telemedicine

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          Abstract

          Objective

          To assess if telemedicine can be used successfully for follow-up care of children with respiratory illnesses. The authors also assessed problems faced by the doctors and satisfaction of caregivers of these patients with telemedicine.

          Methods

          The authors conducted an ambispective observational study. Data related to demographic details and diagnoses of patients who had telemedicine consultation (teleconsultation) appointments between 2nd April 2020 to 15th May 2020 were reviewed retrospectively. They noted proportion of patients having successful prescription. To assess problems faced by doctors and satisfaction of caregiver of patients with teleconsultation, a prospective questionnaire was sent via Google Forms 6–10 wk after the initial appointment date. Those who did not respond to Google Forms were called by phone to assess the same.

          Results

          A total of 188 patients received teleconsultation during the study period. Team was able to prescribe treatment in 181 (96.3%) patients via teleconsultation and other seven (3.7%) required physical evaluation. Mean (SD) age of patients was 9.7 (4.9) y, range 3 mo to 18 y. There were 117 (62.2%) boys and 71 (37.8%) girls. Majority (58%) of the patients were asthmatics. The team advised refill prescription in 83% patients as symptoms were controlled. Three out of five residents faced minor problems while providing teleconsultation. In satisfaction assessment, 78% of caregivers rated teleconsultation 8 or more, out of 10 points, suggesting that most of them were satisfied with telemedicine.

          Conclusion

          In majority of children with respiratory illnesses, successful follow-up care can be provided by telemedicine.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s12098-020-03590-8.

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          Most cited references12

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          Is Open Access

          Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health

          Telehealth is an alternative method of delivering health care to people required to travel long distances for routine health care. The aim of this systematic review was to examine whether patients and their caregivers living in rural and remote areas are satisfied with telehealth videoconferencing as a mode of service delivery in managing their health. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42017083597) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Ovid Medline, Embase, CINAHL, ProQuest Health Research Premium Collection, Joanna Briggs Institute and the Cochrane Library was conducted. Studies of people living in rural and remote areas who attended outpatient appointments for a health condition via videoconference were included if the studies measured patient and/or caregivers’ satisfaction with telehealth. Data on satisfaction was extracted and descriptively synthesised. Methodological quality of the included studies was assessed using a modified version of the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Thirty-six studies of varying study design and quality met the inclusion criteria. The outcomes of satisfaction with telehealth were categorised into system experience, information sharing, consumer focus and overall satisfaction. There were high levels of satisfaction across all these dimensions. Despite these positive findings, the current evidence base lacks clarity in terms of how satisfaction is defined and measured. People living in rural and remote areas are generally satisfied with telehealth as a mode of service delivery as it may improve access to health care and avoid the inconvenience of travel.
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            Addressing health disparities in rural communities using telehealth

            The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.
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              Using telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community.

              For children with special health care needs (CSHCN) that live in rural, medically underserved communities, obtaining subspecialty care is a challenge. Telemedicine is a means of improving access to these children by addressing rural physician shortages and geographic barriers. This article reports a medical-needs assessment of parents/guardians with CSHCN and the status of a telemedicine program for CSHCN as well as the results of parent/guardian and local provider satisfaction with the telemedicine program. We report the results of a pretelemedicine medical-needs survey conducted in March 1999 by using a convenience sample of CSHCN living in a rural, medically underserved community located 90 miles north of the University of California Davis Children's Hospital (Davis, CA). In April 1999, a telemedicine program was initiated to provide consultations to CSHCN and has continued since. We also report the parent/guardian's perceptions of the appropriateness and quality of telemedicine consultations and the local provider's satisfaction with telemedicine consultations completed from April 1999 to April 2002. The pretelemedicine medical-needs assessment demonstrated several barriers in access to subspecialty care including traveling >1 hour for appointments (86% of parents/guardians), missing work for appointments (96% of working parents/guardians), and frequently relying on emergency department services and/or self-regulation of their child's medications. From April 1999 to April 2002, 130 telemedicine consultations were completed on 55 CSHCN. Overall, satisfaction was very high. All the parents/guardians rated satisfaction with telemedicine care as either "excellent" or "very good," and all but 2 of the rural providers' surveys reported satisfaction with telemedicine as "excellent" or "very good." The frequency of telemedicine consultations has increased with time. Pediatric subspecialty telemedicine consultations can be provided to CSHCN living in a rural, medically underserved community with high satisfaction among local providers and parents/guardians. Telemedicine should be considered as a means of facilitating care to CSHCN that, relative to the customary delivery of health care, is more accessible, family-centered, and coordinated among patients and their health care providers.
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                Author and article information

                Contributors
                drkanaram@gmail.com
                Journal
                Indian J Pediatr
                Indian J Pediatr
                Indian Journal of Pediatrics
                Springer India (New Delhi )
                0019-5456
                0973-7693
                4 January 2021
                : 1-5
                Affiliations
                GRID grid.413618.9, ISNI 0000 0004 1767 6103, Department of Pediatrics, , All India Institute of Medical Sciences, ; New Delhi, 110029 India
                Article
                3590
                10.1007/s12098-020-03590-8
                7780214
                33394296
                f37984ef-fb7e-4b57-8869-8deddc0578ba
                © Dr. K C Chaudhuri Foundation 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                Categories
                Original Article

                Pediatrics

                children, covid-19, respiratory, telemedicine

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