Barriers and facilitators to mobile health and active surveillance use among older adults with skin disease.
Health expectations : an international journal of public participation in health care and health policy
BACKGROUND: The COVID-19 pandemic has accelerated the adoption of telemedicine, including teledermatology. Monitoring skin lesions using teledermatology may become increasingly important for several skin diseases, including low-risk skin cancers. The purpose of this study was to describe the key factors that could serve as barriers or facilitators to skin disease monitoring using mobile health technology (mHealth) in older adults.METHODS: Older adult dermatology patients 65years or older and their caregivers who have seen a dermatologist in the last 18months were interviewed and surveyed between December 2019 and July 2020. The purpose of these interviews was to better understand attitudes, beliefs and behaviours that could serve as barriers and facilitators to the use of mHealth and active surveillance to monitor low-risk skin cancers.RESULTS: A total of 33 interviews leading to 6022 unique excerpts yielded 8 factors, or themes, that could serve as barriers, facilitators or both to mHealth and active surveillance. We propose an integrated conceptual framework that highlights the interaction of these themes at both the patient and provider level, including care environment, support systems and personal values.DISCUSSION AND CONCLUSIONS: These preliminary findings reveal factors influencing patient acceptance of active surveillance in dermatology, such as changes to the patient-provider interaction and alignment with personal values. These factors were also found to influence adoption of mHealth interventions. Given such overlap, it is essential to address barriers and facilitators from both domains when designing a new dermatology active surveillance approach with novel mHealth technology.PATIENT OR PUBLIC CONTRIBUTION: The patients included in this study were participants during the data collection process. Members of the Stanford Healthcare and Denver Tech Dermatology health-care teams aided in the recruitment phase of the data collection process.
View details for DOI 10.1111/hex.13229
View details for PubMedID 34190397
Social media and vision therapy: perspectives of providers and patients on Instagram.
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus
PURPOSE: To formally assess the content, intent, and authorship of the most popular Instagram hashtags related to pediatric ophthalmology.METHODS: Public Instagram posts with over 20 likes, using one or more of 6 vision therapy (VT) hashtags and containing English content were identified. A categorical classification system was used to analyze each post for the target audience: post owner, primary intent of post, diagnosis addressed, whether advice was provided, and whether references to studies were provided.RESULTS: A total of 1,766 Instagram posts were analyzed. Half were made by VT clinics or therapists (50%), and only 14 posts were made by physicians (0.8%). The majority were self-promotional. Statistically significant relationships between post owner and intent, post owner and diagnosis, and the provision of advice and diagnosis were found.CONCLUSIONS: Although VT Instagram posts are dominated by self-promotion and advertisements, social media provides an outlet for patients and parents to seek support and information. Ophthalmologists have yet to discuss VT on Instagram.
View details for DOI 10.1016/j.jaapos.2020.11.023
View details for PubMedID 33965588
Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study.
2021; 5 (2): e28246
BACKGROUND: Telehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention.OBJECTIVE: The objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program.METHODS: In 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic.RESULTS: In this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic's CVD prevention program (76/118, 64.4% vs 173/441, 39.2%, respectively; P<.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; P<.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort.CONCLUSIONS: Telehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics.
View details for DOI 10.2196/28246
View details for PubMedID 34499037
Application of the Quadruple Aim to evaluate the operational impact of a telemedicine program.
Healthcare (Amsterdam, Netherlands)
2021; 9 (4): 100593
In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs.We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits.Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002).Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution.The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems.Level III (retrospective comparative study).
View details for DOI 10.1016/j.hjdsi.2021.100593
View details for PubMedID 34749227