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Telemedicine in the Era of COVID-19

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 29875

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Special Issue Editor

Dr. Giulio Nittari

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Guest Editor

Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
Interests: telemedicine; pharmacy; telepharmacy; overweight/obesity; chronic diseases; non-communicable diseases; public health; ethical and legal challenges and COVID-19

Special Issue Information

Dear Colleagues,

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the deadly coronavirus disease 2019 (COVID-19), is a member of a large family of viruses—coronaviruses—that cause various diseases of the pulmonary system ranging from the common cold to severe respiratory syndromes such as the Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). COVID-19 afflicts all age groups; in particular, 95% of deaths have occurred in people over the age of 60. In preventing this COVID-19 deadly pandemic, telemedicine can help by enabling mildly ill patients to receive the supportive care they need while minimizing their exposure to other seriously ill patients. Hence, in promoting telemedicine during the COVID-19 era, it is important to reduce the spread of viruses and support public health measures. In this Special Issue, the management of patients with COVID-19 and how to reduce the infection rate using telemedicine technology are discussed. Therefore, an evidence-based prevention strategy is essential to reduce mortality and morbidity due to the COVID-19 pandemic, particularly through the use of telemedicine technologies.

Dr. Giulio Nittari
Guest Editor

Manuscript Submission Information

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Keywords

COVID-19
SARS-CoV-2
digital health
digital medicine
public health
surveillance
telehealth
telemedicine

Published Papers (10 papers)

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Research

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10 pages, 339 KiB

Open AccessArticle

Use of an Online Platform to Evaluate the Impact of Social Distancing Measures on Psycho-Physical Well-Being in the COVID-19 Era

by Stefania Scuri, Marina Tesauro, Fabio Petrelli, Ninfa Argento, Genny Damasco, Giovanni Cangelosi, Cuc Thi Thu Nguyen, Demetris Savva and Iolanda Grappasonni

Int. J. Environ. Res. Public Health 2022, 19(11), 6805; https://doi.org/10.3390/ijerph19116805 - 02 Jun 2022

Cited by 2 | Viewed by 1510

Abstract

Background: The SARS-CoV-2 pandemic (Severe Acute Respiratory Syndrome Coronavirus 2) and the worldwide health crisis have significantly changed both people’s habits and lifestyles. Most of the studies found in the literature were carried out on specific professional categories in the socio-health sector, taking into consideration psychological disorders in relation to work. The purpose of this study was to analyze the psychological impact on a portion of the normal population subjected to lockdown. Methods: A questionnaire was distributed in the period between 23 March 2020 and 18 May 2020 (during Italian lockdown) using an online platform. The scales GAD-7, IES-r, PHQ-9 and MANSA were used to investigate the level of anxiety, the presence of post-traumatic stress disorder, the severity of depression and the perceived quality of life, respectively. Results: Four hundred and eight Italian subjects responded. Females and younger people were more affected by anxiety and depression. Post-traumatic stress disorder affected about 40% of the population sample, significantly young people and women, thus attesting to an important psychopathological response. About one-fifth of the sample population recorded an unsatisfactory quality of life. Conclusions: The results highlight the need to set up preventive interventions (primary and secondary), trying to focus on the most fragile group of subjects from a psychosocial point of view, in order to obtain a significant reduction in psychophysical damage in terms of relapses and outcomes. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

10 pages, 980 KiB

Open AccessArticle

A Utility Framework for COVID-19 Online Forward Triage Tools: A Swiss Telehealth Case Study

by Janet Michel, Annette Mettler, Martin Müller, Wolf E. Hautz and Thomas C. Sauter

Int. J. Environ. Res. Public Health 2022, 19(9), 5184; https://doi.org/10.3390/ijerph19095184 - 24 Apr 2022

Cited by 5 | Viewed by 1437

Abstract

The SARS-CoV-2 pandemic caused a surge in online tools commonly known as symptom checkers. The purpose of these symptom checkers was mostly to reduce the health system burden by providing worried people with testing criteria, where to test and how to self-care. Technical, usability and organizational challenges with regard to online forward triage tools have also been reported. Very few of these online forward triage tools have been evaluated. Evidence for decision frameworks may be of particular value in a pandemic setting where time frames are restricted, uncertainties are ubiquitous and the evidence base is changing rapidly. The objective was to develop a framework to evaluate the utility of COVID-19 online forward triage tools. The development of the online forward triage tool utility framework was conducted in three phases. The process was guided by the socio-ecological framework for adherence that states that patient (individual), societal and broader structural factors affect adherence to the tool. In a further step, pragmatic incorporation of themes on the utility of online forward triage tools that emerged from our study as well as from the literature was performed. Seven criteria emerged; tool accessibility, reliability as an information source, medical decision-making aid, allaying fear and anxiety, health system burden reduction, onward forward transmission reduction and systems thinking (usefulness in capacity building, planning and resource allocation, e.g., tests and personal protective equipment). This framework is intended to be a starting point and a generic tool that can be adapted to other online forward triage tools beyond COVID-19. A COVID-19 online forward triage tool meeting all seven criteria can be regarded as fit for purpose. How useful an OFTT is depends on its context and purpose. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

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7 pages, 621 KiB

Open AccessArticle

Telemedicine in the Management of Patients with Rheumatic Disease during COVID-19 Pandemic: Incidence of Psychiatric Disorders and Fibromyalgia in Patients with Rheumatoid Arthritis and Psoriatic Arthritis

by Rosario Foti, Giorgio Amato, Ylenia Dal Bosco, Antonio Longo, Caterina Gagliano, Raffaele Falsaperla, Roberta Foti, Sergio Speranza, Francesco De Lucia and Elisa Visalli

Int. J. Environ. Res. Public Health 2022, 19(6), 3161; https://doi.org/10.3390/ijerph19063161 - 08 Mar 2022

Cited by 4 | Viewed by 1862

Abstract

The management of patients with immuno-rheumatological diseases has profoundly changed during the COVID-19 pandemic and telemedicine has played an important role in the disease follow-up. In addition to monitoring disease activity and any adverse events, especially infectious events, assessing the psychological situation of the patient can be fundamental. Furthermore, COVID-19 has a serious impact on mental health and, since the beginning of the pandemic, a significantly higher incidence of anxiety disorders and depressive symptoms especially in younger people was observed. In this study, we evaluated the incidence of depressive disorders, anxiety, and fibromyalgia (FM) in our patients with rheumatoid arthritis and psoriatic arthritis during the lockdown period due to the COVID-19 pandemic and we validate the use of telemedicine in the clinical management of these patients. Mental and physical stress during the COVID-19 pandemic can greatly worsen FM symptoms and intensify patients’ suffering without a clinical flare of the inflammatory disease for patients affected by rheumatoid arthritis. Telemedicine has allowed us to identify patients who needed a face-to-face approach for therapeutic reevaluation even if not related to a flare of the inflammatory disease. Even if our data does not allow us to draw definitive conclusions regarding the effectiveness of telemedicine as greater than or equal to the standard face-to-face approach, we continue to work by modifying our approach to try to ensure the necessary care in compliance with safety and, optimistically, this tool will become an important part of rheumatic disease management. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

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16 pages, 1997 KiB

Open AccessArticle

Strengthening the Trialability for the Intention to Use of mHealth Apps Amidst Pandemic: A Cross-Sectional Study

by Munshi Muhammad Abdul Kader Jilani, Md. Moniruzzaman, Mouri Dey, Edris Alam and Md. Aftab Uddin

Int. J. Environ. Res. Public Health 2022, 19(5), 2752; https://doi.org/10.3390/ijerph19052752 - 27 Feb 2022

Cited by 10 | Viewed by 3808

Abstract

Recent advancements in mHealth apps and services have played a vital role in strengthening healthcare services and enabling their accessibility to marginalized people. With the alarming rise in COVID-19 infection rates around the world, there appears to be an urgent call to modernize traditional medical practices to combat the pandemic. This study aims to investigate the key factors influencing the trialability of mHealth apps/services and behavioral intention to adopt mobile health applications. The study also examines the moderating effects of self-discipline motivation, knowledge, and attitude on the relationship between trialability and behavioral intention to use. The deductive reasoning approach was followed in a positivism paradigm. The study used convenience sampling and collected responses from 280 Generation Y participants in Bangladesh. Partial least square-based structural equation modeling was employed. The results revealed that relative advantage (β = 0.229, p < 0.05), compatibility (β = 0.232, p < 0.05), complexity (β = −0.411, p < 0.05), and observability (β = 0.235, p < 0.05) of mHealth apps influence the trialability of mHealth apps and services among users. Trialability compatibility (β = 0.425, p < 0.05) of mHealth was positively related to the behavioral intention to use these mobile apps. The study found no moderating effects of attitude (β = 0.043, p > 0.05) or self-discipline motivation (β = −0.007, p > 0.05) on the hypothesized relationships. The empirical findings of this study may facilitate the development, design process, and implementation of mHealth applications with improved features that can lead to high user acceptance among Generation Y during future health crises. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

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9 pages, 535 KiB

Open AccessArticle

Following the COVID-19 Experience, Many Patients with Type 1 Diabetes Wish to Use Telemedicine in a Hybrid Format

by Tal Schiller, Taiba Zornitzki, Viviana Ostrovsky, Danielle Sapojnik, Lee Cohen, Tamila Kunyavski, Hilla Knobler and Alena Kirzhner

Int. J. Environ. Res. Public Health 2021, 18(21), 11309; https://doi.org/10.3390/ijerph182111309 - 28 Oct 2021

Cited by 10 | Viewed by 1855

Abstract

Background: The COVID-19 pandemic has brought to light both challenges and unique opportunities regarding type 1 diabetes (T1D) management, including the usage of telemedicine platforms. Methods: This study was conducted in a tertiary hospital diabetes clinic. All consecutive T1D patients during March and June 2021 were asked to fill out a structured anonymous questionnaire that aimed to determine their preference regarding continuous use of a virtual platform. Results: In total, 126 T1D patients answered the questionnaire, of whom 51% were under the age of 40, half were men, half used insulin pumps, and 69% used continuous glucose monitoring. During the pandemic, the exposure of patients to virtual visits has grown about twofold, from 29% to 53%. Of the respondents, 49% expressed an interest in future usage of a virtual platform, but most of them preferred use in a hybrid manner. We found an association between preference to use telemedicine in the future and younger age, previous virtual platform experience, and confidence in being able to download data. Conclusions: Our data demonstrate that the COVID-19 experience has led to a growing interest of T1D patients in using the hybrid format of telemedicine. However, we still need to better understand who will benefit most from this platform and assess its cost-effectiveness and organization. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

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13 pages, 349 KiB

Open AccessArticle

Telemedicine and eHealth Literacy in the Era of COVID-19: A Cross-Sectional Study in a Peripheral Clinic in Israel

by Keren Dopelt, Nofar Avni, Yana Haimov-Sadikov, Iris Golan and Nadav Davidovitch

Int. J. Environ. Res. Public Health 2021, 18(18), 9556; https://doi.org/10.3390/ijerph18189556 - 10 Sep 2021

Cited by 19 | Viewed by 3224

Abstract

The COVID-19 pandemic mandating isolation, quarantine, and social distancing has accelerated and expanded the use of telemedicine. This study examines the extent of the use of telemedicine and the relationship between eHealth literacy and satisfaction with using telemedicine during the pandemic. A total of 156 participants from a clinic in a peripheral community in southern Israel completed an online questionnaire. We found that 85% knew how to use the internet for health information, but only one third felt safe using it to make health decisions. Furthermore, 93% used the internet for technical needs, such as renewing prescriptions or making a doctor’s appointment. Even lower use for telemedicine was found (38%) for consultation or treatment sessions. A positive association was found between eHealth literacy and satisfaction variables with using telemedicine (r_p = 0.39, p < 0.001). Although respondents understood the benefits of telemedicine, they were not satisfied nor interested in online sessions after the epidemic’s end, preferring a meeting involving personal interaction. Young people and academics benefit more from telemedicine, thereby creating usage gaps and potentially increasing existing inequality. We recommend developing intervention programs, especially among vulnerable populations, to strengthen eHealth literacy and remove barriers causing skepticism about the use of telemedicine during and after the pandemic. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

Review

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15 pages, 396 KiB

Open AccessReview

Telemedicine in the COVID-19 Era: A Narrative Review Based on Current Evidence

by Giulio Nittari, Demetris Savva, Daniele Tomassoni, Seyed Khosrow Tayebati and Francesco Amenta

Int. J. Environ. Res. Public Health 2022, 19(9), 5101; https://doi.org/10.3390/ijerph19095101 - 22 Apr 2022

Cited by 43 | Viewed by 5344

Abstract

During the recent COVID-19 pandemic, healthcare providers have been encouraged to increase their use of telemedicine and to adopt telemedicine platforms for the majority of their clients who have chronic illnesses. Due to the outbreak itself, almost all countries worldwide were placed under emergency lockdowns. In this paper, we reviewed the literature regarding the use of telemedicine during the COVID-19 pandemic. Consequentially, we identified the adoption of telemedicine in various countries worldwide and evaluated their future steps in order to increase the adoption of e-health technologies. As a result of COVID-19, the e-health agenda, especially telemedicine, has been accelerated in several countries. COVID-19 is affecting individuals’ daily lives and has created major difficulties in the management of healthcare facilities for both infected and non-infected patients. A large portion of the rapid increase in the use of telemedicine can be attributed to evidence from previous pandemics as well as progress made by the field in response to COVID-19, especially in industrialized countries. A lack of effective treatment, large numbers of unvaccinated individuals, as well as social distancing and lockdown measures suggest telemedicine is the safest and most appropriate way of working with patients and doctors. In spite of this willingness, a large number of barriers need to be overcome in order for the telemedicine system to function properly and effectively throughout countries. In order for telemedicine to be sustainable and beneficial beyond the pandemic, several technical, educational, infrastructure, legal, and economic issues must be addressed and solved. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

10 pages, 320 KiB

Open AccessReview

Telemedicine Applications in the Era of COVID-19: Telesurgery Issues

by Paolo Bailo, Filippo Gibelli, Alberto Blandino, Andrea Piccinini, Giovanna Ricci, Ascanio Sirignano and Riccardo Zoja

Int. J. Environ. Res. Public Health 2022, 19(1), 323; https://doi.org/10.3390/ijerph19010323 - 29 Dec 2021

Cited by 14 | Viewed by 2812

Abstract

Telemedicine allows for the effective delivery of health care to patients at a distance through the application of information technology to the field of medicine. This is optimal during the COVID-19 pandemic to reduce interpersonal contact to mitigate contagion. Among the possible Telemedicine applications, there is Telesurgery, which involves more and more surgical specialties thanks to the numerous benefits in quality and cost containment. In the growing field of Telesurgery, its technical and legal implications must be considered. In this study, a traditional review of the scientific literature was carried out to identify the most relevant issues of interest in Telesurgery. The problematic legal aspects identified are mainly related to the difference in legislation between different geographical areas, which is critical in the case of malpractice. In addition, there is the possibility of a malicious hacker attack on the transmitted data stream either to steal sensitive data or to harm the patient. Finally, there are inherent difficulties with the technology used, such as latency issues in data transmission. All these critical issues are currently not adequately addressed by current legislation. Therefore, one can only hope for a legislative action to allow Telesurgery to be used safely. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

9 pages, 333 KiB

Open AccessReview

Perspectives on Telemedicine during the Era of COVID-19; What Can Saudi Arabia Do?

by Ali Mohsen Al-Hazmi, Haytham A. Sheerah and Ahmed Arafa

Int. J. Environ. Res. Public Health 2021, 18(20), 10617; https://doi.org/10.3390/ijerph182010617 - 11 Oct 2021

Cited by 12 | Viewed by 3152

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has represented a challenge to medical practice in Saudi Arabia and worldwide. In contrary to the increasing numbers of COVID-19 patients, there was a limitation in the capacity of medical practices and access to healthcare. A growing body of evidence from healthcare settings in Saudi Arabia and worldwide has suggested a possible role for telemedicine in responding to this evolving need. Telemedicine can be used for triage, direct care, follow-up, and consultation. It could be delivered through synchronous, asynchronous, and mixed approaches. While telemedicine has several advantages, such as accessibility and cost-effectiveness, its diagnostic reliability should be further investigated. The Saudi Vision (2030) has drawn up a roadmap to invest in digital healthcare during the coming decade; however, some barriers related to using telemedicine in Saudi healthcare settings, including cultural issues and technical difficulties, should be openly discussed. In addition, before putting telemedicine in practice on a wide scale in Saudi Arabia, more efforts should be carried out to issue updated legislation and regulations, discuss and respond to ethical concerns, and ensure data security. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

Other

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13 pages, 1316 KiB

Open AccessPerspective

Telemedicine and Haemodialysis Care during the COVID-19 Pandemic: An Integrative Review of Patient Safety, Healthcare Quality, Ethics and the Legal Considerations in Singapore Practice

by Sabrina Haroon, Teck Chuan Voo, Hillary Chua, Gan Liang Tan and Titus Lau

Int. J. Environ. Res. Public Health 2022, 19(9), 5445; https://doi.org/10.3390/ijerph19095445 - 29 Apr 2022

Cited by 7 | Viewed by 3371

Abstract

The COVID-19 pandemic has been an unprecedented health crisis for the general population as well as for patients with chronic illnesses such as those requiring maintenance dialysis. Patients suffering from chronic kidney disease requiring dialysis are considered a high-risk population. Multiple reports have highlighted an increased need for intensive care and higher death rates among this group of patients. Most maintenance dialysis patients are in-centre haemodialysis patients who receive treatment in shared facilities (community dialysis centres). The inability to maintain social distancing in these facilities has led to case clustering among patients and staff. This poses a substantial risk to the patients, their household members, and the wider community. To mitigate the risks of COVID-19 transmission, telemedicine was rapidly adopted in the past year by nephrologists and other allied-health staff to provide care via remote consultations and reviews. Telemedicine poses unique challenges even in an era where so much is performed online with a high degree of success and satisfaction. In applying distant clinical care for maintenance haemodialysis patients via telemedicine, there is a need to ensure adequate protection for the health and safety of patients as well as understand the ethical and legal implications of telemedicine. We discussed, in this article, these three core aspects of patient safety and quality, ethics and legal implications in telemedicine, and how each of these is crucial to the safe and effective delivery of care in general as well as unique aspects of this in Singapore. Full article

(This article belongs to the Special Issue Telemedicine in the Era of COVID-19)

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