Search

Introduction: Determining appropriate remuneration for teledermoscopy service is important because inadequate remuneration can be a barrier to practitioner uptake and participation. This study explores dermatologist remuneration expectations for a single lesion store-and-forward teledermoscopy consultation.Methods: Fourteen dermatologists participated in telephone interviews during May-June 2017. Questions regarding remuneration focused on a clinical scenario involving teledermoscopy of a single lesion suspected to be skin cancer. The initial scenario was an existing patient, with a provisional diagnosis of benign neoplasm from the images, to be followed-up with routine skin checks, taking three minutes to review. Participants indicated their remuneration expectation by selecting from an ascending array of pre-determined remuneration ranges. The question was repeated a further four times with one aspect of the scenario changed each time; consultation length, source (patient or general practitioner), required follow-up, and a new rather than existing patient. Participants were also asked how appropriate they thought teledermoscopy was for the scenario, and whether they would choose to undertake the consultation presented.Results: Nine dermatologists selected the AU$61-90 or AU$91-120 remuneration ranges for the initial scenario. When given the opportunity to comment on teledermoscopy service provision in Australia, respondents reflected that it was a valuable, advanced dermatology service, but they would prefer face-to-face consultation with patients where possible to allow for a full body examination.Discussion: Dermatologists expect to be remunerated in the range of AU$61-120 for a single lesion store-and-forward teledermoscopy consultation when face-to-face examination is not possible. [ABSTRACT FROM AUTHOR]

Background: Diet and exercise are important components of treatment for complex chronic conditions, however access to allied health support is limited. When available, support is often siloed and fragmented. Digital health incorporating patient choice may help to align health care services with preferences and goals. This study evaluated the implementation of a ubiquitously accessible patient-centred digital health diet and exercise service. Methods: U-DECIDE was a single-centre, 26-week randomised controlled trial set in kidney and liver disease clinics in a tertiary hospital in Brisbane, Australia. Participants were adults with a complex chronic condition referred for dietetic consultation with at least one feature of the metabolic syndrome. All participants received a dietary consultation, an activity monitor and usual care. Intervention participants were offered one text message per week and access to additional digital health options (increased text message frequency, nutrition app, exercise app, group-based diet and/or exercise video consultations). The primary outcome of feasibility was determined by safety (study-related serious adverse events: SRSAEs), recruitment (≥ 50% eligible patients), retention (≥ 70%), exposure uptake (≥ 75% of intervention group had greater access to health professional contact than comparator) and video consultation adherence (≥ 80% attendance). Secondary outcomes included process evaluation metrics and clinical outcomes. Results: Of 67 participants (intervention n = 33, comparator n = 34), 37 (55%) were men, median (IQR) age was 51 (41–58) years. The most chosen digital health options were the nutrition app (n = 29, 88%) and exercise video consultations (n = 26, 79%). Only one participant chose no additional digital health options. The intervention group had no SRSAEs. The study exceeded targets for recruitment (52%), retention (81%) and exposure uptake (94%). Video consultation adherence was 42%. Engagement across digital health options was inconsistent. Conclusions: Digital health options incorporating patient choice were feasible and can be offered to people with complex chronic disease as a service model option. Trial registration: Australia and New Zealand Trials Register: Trial Registration Number: ACTRN12620001282976. Registered 27th November 2020. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (IVR) presents new possibilities for application in health care. Health care professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, evoke targeted emotional responses, inspire, or distract from an experience occurring in reality. Objective: This review aimed to identify patient-focused applications for head-mounted IVR for acute treatment of health conditions and determine the technical specifications of the systems used. Methods: A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. The databases included PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, Scopus, and Web of Science. Search terms relating to health and IVR were used. To be included, studies had to investigate the effectiveness of IVR for acute treatment of a specific health condition. IVR was defined as a head-mounted platform that provides virtual and auditory immersion for the participant and includes a minimum of 3 degrees of orientation tracking. Once identified, data were extracted from articles and aggregated in a narrative review format. Results: A total of 58 studies were conducted in 19 countries. The studies reported IVR use for 5 main clinical areas: neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and others (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=28). Conclusions: IVR has a promising future in health care, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for acute treatment of health conditions, evidence for the effectiveness of IVR is still developing. [ABSTRACT FROM AUTHOR]

Sustaining telehealth uptake hinges on people's desire and ability to effectively engage with it. We explored trust and confidence in telehealth delivered by medical and allied health using cross-sectional survey of 1,116 Australians. Descriptive analysis presented factors that would improve trust and confidence in telehealth cross-tabulated with video consultation experience. Inferential statistics compared levels of trust in medical and allied health telehealth with user-related variables. Trust in medical telehealth was higher than in allied health, but practice with video calls, experience with high-quality telehealth, and good internet were associated with greater levels of trust in both groups. Telehealth with a known health professional and no additional costs were top-ranked factors to improve trust and confidence. Participants confident in troubleshooting trusted telehealth more. This first cross-sectional study on trust and confidence in telehealth suggests that digital upskilling and promoting quality video consultations can potentially enhance telehealth adoption.

Background: Telephone and video consultations have been used as telepharmacy modalities for a number of years, particularly during the COVID-19 pandemic where in-person services were limited. However, a widespread global literature review has yet to be completed on studies since June 2016 regarding the effectiveness of telephone and video consultations as telepharmacy models., Objectives: The aim of this review was to summarise the synchronous telepharmacy models of care for adult outpatients since June 2016. The secondary aim was to report on the effect of these models on clinical, service, and user-perspectives and non-clinical outcomes compared to the standard model of care, as well as facilitators and barriers of the telepharmacy models., Methods: A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and Embase in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient; data extraction and narrative analysis were then performed and NHMRC level of evidence determined., Results: From 2129 unique articles reviewed, 103 were eligible for inclusion. Synchronous telepharmacy services in an outpatient setting were delivered by telephone consultations and video consultations, with the majority being delivered by the telephone modality (87 %) and the remainder by video (13 %). Services primarily involved a pharmacist providing a single consultation with a patient. The purpose of this was either to provide counselling, obtain a best possible medication history, or to provide ongoing support as part of a clinical program, such as diabetes and blood pressure monitoring. Patients reported the quality of care received through telepharmacy consultations provided the same level of care or was superior to in-person services. Key facilitators for the success of telepharmacy services were access to training, technical assistance, digital literacy and availability of technology., Conclusions: Telephone and video telepharmacy services are being delivered across a range of outpatient clinical areas. More evidence is needed for video consultation services and how this modality may potentially provide further benefit for certain clinical tasks such as counselling and use of medication delivery devices. Overall, telepharmacy services enhance patient accessibility to healthcare and offer a convenient method of delivering high quality services., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Medication history telepharmacy consults are conducted prior to patients commencing their systemic anti-cancer therapy. At the study institution, this has historically been carried out as an unscheduled telephone consult. However, due to challenges with telephone consults, a scheduled videoconsult model was established. Funding, time efficiency, and completion rate for videoconsults compared to telephone consults have been examined previously., Objective: The aim of this study was to determine staff perceptions of the factors that influence implementation, including enablers and barriers, for videoconsults compared to telephone consults, to inform model sustainability., Methods: Semi-structured interviews were conducted with staff ( n  = 14) involved with the videoconsult service, or who provided care for patients who had a videoconsult. Interviews were coded for positive or negative influence and strength using the Consolidated Framework for Implementation Research (CFIR) 2.0, to understand which constructs influence implementation., Results: Thirty-nine of the 79 constructs, from across four domains were identified as influences for the telephone and videoconsult models. Six constructs were strongly differentiating for videoconsults over telephone consults. Of the 25 positively influencing constructs for the videoconsult model, strongest ratings (+2) were given for innovation advantages, critical incidents, support persons assisting in the consult, financing related to funding reimbursement, and telehealth coordinator capability and motivation. Barriers unique to the videoconsult model included the many steps that were involved, compatibility with workflows, and pharmacist resource. Similarities and differences unique to each model were identified., Conclusion: Findings demonstrated a number of strongly differentiating constructs highlighting superiority of the videoconsult model. However, implementation of both models had multiple enablers and barriers that may influence adoption. The potential of a hybrid service, using both telephone consults and videoconsults, may help optimise delivery of services., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Telephone and videoconsults are known synchronous telepharmacy modalities being used to respond to the demand for outpatient pharmacy services. However, little is known about the evidence for cancer telepharmacy service models., Objectives: To review existing evidence regarding synchronous telepharmacy service models for adult outpatients with cancer, with a secondary focus on outcomes, enablers, and barriers., Methods: A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and EMBASE in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient. During article selection in Covidence, an extra inclusion criterion of synchronous cancer-focused services was applied; data extraction and narrative analysis were then performed., Results: From 2129 non-duplicate articles, 8 were eligible for inclusion, describing 7 unique patient populations. The service models included pre-treatment medication history taking, adherence monitoring, toxicity assessment, and discharge follow-up. Studies found synchronous telepharmacy services can improve timeliness of care, optimise workload management, and provide individualised and convenient efficacy monitoring and counselling. One study of 177 patients on immune checkpoint inhibitors found 38% of the 726 telephone consults involved at least one intervention. When videoconsults were compared directly with telephone consults for pre-treatment medication history, it was found scheduled videoconsults had a significantly higher success rate than unscheduled telephone consults, and that videoconsults also represented increased funding and equivalent time efficiency. When telephone follow-up was compared to no follow-up, improved treatment adherence was seen, and progression-free survival was significantly higher for the telephone group (6.1 months vs 3.7 months, p = 0.001). Reported enablers included physician buy-in, staff resources, and correct utilisation of technology, while identified barriers included time investment required and technical issues., Conclusion: Both telephone and videoconsult modalities are being used to deliver synchronous telepharmacy services across a range of outpatient services. Although more evidence is needed, data to date supports positive service benefits and enhanced care., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Telepharmacy is the provision of pharmacy services from a distance to a patient using telecommunications and other technologies. There has been limited research investigating the cost-effectiveness of telepharmacy services., Objective: To provide a comprehensive review and narrative synthesis of the available economic evidence on telepharmacy services in non-cancer settings., Method: A systematic literature search of four databases including PubMed, Embase, CINAHL, and EconLit was undertaken to identify economic evaluations comparing telepharmacy services to standard pharmacy care. Abstracts and full texts were screened by two independent reviewers for inclusion against the eligibility criteria. Key economic findings were extracted from included articles to determine the cost-effectiveness of the reported telepharmacy services., Results: The review included six studies; two were cost-minimisation analyses, three were cost effectiveness analyses (CEA) and one study conducted both a CEA and cost-utility analysis. Telepharmacy services predominantly relied upon telephone modes of communication, with three that used remote patient monitoring. These services managed a variety of clinical situations which included newly initiated antibiotics, antiretroviral therapy management, and medications for chronic conditions, as well as hypertension management. Articles were of relatively high reporting quality, scoring an average of 83% on the Consolidated Health Economics Reporting Standards checklist. Four of the six studies reported that telepharmacy was less costly than usual care, with two that reported telepharmacy as cost-effective to the healthcare system according to a specified cost-effectiveness threshold., Conclusions: Overall, this review demonstrates that there is emerging evidence that telepharmacy services can be cost-effective compared with standard care in non-cancer settings. Further research is needed to complement these findings, particularly reflecting the increased uptake of telehealth and telepharmacy services since the onset of the Coronavirus disease pandemic., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care., Methods: A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist., Results: This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis., Conclusions: RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions., (Copyright © 2021 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To quantify the societal benefit of telehealth in terms of the reduction in lost productivity., Methods: Using a case study approach, retrospective data were examined for all telehealth outpatient consults in Queensland, Australia during a 1-year period from July 2017 to June 2018. The productivity gains when individuals had specialist consults via telehealth were estimated using the human capital method by multiplying the estimated travel time with the average Australian daily wage., Results: A total of 30 149 outpatient consults were identified for this analysis. It was estimated that the use of telehealth for these outpatient consults avoided 9 644 569 km of travel (5 992 857 miles) and 27 068 days away from usual activities. Using the average Australian wage and the estimated travel time for these outpatient telehealth consults, the overall productivity gain for society was estimated at A$9 176 052 or A$304 per consult., Conclusion: Consideration of the costs and potential savings attributed to the delivery of telehealth services is important for service planning and government investment. Our study highlights the benefits from a societal perspective. When healthcare is provided using telehealth instead of in person, there are likely to be productivity benefits for both the patients and society., (Copyright © 2021 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia., Methods: Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences., Results: The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18-73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1-20 or AUD 21-40., Conclusion: Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

Background: Videoconference enables outpatient appointments to be conducted in a manner that increases convenience for patients, and this increase in convenience is widely assumed to reduce failure to attend (FTA) rates. Introduction: FTA is the notation used when patients do not attend their designated outpatient appointment. FTA events waste appointment resources that could have been allocated to another patient and increase clinic waiting lists. Therefore, predicting FTA or identifying mechanisms to improve FTA rates could have both economic and patient benefits. Materials and Methods: Using activity data and patient demographic information from the immunology outpatient services at a large metropolitan hospital in Australia, descriptive statistics and regression analysis were used to investigate whether the telehealth modality or other patient or clinic characteristics had the potential to influence FTA rates. Multivariate logistic regression analysis was conducted using a panel set to group individual patient events together to explore the ability of patient characteristics or appointment characteristics to predict FTA events. Ethics approval was received from the Metro South Health Human Research Ethics Committee (HREC/18/QMS/45889). Results: From April 2016 to September 2018, 6,131 appointments occurred, with an overall FTA rate of 16%. Telehealth accounted for 254 or 4.1% of all appointments. When in-person and telehealth modalities were examined separately, the FTA rates were 16.3% and 8.7%, respectively. The greatest predictor of FTA was found to be the modality by which the clinic was delivered, in person or telehealth. Patient-specific characteristics such as Indigenous status, previous FTA behavior, and whether the person was privately funded were also important factors. Discussion and Conclusions: These results indicate that offering appropriate patients the option of telehealth has the potential to reduce FTA. Given the impact of FTA on clinic viability, caseload burden, and waiting lists, telehealth should be explored further and, where possible, should be offered as a routine alternative to in-person appointments.

Objectives: The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic., Methods: Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question., Key Findings: Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to 'social distancing without compromising care' for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question., Conclusions: The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters., (© The Author(s) 2020. Published by Oxford University Press on behalf of Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)