Background: The use of telepharmacy has increased worldwide during the last decades, and facilitated by the COVID-19 pandemic, it will likely accelerate further. Sweden has several pre-conditions needed for telepharmacy, yet, telepharmacy development is slow. Aim: The present study's objective was to examine Swedish pharmacy students' views and opinions on telepharmacy in Sweden today and their education. A particular interest in communication education and whether it has prepared the students for patient communication at a distance. Additionally, the study explores e-pharmacy professionals views on the needed skills and experiences when working in the Swedish telepharmacy field. Methods: Two focus groups of fourth-year pharmacy students were performed in April 2021 via the web-based videoconference program Zoom. An open-ended questionnaire was sent via e-mail to practising e-pharmacy professionals. Five students and three e-pharmacy professionals participated in the study. Thematic inductive analysis was used to analyse the collected data. Results: The study's result implicates that the Swedish pharmacy education curriculum does not include telepharmacy. The students desire further education regarding communication at a distance but believe that part of the current education could be applied in an e-pharmacy setting.  The students' skepticism to e-pharmacies ability to perform safe and satisfactory pharmaceutical services is largely based on preconceptions and assumptions, partly confirmed by e-pharmacy professionals.  Conclusions: To not inhibit future developments in the pharmacy market, future pharmacists must be educated on telepharmacy methods. This study's insights may be useful for future educational initiatives and developments of the pharmacy education curriculum.

Yes / Background Patients with advanced cancer commonly experience pain and it is least controlled in community settings. Community pharmacists in the UK already offer medicines optimisation consultations although not for this patient group. Objective To determine whether medicines consultations for patients with advanced cancer pain are feasible and acceptable. Setting Community-dwelling patients with advanced cancer pain were recruited from primary, secondary and tertiary care using purposive sampling in one UK city. Methods One face-to-face or two telephone delivered medicines optimisation consultations by pharmacists were tested. These were based on services currently delivered in UK community pharmacies. Feedback was obtained from patients and healthcare professionals involved to assess feasibility and acceptability. Main outcome measure Recruitment, acceptability and drug related problems. Results Twenty-three patients, (range 33–88 years) were recruited, 19 completed consultation(s) of whom 17 were receiving palliative care services. Five received face-to-face consultations and 14 by telephone during which 47 drug related problems were identified from 33 consultations (mean 2.5). Advice was provided for 34 drug related problems in 17 patients and referral to other healthcare professionals for 13 in 8 patients, 2 patients had none. Eleven patients returned questionnaires of which 8 (73%) would recommend the consultations to others. Conclusion The consultations were feasible as patients were recruited, retained, consultations delivered, and data collected. Patients found the 20–30 min intervention acceptable, found a self-perceived increase in medicines knowledge and most would recommend it to others. Community pharmacists were willing to carry out these services however they had confidence issues in accessing working knowledge. Most drug related problems were resolved by the pharmacists and even among patients receiving palliative care services there were still issues concerning analgesic management. Pharmacist-conducted medicines consultations demonstrate potential which now needs to be evaluated within a larger study in the future. / Funded as part of the Improving the Management of Pain from Advanced Cancer in the CommuniTy (IMPACCT) study which was a National Institute of Health Research programme Grant of which this was part of the Medicines work stream (RP-PG-0610-10114).

Background: At the end of life, patients living in their own homes experience significantly more pain than those who die in either hospital or hospice care (Office for National Statistics, 2015). With an increasing prevalence of this, person-centred medicines optimisation is essential. Aim: To investigate the feasibility of community pharmacist medicines optimisation services for patients living with advanced cancer pain in community settings. Methods: Mixed methods were used, adopting a pragmatic stance and approach. Qualitative interviews, a systematic review and meta-analysis and a proof-of-concept study were undertaken. Results: Patients with advanced cancer pain need support with their medicines which could be provided by a pharmacist. Patients experienced a significant number of medicines related problems, even those already receiving specialist palliative care. Most problems were addressed by pharmacist advice with the remainder being referred for additional prescribing. Care for patients with cancer pain is currently not person-centred and the current medicines optimisation model is unsuitable for this patient group. An enhanced model of medicines optimisation is therefore presented for patients with advanced cancer and this model can be amended and adopted for other patient groups. Conclusions: An enhanced medicines optimisation model (MOCAP) has been created to inform person-centred medicines optimisation for patients with advanced cancer pain. Feasibility and acceptability were also confirmed and it can be adapted for further clinical use. This model contributes to the goals of the NHS agenda of choice and control of care as proposed in the NHS Long Term Plan (NHS, 2019b).

Uma sistemática de teleconsulta para o processo de programação, verificação e adaptação dos aparelhos de amplificação sonora individuais (AASI) foi desenvolvida e sua eficácia avaliada por meio de um estudo prospectivo, randomizado e cego. Participaram do estudo 50 deficientes auditivos (30 homens; 20 mulheres) candidatos ao uso do AASI, com idades variando entre 39 e 88 anos e média ISO dos limiares audiométricos entre 30 e 68,75dB. Os participantes foram alocados em dois grupos (randomização estratificada): controle (n=25), submetidos aos procedimentos face a face (F) e experimental (n=25) submetidos à teleconsulta (T). O procedimento F foi realizado pelo avaliador 1 em todos os participantes, incluindo: programação do AASI, medidas com microfone sonda (equipamento Unity PC Probe, estímulo speech noise, apresentado em 50, 65 e 80dBNPS) e orientação quanto ao uso e cuidados com o AASI. Para a teleconsulta o participante e um facilitador se posicionaram na sala junto aos equipamentos (ambiente de teste). O avaliador 1 posicionou-se em outra sala (ambiente remoto) com um notebook conectado à LAN USP. Webcams e headsets capturaram áudio e vídeo, transmitidos em tempo real pelo software Polycom PVX (384 kbps), também utilizado para compartilhamento de aplicativos. Por meio desse compartilhamento o avaliador 1 realizava todos os procedimentos diretamente no participante, com auxílio do facilitador. O tempo despendido para as consultas F e T foi cronometrado. Após as consultas o avaliador 2, cego quanto aos grupos, realizou a avaliação de percepção da fala (Hearing in Noise Test - HINT Brasil) para obter o limiar de reconhecimento de fala no silêncio (LRF) e a relação sinal/ruído (S/R) em que os participantes reconheciam 50% das sentenças apresentadas. Aproximadamente um mês após as consultas foi realizada (avaliador 2) a análise do tempo diário de uso do AASI (via datalogging do dispositivo) e do benefício e satisfação em vida diária (questionário International Outcome Inventory for Hearing Aids - IOI-HA). Maior tempo para a programação e verificação e menor tempo para orientação foi observado para o grupo experimental, sendo este estatisticamente significativo (teste t de Student). Não houve diferença entre grupos no tempo total do atendimento em minutos (82,2 controle e 81,3 experimental). A equiparação das medidas com microfone sonda aos respectivos targets foi similar para os dois grupos. Não houve diferença significativa (teste t) entre as médias do LRF no silêncio (56,24 controle e 51,78 experimental) e da relação S/R (4,94 controle e 4,17 experimental), o tempo médio de uso do AASI em horas (7,26 controle e 7,44 experimental) e das pontuações total e dos itens do questionário IOI-HA. Houve correlação (Spearman) positiva forte e significativa entre o tempo de uso do AASI e o tempo de uso informado pelo participante, para ambos os grupos. Para alguns participantes durante a teleconsulta houve interrupção da transmissão de áudio e vídeo que foi prontamente solucionada. Concluiu-se que a teleconsulta é um procedimento eficaz para a realização da programação, verificação do AASI e orientação de usuários quando, por algum motivo, serviços face a face não estiverem disponíveis. / A teleconsultation system for hearing aid (HA) programming, verification and fitting has been developed and its efficacy assessed through a prospective, randomized and blind study. Fifty hearing impaired individuals (30 men; 20 women), HA candidates, in the age range 39 - 88 years and ISO mean of audiometric thresholds between 30 and 68.75dBNA, participated in the study. The participants were divided into two groups (stratified randomization): control (n=25), submitted to face to face procedures (F) and experimental (n=25), submitted to teleconsultation (T). Procedure F was performed by evaluator 1 in all participants: HA programming, probe microphone measures (Unity PC Probe equipment, speech noise stimulus presented at 50, 65 and 80dBSPL) and HA use and care orientation. For the teleconsultation, the participant and a facilitator positioned themselves in the room with the equipment (test environment). Evaluator 1 stayed in another room (remote environment) with a notebook connected to the LAN USP. Webcams and headsets captured audio and video, transmitted in real time by software Polycom PVX (384 kbps), utilized as well for application sharing, through which evaluator 1 performed all the procedures directly in the patient, aided by the facilitator. The time spent for consultations F and T was recorded. Following the consultations, evaluator 2, blind to the groups, performed the speech perception assessment (Hearing in Noise Test - HINT Brazil) so as to obtain the speech reception threshold (SRT) in silence and the signal/noise ratio (S/N) in which the participants recognized 50% of the sentences presented. Nearly a month following the consultations the evaluator 2 carried out the analysis of daily time of HA use (via datalogging of the device) as well as benefit and satisfaction (questionnaire International Outcome Inventory for Hearing Aids - IOI-HA). An statistically significant (Students t test) greater time for the programming and verification and a smaller one for HA orientation were observed for the experimental group. No difference was found between the groups for the total consultation time in minutes (control: 82.2; experimental: 81.3). The real ear measures matching to targets were similar for the both groups. No significant difference was observed (Students t test) between the means of SRT in silence (56.24 control and 51.78 experimental) as well as the S/N ratio (4.94 control and 4.17 experimental), the daily amount HA use in hours (7.26 control and 7.44 experimental) and the IOI scores. For both groups there was a positive, strong and significant correlation (Spearman) between the daily amount of HA use (datalogging) and the reported HA use. For some participants, during the teleconsultation, the transmission of audio and video was interrupted, but readily restored. Conclusion: teleconsultation is an effective procedure for hearing aid programming, verification and fitting when face to face services are not available.

Made available in DSpace on 2015-07-22T20:49:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-24 / INTRODUÇÃO. A segunda opinião médica pode ser definida como a busca de conselhos ou informações médicas entre profissionais de saúde. OBJETIVO. Este trabalho tem o objetivo de apresentar os passos da construção de um sistema de segunda opinião médica, bem como os resultados da avaliação do sistema desenvolvido. MÉTODOS. No trabalho realizou-se um estudo observacional com enfoque etnográfico de investigação empírica. Um sistema web que reproduz o processo de segunda opinião médica definido foi construído a partir de tecnologias de software livre. Para a avaliação, o sistema foi utilizado por 49 médicos residentes da Universidade Federal de São Paulo que emitiram a sua opinião para 52 solicitações de segunda opinião médica. Como instrumentos de avaliação foram utilizados questionários a respeito do conhecimento prévio, da solicitação, de opinião e de satisfação. RESULTADOS. Foram emitidas 1.891 respostas de segunda opinião pelos médicos para as 52 solicitações. Na avaliação da satisfação subjetiva do usuário, o sistema apresentou média de 87,8% no quesito facilidade de utilização e 95,6% no quesito aprendizado para a utilização do sistema. Os médicos indicaram a necessidade de incluir recursos para auxiliar a observação de imagens como, por exemplo, ampliação (zoom), brilho e contraste, em 38,2% das respostas. Apontaram também, em 47,3% das respostas, que os dados clínicos constituem a informação de maior importância para a emissão da segunda opinião. Respostas às solicitações de segunda opinião apresentaram linguagem inadequada que poderia prejudicar a colaboração entre os médicos. CONCLUSÃO. Os resultados da construção e da avaliação deixam em evidência a efetividade do processo definido para a obtenção de segunda opinião médica em radiologia à distância. Palavras-chave: Telemedicina, Consulta Remota, Referência e Consulta, Radiologia, Diagnóstico por Imagem. / INTRODUCTION. The second opinion can be defined as the search of advices or medical information between health professionals. OBJECTIVE. The objective of this work is to present the steps of the construction of a second opinion system, as well as the evaluation results of the developed system. METHODS. In this work an observational study with an empirical ethnographic research focus was implemented. A web system was developed based on open-source technologies. For the evaluation, the system was used by 49 residents from the Federal University of São Paulo that informed their opinion to 52 medical second opinion requests. Questionnaires of previous knowledge, request, opinion and satisfaction where employed as evaluation tools. RESULTS. 1.891 second opinion responses were given by the physicians to the 52 requests. Regarding to the user satisfaction evaluation, the system presents a 87,8% mean in the easy utilization item and a 95,6% mean in learning to operate the system. The physicians showed the necessity to add resources to help observing images, as example, magnifying, brightness and contrast, on 38,2% of the responses. 47,3% responses indicated also that clinical information is the most important information for a second opinion emission. Inappropriate language was found on responses for medical second opinion requests which could difficult physicians’ cooperation. CONCLUSION. The results of the development and evaluation of the second opinion system show that the defined process was effective for the achievement of remote radiology second opinion. / TEDE / BV UNIFESP: Teses e dissertações

Uma sistemática de teleconsulta para o processo de programação, verificação e adaptação dos aparelhos de amplificação sonora individuais (AASI) foi desenvolvida e sua eficácia avaliada por meio de um estudo prospectivo, randomizado e cego. Participaram do estudo 50 deficientes auditivos (30 homens; 20 mulheres) candidatos ao uso do AASI, com idades variando entre 39 e 88 anos e média ISO dos limiares audiométricos entre 30 e 68,75dB. Os participantes foram alocados em dois grupos (randomização estratificada): controle (n=25), submetidos aos procedimentos face a face (F) e experimental (n=25) submetidos à teleconsulta (T). O procedimento F foi realizado pelo avaliador 1 em todos os participantes, incluindo: programação do AASI, medidas com microfone sonda (equipamento Unity PC Probe, estímulo speech noise, apresentado em 50, 65 e 80dBNPS) e orientação quanto ao uso e cuidados com o AASI. Para a teleconsulta o participante e um facilitador se posicionaram na sala junto aos equipamentos (ambiente de teste). O avaliador 1 posicionou-se em outra sala (ambiente remoto) com um notebook conectado à LAN USP. Webcams e headsets capturaram áudio e vídeo, transmitidos em tempo real pelo software Polycom PVX (384 kbps), também utilizado para compartilhamento de aplicativos. Por meio desse compartilhamento o avaliador 1 realizava todos os procedimentos diretamente no participante, com auxílio do facilitador. O tempo despendido para as consultas F e T foi cronometrado. Após as consultas o avaliador 2, cego quanto aos grupos, realizou a avaliação de percepção da fala (Hearing in Noise Test - HINT Brasil) para obter o limiar de reconhecimento de fala no silêncio (LRF) e a relação sinal/ruído (S/R) em que os participantes reconheciam 50% das sentenças apresentadas. Aproximadamente um mês após as consultas foi realizada (avaliador 2) a análise do tempo diário de uso do AASI (via datalogging do dispositivo) e do benefício e satisfação em vida diária (questionário International Outcome Inventory for Hearing Aids - IOI-HA). Maior tempo para a programação e verificação e menor tempo para orientação foi observado para o grupo experimental, sendo este estatisticamente significativo (teste t de Student). Não houve diferença entre grupos no tempo total do atendimento em minutos (82,2 controle e 81,3 experimental). A equiparação das medidas com microfone sonda aos respectivos targets foi similar para os dois grupos. Não houve diferença significativa (teste t) entre as médias do LRF no silêncio (56,24 controle e 51,78 experimental) e da relação S/R (4,94 controle e 4,17 experimental), o tempo médio de uso do AASI em horas (7,26 controle e 7,44 experimental) e das pontuações total e dos itens do questionário IOI-HA. Houve correlação (Spearman) positiva forte e significativa entre o tempo de uso do AASI e o tempo de uso informado pelo participante, para ambos os grupos. Para alguns participantes durante a teleconsulta houve interrupção da transmissão de áudio e vídeo que foi prontamente solucionada. Concluiu-se que a teleconsulta é um procedimento eficaz para a realização da programação, verificação do AASI e orientação de usuários quando, por algum motivo, serviços face a face não estiverem disponíveis. / A teleconsultation system for hearing aid (HA) programming, verification and fitting has been developed and its efficacy assessed through a prospective, randomized and blind study. Fifty hearing impaired individuals (30 men; 20 women), HA candidates, in the age range 39 - 88 years and ISO mean of audiometric thresholds between 30 and 68.75dBNA, participated in the study. The participants were divided into two groups (stratified randomization): control (n=25), submitted to face to face procedures (F) and experimental (n=25), submitted to teleconsultation (T). Procedure F was performed by evaluator 1 in all participants: HA programming, probe microphone measures (Unity PC Probe equipment, speech noise stimulus presented at 50, 65 and 80dBSPL) and HA use and care orientation. For the teleconsultation, the participant and a facilitator positioned themselves in the room with the equipment (test environment). Evaluator 1 stayed in another room (remote environment) with a notebook connected to the LAN USP. Webcams and headsets captured audio and video, transmitted in real time by software Polycom PVX (384 kbps), utilized as well for application sharing, through which evaluator 1 performed all the procedures directly in the patient, aided by the facilitator. The time spent for consultations F and T was recorded. Following the consultations, evaluator 2, blind to the groups, performed the speech perception assessment (Hearing in Noise Test - HINT Brazil) so as to obtain the speech reception threshold (SRT) in silence and the signal/noise ratio (S/N) in which the participants recognized 50% of the sentences presented. Nearly a month following the consultations the evaluator 2 carried out the analysis of daily time of HA use (via datalogging of the device) as well as benefit and satisfaction (questionnaire International Outcome Inventory for Hearing Aids - IOI-HA). An statistically significant (Students t test) greater time for the programming and verification and a smaller one for HA orientation were observed for the experimental group. No difference was found between the groups for the total consultation time in minutes (control: 82.2; experimental: 81.3). The real ear measures matching to targets were similar for the both groups. No significant difference was observed (Students t test) between the means of SRT in silence (56.24 control and 51.78 experimental) as well as the S/N ratio (4.94 control and 4.17 experimental), the daily amount HA use in hours (7.26 control and 7.44 experimental) and the IOI scores. For both groups there was a positive, strong and significant correlation (Spearman) between the daily amount of HA use (datalogging) and the reported HA use. For some participants, during the teleconsultation, the transmission of audio and video was interrupted, but readily restored. Conclusion: teleconsultation is an effective procedure for hearing aid programming, verification and fitting when face to face services are not available.

Abstract The background to this study was, firstly, the shortage of doctors in the remote areas in Finland and secondly, the possibilities to use new IT-technology to the organization of health care services. The aim was to find out whether it is possible to organize consultations between GPs and patients as remote work through the use of videoconferencing equipment. In literature the results of the studies on teleconsultations in remote areas have been positive in many specialties from the point of view of operating the system, patient satisfaction and costs. However few studies of teleconsultations are available in the area of general practice. The aims of this study were to identify the technical solutions what teleconsultation requires and to report on the implementation of the solutions and process of the teleconsultations. Two hypotheses were to be tested in the study: first that patients treated in the traditional way were more satisfied than teleconsultation patients: the second was that while a sizeable patient group could be treated remotely, teleconsultation would prove to be more expensive than the traditional consultation. The teleconsultation part of the study was organized so, that the patient and a trained nurse were in Puolanka Health Center and the GP in the city of Kajaani (100 kilometers away). The videoconferencing system worked on the LAN in the Kainuu area. The study group consisted of two random groups, 508 patient visits were treated as remote work and 490 visits were treated in the traditional way in Puolanka Health Center. In addition to the diary of technical problems and the patient satisfaction questionnaires the measures of the study were the analysis of success in the consultation and the account of the return consultations in the remote group. A part of consultations were videotaped and the success in transfer of information was analysed from those tapes. The cost of the consultation was calculated, and sensitivity analysis was used to examine the cost of teleconsultations for diabetic patients. The results indicated that with a local area network it is possible to build a well functioning, reasonably priced teleconsultation system. The patients were equally satisfied with the teleconsultation as with the traditional consultation. The transfer of information in teleconsultations was good enough to make reliable diagnoses. It is estimated that three out of four from a random population in general practice could be treated in teleconsultation. Although it is about 30% more expensive to treat patients by teleconsultation than by the traditional method, the advantages of the teleconsultation model are that it enables an efficient transfer of information and know-how regardless of distance, and that it enhances considerably the traditional scope of health care services. / Tiivistelmä Tutkimuksen lähtökohtana oli syrjäisten alueiden lääkäripula ja toisaalta telelääketieteen mukanaan tuomat mahdollisuudet järjestää palveluja uudella tavalla. Tarkoituksena oli selvittää, voidaanko lääkärin vastaanottopalveluita tuottaa etätyönä videoneuvottelujärjestelmää käyttäen. Kirjallisuuden mukaan tulokset monien erikoisalojen televideokonsultaatioista olivat myönteisiä toimivuuden, potilastyytyväisyyden ja kustannusten näkökulmista: mutta perusterveydenhuollon tutkimuksia etävastaanotosta ei löytynyt. Tutkimuksen tavoitteena oli selvittää millaisia teknisiä ratkaisuja etävastaanotto vaatii ja kuvata valitun järjestelmän toimivuus sekä etävastaanottotapahtuman kulku. Hypoteesissa oletettiin tavallisella vastaanotolla hoidettujen olevan hieman etä-vastaanotolla käyneitä tyytyväisempiä ja että merkittävä osa potilasjoukosta voidaan hoitaa etätyönä sekä että etävastaanottokäynti on kalliimpi kuin tavallinen vastaanottokäynti. Tutkimus toteutettiin siten, että etävastaanottotilanteessa potilas oli hoitajan kanssa Puolangan terveyskeskuksessa ja lääkäri Kajaanissa. Yhteys hoidettiin videoneuvottelujärjestelmällä, joka käytti Kainuun atk-alueverkkoa. Tutkimusjoukko koostui kahdesta satunnaistetusta ryhmästä, joista 508 vastaanottokäynnin ryhmä hoidettiin etätyönä ja toinen 490 käynnin ryhmä tavallisella vastaanotolla Puolangan terveyskeskuksessa. Mittareina käytettiin teknisten ongelmien päiväkirjaa ja potilastyytyväisyyskyselyä, vastaanoton onnistumisen arviointia ja etävastaanoton uusintakäyntien tarpeen selvitystä. Tiedon siirtymisen onnistumista tutkittiin siten, että analysoitiin joukko videonauhoitettuja vastaanottoja, laskettiin vastaanottokäyntien kustannukset ja tarkasteltiin herkkyysanalyysien avulla etävastaanottomallilla toteutetun diabetesetävastaanoton kustannuksia. Tuloksien mukaan on mahdollista rakentaa toimiva, kohtuuhintainen etävastaanottojärjestelmä, kun käytetään alueellista atk-verkkoa. Potilaat olivat vähintään yhtä tyytyväisiä etävastaanottoon kuin tavalliseen. Tiedon siirtyminen etävastaanotolla on riittävän hyvä luotettavien päätelmien tekemiseksi. Noin kolme neljäsosaa valikoimattomasta perusterveydenhuollon potilasjoukosta voitiin hoitaa etätyönä. Lääkärin oma arvio vastaanoton onnistumisesta oli kuitenkin parempi perinteisessä vastaanotossa ja etävastaanotolla jouduttiin määräämään hieman enemmän laboratoriokokeita. Kun etävastaanottomallia käytetään korvaamaan tavanomainen vastaanottotapa ilman toiminnallisia ja organisatorisia muutoksia, se on noin 30 % kalliimpi kuin tavanomainen. Etävastaanottomalli kuitenkin mahdollistaa tehokkaan tiedon ja osaamisen siirtymisen välimatkasta riippumatta ja luo edellytykset uudenlaisille tavoille organisoida terveydenhuollon palveluita.

A demanda crescente de usuários de implante coclear (IC) e a distribuição irregular de profissionais especializados no país, tornam necessário o deslocamento de pacientes por longas distâncias para os atendimentos, com consequente aumento dos custos diretos e indiretos do tratamento. A teleconsulta pode ser vista como uma alternativa em potencial para o acesso desta população a estes serviços. O presente ensaio clínico, randomizado, controlado, avaliou a eficácia da teleconsulta síncrona na programação dos sistemas de IC em usuários acompanhados em um Programa de Implante Coclear credenciado pelo Sistema Único de Saúde. Participaram do estudo 79 indivíduos com idades entre nove e 68 anos (média de 21,6), 41 do sexo masculino e 38 do sexo feminino, usuários de IC por um período de 0,58 a 24,75 anos. Estes indivíduos foram divididos em dois grupos, de acordo com o modo de programação do IC: controle (n=40), que realizou o procedimento face a face e experimental (n=39) que realizou a teleconsulta síncrona. Treze fonoaudiólogos sem experiência na programação do dispositivo atuaram como facilitadores das teleconsultas. Os procedimentos de programação do IC englobaram a telemetria de impedância, definição dos níveis de estimulação elétrica, varredura e balanceamento dos eletrodos e ajuste fino da programação. Como medidas de avaliação de resultados foram utilizados o tempo dispendido na consulta, a audiometria em campo livre, o percentual de reconhecimento de sentenças no silêncio e no ruído, o limiar de reconhecimento de sentenças no silêncio e ruído (HINT-Brasil), a avaliação da satisfação com a consulta (escala MISS-21) e de aspectos pertinentes à teleconsulta. Os facilitadores responderam as questões abertas referentes à suas impressões dos atendimentos. Os dados foram analisados por meio de estatística inferencial (testes t de Student, Wilcoxon, Mann-Whitney e correlação de Spearman). Os resultados mostraram que após a programação do IC, em média, os participantes apresentaram limiares audiométricos abaixo de 30 dB NA. O reconhecimento da fala pós atendimento, respectivamente para os grupos experimental e controle, foram de 81,3% e 83,8% (silêncio) e 57,9% e 58,1% (ruído). No HINT-Brasil os resultados foram, respectivamente, para os grupos experimental e controle 61,4 dB NA e 61,8 dB NA (silêncio) e relação S/R de 9,5 dB NA e 10,4 dB NA (ruído). Os participantes estiveram satisfeitos com a consulta. Não houve diferença estatisticamente significativa entre os grupos em nenhuma das medidas de resultado. Todos os participantes relataram que teleconsulta pode ser vista como uma alternativa viável ao atendimento face a face e sua aplicação clínica facilitaria a rotina de pacientes usuários de IC. Os facilitadores destacaram a sua importância para o aprendizado e como ferramenta de formação continuada. A teleconsulta síncrona foi eficaz na programação dos sistemas de IC e amplamente aceita pelos usuários e profissionais. / The growing number of cochlear implant (CI) users and the uneven distribution of specialized professionals in the country makes necessary patients traveling over long distances to receive care, with consequent increase in direct and indirect costs of treatment. The telehealth can be viewed as an alternative for this population to access such services. This clinical randomized, controlled clinical trial evaluated the efficacy of synchronous teleconsultation in the programming of CI systems in a Cochlear Implant Program accredited by the National Health System in Brazil. Participate in this study 79 subjects aged between nine and 68 years (average 21.6), 41 males and 38 females, CI users for a period from 0.58 to 24.75 years. The participants were divided into two groups, according to the nature of consultation: control group (n = 40), who performed the CI programming face-to-face and experimental group (n = 39) who performed the CI programming through the synchronous teleconsultation. Thirteen audiologists without experience in CI programming acted as facilitators of teleconsultation. The CI programming procedures encompassed the impedance telemetry, setting of electrical stimulation levels, sweeping and balancing of the electrodes and programming evaluation in live speech mode. The outcome measures were the time spent in consultation, free field audiometry, the percentage of sentence recognition in quiet and in noise, the sentence recognition threshold in silence and noise (HINT-Brazil), satisfaction with the consultation (MISS-21 scale) and aspects related to teleconsultation. The facilitators responded open questions regarding their impressions of the teleconsultations. Data were analyzed using inferential statistics (Student t test, Wilcoxon, Mann-Whitney and Spearman correlation). The results showed that after CI programming, on average, the participants had audiometric thresholds below 30 dB HL. The speech perception for the experimental and control groups post CI programming were respectively, 81.3% and 83.8% (in silence) and 57.9% and 58.1% (in noise). In HINT-Brazil the results were, respectively, for the experimental and control groups 61.4 and 61.8 dB (silence) and S/N ratio of 9.5 dB and 10.4 dB (in noise). Participants were satisfied with the teleconsultation. There were no statistically significant difference between the groups in any of the outcome measures. All participants reported that teleconsultation could be a viable alternative to facilitate CI users follow up routine. Facilitators emphasized the importance of teleconsultation for learning and for continuing education. The teleconsultation was effective in programming the CI systems and accepted by users and professionals.

Introdução: As consultas de seguimento com o profissional fonoaudiólogo após a aquisição da prótese auditiva são de extrema importância para a garantia da manutenção do uso com qualidade. As dificuldades enfrentadas pelos usuários no comparecimento ao serviço de saúde impedem que esse processo ocorra de maneira adequada e impactam negativamente no processo de reabilitação auditiva do indivíduo ocasionando, inclusive, o abandono do uso. A incorporação da teleconsulta nesses seguimentos seria uma solução para impedir a ocorrência de tal fato, por permitir que as intervenções de orientações e aconselhamentos sejam realizadas remotamente. Objetivos: desenvolver um programa de seguimento semipresencial para novos usuários de prótese auditiva e verificar sua aplicabilidade. Método: estudo prospectivo (exploratório), no qual dez indivíduos adultos novos usuários de prótese auditiva bilateral, pertencentes a um serviço público de saúde, foram avaliados e submetidos a uma consulta inicial, seguido pela teleconsulta e novamente avaliados numa última etapa presencial. As intervenções realizadas foram classificadas em primárias e secundárias. O questionário para avaliação da satisfação foi aplicado nas etapas presenciais e os dados obtidos pelos registros foram enviados para análise estatística descritiva. Resultados: todos os indivíduos necessitaram de pelo menos uma intervenção na consulta presencial inicial. A maioria esteve relacionada a orientações e aconselhamentos referentes ao uso e manuseio da prótese auditiva (consideradas intervenções secundárias). Na etapa da teleconsulta, todos os indivíduos precisaram de intervenções secundárias, diminuindo sua ocorrência na consulta presencial final. O questionário utilizado para verificar a satisfação apresentou média de escore global com valores de 5,7 na consulta presencial inicial e 6,1 na consulta presencial final, o que correspondeu à satisfação dos participantes. Todos os participantes atribuíram nota máxima ao programa desenvolvido, o que representou a \"muito satisfeitos\". Conclusão: O estudo traz contribuições para a área da Telessaúde em Fonoaudiologia, pois a utilização das teleconsultas permitiu a resolução de problemas secundários no processo de adaptação à prótese auditiva. Apesar dessa amostra ser reduzida, o estudo inicial foi satisfatório para a continuidade do programa demonstrado ser aplicável. Ainda estudos com maior amostra em diferentes populações são necessários com intuito de validar novos protocolos / Introduction: Follow-up visits with the audiologist after the hearing aid fitting process are critical to ensure the maintenance of quality use. The difficulties faced by users in adhering to sequential return visits directly affect this process in an inadequate way and negatively impact on individual auditory rehabilitation process, even causing the use abandonment. The inclusion of virtual assistance in these follow-ups would be a solution to avoid this situation, allowing interventions of orientations and counseling by remote consultation. Objectives: to develop a follow-up program combining face-to-face appointments and telehealth for new hearing aid users as well as verifying its applicability. Methods: prospective (exploratory) study evaluated ten new bilateral hearing aid users, seen in a public health service. The first and the last appointments were face-to-face and five followed-ups by virtual assistance. The required interventions were classified as primary and secondary. The questionnaire for satisfaction evaluation were applied during the face-to-face assessments and all registered data was sent for descriptive statistical analysis. Results: all study subjects required at least one intervention during the initial face-to-face visit. Most were related to provide informative counseling and to clarify new users\' doubts regarding the use of the hearing aid (considered secondary interventions). At telehealth assistance stage, all subjects required secondary interventions, reducing their occurrence in the final face-to-face assistance. The questionnaire used to verify the satisfaction showed an average overall score of 5.7 in initial stage and 6.1 in the final stage, which proved subjects\' satisfaction. All subjects attributed the maximum score to the developed program, which represented \"very satisfied\". Conclusion: The study contributes to Telemedicine, since the use of virtual assistance allowed the resolution of secondary problems in the hearing aid fitting process. Although this sample was reduced, the initial study was satisfactory for the continuity of this program which has been shown to be applicable. Further studies with larger samples in different populations are needed to validate new protocols

Introdução: As consultas de seguimento com o profissional fonoaudiólogo após a aquisição da prótese auditiva são de extrema importância para a garantia da manutenção do uso com qualidade. As dificuldades enfrentadas pelos usuários no comparecimento ao serviço de saúde impedem que esse processo ocorra de maneira adequada e impactam negativamente no processo de reabilitação auditiva do indivíduo ocasionando, inclusive, o abandono do uso. A incorporação da teleconsulta nesses seguimentos seria uma solução para impedir a ocorrência de tal fato, por permitir que as intervenções de orientações e aconselhamentos sejam realizadas remotamente. Objetivos: desenvolver um programa de seguimento semipresencial para novos usuários de prótese auditiva e verificar sua aplicabilidade. Método: estudo prospectivo (exploratório), no qual dez indivíduos adultos novos usuários de prótese auditiva bilateral, pertencentes a um serviço público de saúde, foram avaliados e submetidos a uma consulta inicial, seguido pela teleconsulta e novamente avaliados numa última etapa presencial. As intervenções realizadas foram classificadas em primárias e secundárias. O questionário para avaliação da satisfação foi aplicado nas etapas presenciais e os dados obtidos pelos registros foram enviados para análise estatística descritiva. Resultados: todos os indivíduos necessitaram de pelo menos uma intervenção na consulta presencial inicial. A maioria esteve relacionada a orientações e aconselhamentos referentes ao uso e manuseio da prótese auditiva (consideradas intervenções secundárias). Na etapa da teleconsulta, todos os indivíduos precisaram de intervenções secundárias, diminuindo sua ocorrência na consulta presencial final. O questionário utilizado para verificar a satisfação apresentou média de escore global com valores de 5,7 na consulta presencial inicial e 6,1 na consulta presencial final, o que correspondeu à satisfação dos participantes. Todos os participantes atribuíram nota máxima ao programa desenvolvido, o que representou a \"muito satisfeitos\". Conclusão: O estudo traz contribuições para a área da Telessaúde em Fonoaudiologia, pois a utilização das teleconsultas permitiu a resolução de problemas secundários no processo de adaptação à prótese auditiva. Apesar dessa amostra ser reduzida, o estudo inicial foi satisfatório para a continuidade do programa demonstrado ser aplicável. Ainda estudos com maior amostra em diferentes populações são necessários com intuito de validar novos protocolos / Introduction: Follow-up visits with the audiologist after the hearing aid fitting process are critical to ensure the maintenance of quality use. The difficulties faced by users in adhering to sequential return visits directly affect this process in an inadequate way and negatively impact on individual auditory rehabilitation process, even causing the use abandonment. The inclusion of virtual assistance in these follow-ups would be a solution to avoid this situation, allowing interventions of orientations and counseling by remote consultation. Objectives: to develop a follow-up program combining face-to-face appointments and telehealth for new hearing aid users as well as verifying its applicability. Methods: prospective (exploratory) study evaluated ten new bilateral hearing aid users, seen in a public health service. The first and the last appointments were face-to-face and five followed-ups by virtual assistance. The required interventions were classified as primary and secondary. The questionnaire for satisfaction evaluation were applied during the face-to-face assessments and all registered data was sent for descriptive statistical analysis. Results: all study subjects required at least one intervention during the initial face-to-face visit. Most were related to provide informative counseling and to clarify new users\' doubts regarding the use of the hearing aid (considered secondary interventions). At telehealth assistance stage, all subjects required secondary interventions, reducing their occurrence in the final face-to-face assistance. The questionnaire used to verify the satisfaction showed an average overall score of 5.7 in initial stage and 6.1 in the final stage, which proved subjects\' satisfaction. All subjects attributed the maximum score to the developed program, which represented \"very satisfied\". Conclusion: The study contributes to Telemedicine, since the use of virtual assistance allowed the resolution of secondary problems in the hearing aid fitting process. Although this sample was reduced, the initial study was satisfactory for the continuity of this program which has been shown to be applicable. Further studies with larger samples in different populations are needed to validate new protocols