The cost of health care services is rising and the number of patients requesting overseas treatment from the Kuwait Government continues to increase; this is becoming an unsustainable financial burden. A telemedicine system has the potential to support the Kuwaiti health system to provide medical consultations from global medical centres, and thereby reduce the number of Kuwaiti patients being sent abroad for treatment, and so reduce costs. This research investigates the readiness of the key stakeholders in regard to adoption of telemedicine systems in the Kuwaiti healthcare system. This is achieved by assessing the readiness of individuals (physicians and patients), the organisation (policy makers) and the technical infrastructure (IT managers). Moreover, the lack of research on this topic, particularly in the Arabian Gulf Region, was the reason behind carrying out this study. An in-depth study was conducted by using a quantitative and qualitative approach. A questionnaire was used to explore the attitudes of specialised physicians and patients by obtaining their opinions based on specific criteria. Next, semi-structured interviews were conducted: (1) with IT managers to assess the technical infrastructure of the health system; and (2) with policy makers to assess the organisation in regard to its readiness towards telemedicine adoption. The study shows that the overseas referral patients are ready to use telemedicine systems, as a consequence of their need to receive medical consultations from global experts. However, they expressed some concerns, such as privacy and confidentiality of their data. The specialised physicians also showed readiness towards adoption of telemedicine in the Kuwaiti health system, and their responses indicated that they are willing to use such systems. However, the findings of the interviews reveal that the current technical infrastructure for ICT in the Kuwaiti healthcare system is not ready for telemedicine adoption and there are needs to be change in the way management is organized in order to improve and enhance trust among departments. The qualitative approach identified factors that would inhibit and hinder the adoption of telemedicine in Kuwait, as well as the supportive factors in the organisation. Using the results, a strategy was developed to demonstrate how the Kuwaiti health system could be made ready to receive a telemedicine system, together with policies for the use of telemedicine systems by overseas referral patients. A comparison with Jordan and Syria shows that the Kuwaiti healthcare system is more ready to adopt a telemedicine system with respect to the individuals, technical infrastructure and governmental support. Finally, an economic analysis was performed in order to investigate the cost effectiveness of the proposed system.

This research of teleconsultation services aims to improve the quality of diagnosis and treatment for rural cardiovascular patients through utilizing distant medical expertise. Equitable access to expert healthcare as well as improved medical management for these patients can assist in modifying cardiovascular disease (CVD) risk and reduce morbidity and mortality in Saudi Arabia. The objectives were to design and develop a new care pathway for cardiovascular disease patients by utilizing teleconsultation technology, investigate factors and issues that might act as barriers to its adoption, and then evaluate the impact of this model on the stakeholders. A small scale pilot project was used to determine the issues of technology, processes and human resources required to deliver an effective service with the context of the research setting. Four primary healthcare centres, two regional hospitals, fifteen patients and sixty other participant stakeholders were included in this study. An approach using (PCP) patient care pathways was used to introduce the teleconsultation technology and integrate it within the healthcare delivery system. Compared to the traditional PCP, the modified PCP utilising teleconsultation technology improved the quality of healthcare through:  Improved access to medical care and quality of diagnosis by obtaining the expertise of a distant specialist.  More efficient medical evaluation and management.  Enhanced role of primary healthcare centres and participating hospitals by providing all levels of health services for patients.  Evidence-based referral (reduced waiting time, reduced burden on outpatient clinics). The telconsultation adoption barriers included:  Inadequacy of finance  Limited infrastructure  Legal and regularity difficulties.  Organization issues.  Literacy on technology. This study recommends the following for telemedicine implementation in the country:  Promote perception and readiness for ICT services with the healthcare community.  Enhance structural readiness including appropriate infrastructure and adequate funding, human resources and equipment.  Proactive policies to encourage growth of the telecommunication sector and to address concerns regarding privacy and security.

Avaliou-se a eficácia de um procedimento de teleconsulta baseado na internet para a verificação do aparelho de amplificação sonora individual (AASI) por meio da realização de medidas com microfone sonda em adultos deficientes auditivos. Foram comparados os valores da amplitude da resposta de ressonância da orelha externa (REUR), resposta de ressonância da orelha externa com uso da amplificação (REAR) e o ganho de inserção (REIG) realizados face a face (F) e à distância (D). O erro casual das medidas da REUR, REAR e REIG realizadas pelos dois métodos foi analisado. Participaram do estudo: grupo A: sessenta adultos (média de idade de 67 anos) com deficiência auditiva unilateral (n=15) ou bilateral (n=45), totalizando 105 orelhas; grupo B: 19 adultos (média de idade de 28 anos) sem queixas auditivas (19 orelhas). Os AASIs utilizados foram do tipo mini-retroauricular e não possuíam microfone direcional ou algoritmos de cancelamento de retroalimentação e/ou redução de ruído. Para o grupo B foi feito ajuste do AASI resultando na menor saída possível. Cinco fonoaudiólogos voluntários auxiliaram na coleta dos dados à distância. O procedimento face a face foi realizado pela pesquisadora em todos os participantes, utilizando-se o equipamento Unity PC Probe Mic (Siemens) conectado a um computador pessoal. Para realização das medidas à distância esse computador foi conectado à LAN (10 Mpbs). O participante e o fonoaudiólogo voluntário se posicionaram na sala junto ao equipamento (ambiente de teste). A pesquisadora posicionou-se em outra sala denominada ambiente remoto juntamente com um notebook também conectado à LAN. Webcams e headsets foram utilizados para a captura de audio e video, transmitidas em tempo real pelo software Polycom PVX, o qual também foi utilizado para compartilhamento de aplicativos. Por meio desse compartilhamento a pesquisadora realizava as medidas diretamente no participante, com auxílio do fonoaudiólogo voluntário. Quatro repetições das medidas da REUR, REAR e REIG foram obtidas apenas para o grupo B. Correlações (Pearson) muito fortes e significativas foram obtidas entre as medidas realizadas face a face (F) e à distância (D). O teste t pareado revelou diferenças pequenas, porém significativas entre as medidas F e D para a REUR e REAR. A ANOVA mostrou diferenças significativas entre as repetições realizadas. Diferenças entre os métodos F e D foram obtidas apenas na freqüência de 2000 Hz. Os erros causais obtidos pelas medidas face a face e à distância foram muito semelhantes. As diferenças e variações encontradas entre as medidas face a face e à distância não foram maiores do que a magnitude de variabilidade do próprio procedimento de medidas com microfone sonda. É possível realizar medidas de microfone sonda confiáveis via teleconsulta / telessaúde baseada na internet. Outras investigações são necessárias para validar esse procedimento. / The efficacy of an internet based teleconsultation for hearing aid probe microphone measures in hearing impaired adults was evaluated. The amplitudes of face to face (F) and remote (R) real ear unaided response (REUR), real ear aided response (REAR) and real ear insertion gain (REIG) were compared. The measurement error for repeated measures of REUR, REAR and REIG was analyzed. Participated in this study: group A: 60 adults (mean age: 67 years), with unilateral (n=15) or bilateral (n=45) hearing loss, totalizing 105 ears; group B: 19 normal hearing adults (mean age: 28 years) totalizing 19 ears. Behind the ear hearing aids with no directional microphone, noise reduction and/or feedback cancellation were used. For group B these hearing aids were adjusted as to produce the least amount of gain and output. Five audiologists volunteers helped the data collection. The Unity PC Probe Mic (Siemens) coupled to a personal computer were used by the researcher to carry out face to face measures. For the remote measures this equipment was connected to a local area network (LAN 10 Mpbs). The volunteer and the participant were located in this room (test site). At the remote site the researcher used a notebook connected to the LAN. Webcams and headsets were used for audio and video capture which was transmitted in real time by the Polycom PVX software, which was also used for application sharing. By means of remote controlling of the PC Probe Mic equipment the researcher could perform the remote real ear measurements in the participants. Four repeated measures of REUR, REAR and REIG were obtained for group B only. Strong and significant correlations (Pearson) were obtained between face to face and remote real ear measures. Paired t tests revealed small but significant differences between face to face and remote REUR and REAR. Analysis of variance showed significant differences between repeated measures. Measurement errors for face to face and remote real ear measures were very similar. The differences as well as errors found between face to face and remote measures were never higher than the reported variability for probe microphone measures themselves. It is possible to carry out probe microphone measures by means of teleconsultation / telehealth. Further investigations to validate this procedure are necessary.

Este estudo teve como objetivos avaliar a comunicação profissional/paciente durante o processo de programação e verificação do aparelho de amplificação sonora individual (AASI) e aconselhamento informativo ao paciente, verificar a satisfação dos pacientes com o uso da teleconsulta no processo de seleção e adaptação do aparelho de amplificação sonora individual e avaliar se e como a teleconsulta afeta a comunicação profissional/paciente, quando comparada à consulta face a face. Foram avaliados 40 indivíduos (15 mulheres e 25 homens) com idade entre 23 e 89 anos (média de 69,55 anos), que apresentavam deficiência auditiva sensorioneural de graus variados e eram candidatos ao uso do AASI. Os participantes foram divididos (randomização) em grupos experimental (n=20) e controle (n=20). A programação e verificação do AASI e aconselhamento informativo foram realizados face a face (grupo controle) e via teleconsulta síncrona com controle remoto de aplicativos (grupo experimental). Um facilitador (fonoaudiólogo com pouca experiência na área) auxiliou na realização dos procedimentos durante a teleconsulta. Todas as consultas foram filmadas. Ao final de cada sessão os participantes responderam ao Questionário de Experiência do Paciente (PEQ), para avaliar a satisfação com a consulta. As filmagens foram analisadas e codificadas de acordo com uma adaptação do Davis Observation Code (DOC). Não houve diferença significativa entre os grupos experimental e controle em relação à idade, gênero e limiares auditivos da melhor orelha (teste t de Student). No processo de programação e verificação do aparelho de amplificação sonora individual houve predominância de comportamentos técnicos, de fornecimento de informação e do profissional na comunicação profissional/paciente, que podem ter refletido a natureza geralmente procedimental desta consulta, bem como a influência do modelo biomédico. A duração da teleconsulta foi significativamente maior que a da consulta presencial (teste t de Student), sendo isto um reflexo do tempo despendido nos procedimentos de programação e verificação do AASI e necessidade de instrução ao facilitador. Foram observadas diferenças estatisticamente significativas (teste t de Student) entre a teleconsulta e a consulta face a face de acordo com os resultados do DOC: comportamentos técnicos (explicação da estrutura da consulta e realização de procedimentos) foram mais frequentes na teleconsulta. Discussões sobre a observância quanto ao correto uso do aparelho de amplificação sonora individual assim como expressões espontâneas do paciente sobre a sua condição foram menos frequentes para a teleconsulta. A despeito destas diferenças, foram obtidas altas pontuações no Questionário PEQ, indicando que não houve diferença da satisfação dos pacientes atendidos presencialmente ou via teleconsulta nas dimensões Resultados da Consulta, Barreiras de Comunicação, Experiência de Comunicação. Pontuações significativamente maiores (teste de Mann Whitney) foram obtidas para a teleconsulta na dimensão Emoções após a Consulta. A experiência dos participantes do grupo experimental com a presença do facilitador foi positiva. / This study aimed to evaluate the communication between professional/patient during the process of programming and checking of hearing aids and informative counseling to patients, verify patients\' satisfaction with the use of teleconsultation in the process of selection and adaptation of the hearing instrument and assess whether and how teleconsultation affects communication between professional and patient when compared to face-to-face consultation. There were 40 subjects evaluated (15 women and 25 men) between the ages of 23 and 89 (average of 69.55 years old), who had sensorineural hearing loss of different degrees and were candidates for the use of a hearing aids. The participants were divided (randomization) in groups: experimental (n=20) and control (n=20). The programming and checking of hearing aids and informative counseling were conducted face to face (control group) and via synchronous teleconsultation with remote control application (experimental group). A facilitator (audiologist with little experience in the area) assisted in procedures during the teleconsultation. All consultations were videotaped. At the end of each session, participants responded to the \"Patient Experience Questionnaire\" (PEQ), to assess satisfaction with the consultation. The recordings were analyzed and coded according to an adaptation of \"Davis Observation Code\" (DOC). There was no significant different between the experimental and control groups in terms of age, gender and audiometric thresholds of the better ear (Student t test). In the process of programming and checking of the hearing aids there was predominance of technical behaviors, in providing information and from the professional communication professional/patient, which may have reflected the nature generally procedural of this consultation, as well as the influence of the biomedical model. The duration of teleconsultation was significantly longer than the face-to-face consultation (Student t test), this being a reflection of time spent in programming procedures and verification of the hearing aid and the need of instruction of the facilitator. It was observed significant statistical differences (Student\'s t test) between teleconsultation and face-to-face consultation in accordance to the results of the DOC: technical behaviors (explaining the structure of the consultation and performing procedures) were more frequent in teleconsultation. Discussions about the observances as to the correct use of hearing aids as well as patient\'s spontaneous expressions on their condition were less frequent in teleconsultation. Despite these differences, we obtained high scores on the PEQ questionnaire, indicating no difference between face-to-face and via teleconsultation patients in the dimensions \"Consultation Results\", \"Communication Barriers\", \"Communication Experience.\" Scores significantly higher (Mann Whitney) were obtained for teleconsultation in \"Emotions after consultation dimension. The experience of the participants in the experimental group with the presence of the facilitator was positive.

The field of telehealth has developed rapidly in recent years. It provides medical support particularly to those who are living in remote areas and in emergency cases. Although developments in both technology and practice have been rapid, there are still many gaps in our knowledge with regard to the effective application of telehealth. This study investigated human colour perception in telehealth, specifically the colour red as one of the key symptoms when diagnosing different pathologies. The quality of medical images is safety critical when transmitting the symptoms of pathologies in telehealth, as distorted or degraded colours may result in errors. The study focused on the use of digital images in teleconsultation, particularly on images showing cellulitis (bacterial skin infection) and conjunctivitis (red eye) as case studies, as both of these pathologies involve the colour red in their diagnosis. The study proposed and tested the use of an image quality scale, which represented the level of image resolution; a red colour scale, which represented the intensity of redness in an image; and a confidence scale, which represented the levels of confidence that telehealth users had when judging the colour red. The research involved a series of experiments using hypothetico-deductive and formal hypothesis testing with two groups of participants, medical doctors and non-medical participants. The experiments were conducted in collaboration with the local National Health Service (NHS) Accident and Emergency (A&E) department at Aberdeen Royal Infirmary (ARI). Medical experts in ophthalmology and dermatology were also involved in selecting and verifying the relevant images. The study found that doctors and non-doctors were consistent in the majority of the experiments. The accuracy of the participants was demonstrably higher when using a colour scale with pictures, more so for the non-doctor group than the doctor group. It also found that the level of accuracy for both doctors and nondoctors was higher when using red colour scale of three divisions than when using a scale of five divisions. This result was supported by previous studies, which used telehealth for diagnosing extreme cases. The study also found that when the image quality was poor the participants had higher error rates and less consistency in their answers. The study found poor correlation between accuracy, confidence and time for both participant groups. The study found that most participants in both doctor and non-doctor groups had high confidence most of the time, whether the accuracy was high or low. It was also found that medical background or clinical experience had no effect on the accuracy level across the experiment sets. In some cases, doctors with no or little experience had higher accuracy than those with greater experience. This result may have significant implications for the feasibility of involving non-doctors in the management of telehealth systems, especially in tasks not requiring medical skills, such as colour classification. This has the potential to provide a considerable saving in resources and costs for healthcare providers. An auto-evaluation system was introduced, and proposed for further study, in order to improve the current telehealth diagnostic protocol and to avoid or prevent errors by making red colour classification more objective and accurate.

Este estudo teve como objetivos avaliar a comunicação profissional/paciente durante o processo de programação e verificação do aparelho de amplificação sonora individual (AASI) e aconselhamento informativo ao paciente, verificar a satisfação dos pacientes com o uso da teleconsulta no processo de seleção e adaptação do aparelho de amplificação sonora individual e avaliar se e como a teleconsulta afeta a comunicação profissional/paciente, quando comparada à consulta face a face. Foram avaliados 40 indivíduos (15 mulheres e 25 homens) com idade entre 23 e 89 anos (média de 69,55 anos), que apresentavam deficiência auditiva sensorioneural de graus variados e eram candidatos ao uso do AASI. Os participantes foram divididos (randomização) em grupos experimental (n=20) e controle (n=20). A programação e verificação do AASI e aconselhamento informativo foram realizados face a face (grupo controle) e via teleconsulta síncrona com controle remoto de aplicativos (grupo experimental). Um facilitador (fonoaudiólogo com pouca experiência na área) auxiliou na realização dos procedimentos durante a teleconsulta. Todas as consultas foram filmadas. Ao final de cada sessão os participantes responderam ao Questionário de Experiência do Paciente (PEQ), para avaliar a satisfação com a consulta. As filmagens foram analisadas e codificadas de acordo com uma adaptação do Davis Observation Code (DOC). Não houve diferença significativa entre os grupos experimental e controle em relação à idade, gênero e limiares auditivos da melhor orelha (teste t de Student). No processo de programação e verificação do aparelho de amplificação sonora individual houve predominância de comportamentos técnicos, de fornecimento de informação e do profissional na comunicação profissional/paciente, que podem ter refletido a natureza geralmente procedimental desta consulta, bem como a influência do modelo biomédico. A duração da teleconsulta foi significativamente maior que a da consulta presencial (teste t de Student), sendo isto um reflexo do tempo despendido nos procedimentos de programação e verificação do AASI e necessidade de instrução ao facilitador. Foram observadas diferenças estatisticamente significativas (teste t de Student) entre a teleconsulta e a consulta face a face de acordo com os resultados do DOC: comportamentos técnicos (explicação da estrutura da consulta e realização de procedimentos) foram mais frequentes na teleconsulta. Discussões sobre a observância quanto ao correto uso do aparelho de amplificação sonora individual assim como expressões espontâneas do paciente sobre a sua condição foram menos frequentes para a teleconsulta. A despeito destas diferenças, foram obtidas altas pontuações no Questionário PEQ, indicando que não houve diferença da satisfação dos pacientes atendidos presencialmente ou via teleconsulta nas dimensões Resultados da Consulta, Barreiras de Comunicação, Experiência de Comunicação. Pontuações significativamente maiores (teste de Mann Whitney) foram obtidas para a teleconsulta na dimensão Emoções após a Consulta. A experiência dos participantes do grupo experimental com a presença do facilitador foi positiva. / This study aimed to evaluate the communication between professional/patient during the process of programming and checking of hearing aids and informative counseling to patients, verify patients\' satisfaction with the use of teleconsultation in the process of selection and adaptation of the hearing instrument and assess whether and how teleconsultation affects communication between professional and patient when compared to face-to-face consultation. There were 40 subjects evaluated (15 women and 25 men) between the ages of 23 and 89 (average of 69.55 years old), who had sensorineural hearing loss of different degrees and were candidates for the use of a hearing aids. The participants were divided (randomization) in groups: experimental (n=20) and control (n=20). The programming and checking of hearing aids and informative counseling were conducted face to face (control group) and via synchronous teleconsultation with remote control application (experimental group). A facilitator (audiologist with little experience in the area) assisted in procedures during the teleconsultation. All consultations were videotaped. At the end of each session, participants responded to the \"Patient Experience Questionnaire\" (PEQ), to assess satisfaction with the consultation. The recordings were analyzed and coded according to an adaptation of \"Davis Observation Code\" (DOC). There was no significant different between the experimental and control groups in terms of age, gender and audiometric thresholds of the better ear (Student t test). In the process of programming and checking of the hearing aids there was predominance of technical behaviors, in providing information and from the professional communication professional/patient, which may have reflected the nature generally procedural of this consultation, as well as the influence of the biomedical model. The duration of teleconsultation was significantly longer than the face-to-face consultation (Student t test), this being a reflection of time spent in programming procedures and verification of the hearing aid and the need of instruction of the facilitator. It was observed significant statistical differences (Student\'s t test) between teleconsultation and face-to-face consultation in accordance to the results of the DOC: technical behaviors (explaining the structure of the consultation and performing procedures) were more frequent in teleconsultation. Discussions about the observances as to the correct use of hearing aids as well as patient\'s spontaneous expressions on their condition were less frequent in teleconsultation. Despite these differences, we obtained high scores on the PEQ questionnaire, indicating no difference between face-to-face and via teleconsultation patients in the dimensions \"Consultation Results\", \"Communication Barriers\", \"Communication Experience.\" Scores significantly higher (Mann Whitney) were obtained for teleconsultation in \"Emotions after consultation dimension. The experience of the participants in the experimental group with the presence of the facilitator was positive.

Avaliou-se a eficácia de um procedimento de teleconsulta baseado na internet para a verificação do aparelho de amplificação sonora individual (AASI) por meio da realização de medidas com microfone sonda em adultos deficientes auditivos. Foram comparados os valores da amplitude da resposta de ressonância da orelha externa (REUR), resposta de ressonância da orelha externa com uso da amplificação (REAR) e o ganho de inserção (REIG) realizados face a face (F) e à distância (D). O erro casual das medidas da REUR, REAR e REIG realizadas pelos dois métodos foi analisado. Participaram do estudo: grupo A: sessenta adultos (média de idade de 67 anos) com deficiência auditiva unilateral (n=15) ou bilateral (n=45), totalizando 105 orelhas; grupo B: 19 adultos (média de idade de 28 anos) sem queixas auditivas (19 orelhas). Os AASIs utilizados foram do tipo mini-retroauricular e não possuíam microfone direcional ou algoritmos de cancelamento de retroalimentação e/ou redução de ruído. Para o grupo B foi feito ajuste do AASI resultando na menor saída possível. Cinco fonoaudiólogos voluntários auxiliaram na coleta dos dados à distância. O procedimento face a face foi realizado pela pesquisadora em todos os participantes, utilizando-se o equipamento Unity PC Probe Mic (Siemens) conectado a um computador pessoal. Para realização das medidas à distância esse computador foi conectado à LAN (10 Mpbs). O participante e o fonoaudiólogo voluntário se posicionaram na sala junto ao equipamento (ambiente de teste). A pesquisadora posicionou-se em outra sala denominada ambiente remoto juntamente com um notebook também conectado à LAN. Webcams e headsets foram utilizados para a captura de audio e video, transmitidas em tempo real pelo software Polycom PVX, o qual também foi utilizado para compartilhamento de aplicativos. Por meio desse compartilhamento a pesquisadora realizava as medidas diretamente no participante, com auxílio do fonoaudiólogo voluntário. Quatro repetições das medidas da REUR, REAR e REIG foram obtidas apenas para o grupo B. Correlações (Pearson) muito fortes e significativas foram obtidas entre as medidas realizadas face a face (F) e à distância (D). O teste t pareado revelou diferenças pequenas, porém significativas entre as medidas F e D para a REUR e REAR. A ANOVA mostrou diferenças significativas entre as repetições realizadas. Diferenças entre os métodos F e D foram obtidas apenas na freqüência de 2000 Hz. Os erros causais obtidos pelas medidas face a face e à distância foram muito semelhantes. As diferenças e variações encontradas entre as medidas face a face e à distância não foram maiores do que a magnitude de variabilidade do próprio procedimento de medidas com microfone sonda. É possível realizar medidas de microfone sonda confiáveis via teleconsulta / telessaúde baseada na internet. Outras investigações são necessárias para validar esse procedimento. / The efficacy of an internet based teleconsultation for hearing aid probe microphone measures in hearing impaired adults was evaluated. The amplitudes of face to face (F) and remote (R) real ear unaided response (REUR), real ear aided response (REAR) and real ear insertion gain (REIG) were compared. The measurement error for repeated measures of REUR, REAR and REIG was analyzed. Participated in this study: group A: 60 adults (mean age: 67 years), with unilateral (n=15) or bilateral (n=45) hearing loss, totalizing 105 ears; group B: 19 normal hearing adults (mean age: 28 years) totalizing 19 ears. Behind the ear hearing aids with no directional microphone, noise reduction and/or feedback cancellation were used. For group B these hearing aids were adjusted as to produce the least amount of gain and output. Five audiologists volunteers helped the data collection. The Unity PC Probe Mic (Siemens) coupled to a personal computer were used by the researcher to carry out face to face measures. For the remote measures this equipment was connected to a local area network (LAN 10 Mpbs). The volunteer and the participant were located in this room (test site). At the remote site the researcher used a notebook connected to the LAN. Webcams and headsets were used for audio and video capture which was transmitted in real time by the Polycom PVX software, which was also used for application sharing. By means of remote controlling of the PC Probe Mic equipment the researcher could perform the remote real ear measurements in the participants. Four repeated measures of REUR, REAR and REIG were obtained for group B only. Strong and significant correlations (Pearson) were obtained between face to face and remote real ear measures. Paired t tests revealed small but significant differences between face to face and remote REUR and REAR. Analysis of variance showed significant differences between repeated measures. Measurement errors for face to face and remote real ear measures were very similar. The differences as well as errors found between face to face and remote measures were never higher than the reported variability for probe microphone measures themselves. It is possible to carry out probe microphone measures by means of teleconsultation / telehealth. Further investigations to validate this procedure are necessary.

Since the 1800's, technological advances have extended the foundation on which telemedicine could build. With its evolution, telemedicine has proven to be a means of offering effective health care interventions, from a multitude of disciplines. Teledermatology, a specialty application of telemedicine, offers great potential in improving the standard of dermatologic care by bridging the gap between the expert opinion of dermatologists and those without access to basic dermatologic care, particularly in developing nations, where skin disease continues to be a major public health problem. In Honduras, the setting for this study, and other developing nations, technology to support telemedicine is available. Dermatologic disease is among the most common disease presentations in the developing world, which left untreated due to a lack of access to adequate medical care, can progress causing increased morbidity or even death. A potential but untested solution is teledermatology. Teledermatology offers great potential in improving the standard of dermatologic care by bridging the gap between the expert opinion of dermatologists and those without access to basic dermatologic care. The purpose of this study was to evaluate the prevalence and types of dermatologic conditions and the feasibility of a store-and-forward teledermatology system in an underserved area of Honduras, so as to potentially provide more timely diagnosis and treatment, implementation of preventative measures, and offer long term solutions.so as The justification and significance of this study was the potential of store-and-forward teledermatology to improve the standard of dermatologic care by improving access of populations in underserved areas to dermatology specialists through affordable technology. The methodology of this study was primarily case study descriptive. This study was conducted at a public primary care clinic (JMA Clinic) and satellite sites in underserved areas of Francisco Morazán, Honduras. During a four week period in Spring 2011, patients with dermatologic conditions were examined and photos taken of condition. The patient information was sent to 3 U.S. board certified dermatologists, who provided diagnosis and treatment within 24 hours, which allowed the clinic physician sufficient time to review recommendations before patient follow-up. Patients would receive follow-up within 48 hours of initial visit. Diagnostic agreement, image quality, and user satisfaction were evaluated. IRB forms were submitted and clearance given. The data was analyzed with SPSS using descriptive statistics. The primary findings were the types of dermatologic conditions, interobserver agreement, image quality, and patient and physician satisfaction. The findings of this study substantiate the need for dermatologic care, as approximately 1 out of every 5 patients of the JMA Clinic presented with a dermatologic condition. The majority of these patients were children or women in their late 20s and early 30s; many of whom had their condition for more than a year and most had not received prior therapy. The types of dermatologic conditions observed were typical of that seen at a dermatology clinic in the U.S., yet inclusive of tropical and regional differences. Dermatitis, infectious and pigmentary conditions were the most common presentations. The interobserver diagnostic agreement achieved was 78%, and improved when considering differential diagnoses. Image quality received high ratings. Patients and physicians recorded a high level of overall satisfaction. Physicians indicated improved knowledge of teledermatology. Because of the unique environment and circumstances, the results are limited to the setting in which the study occurs. This project was a pilot study limited to 4 weeks of data collection and will be limited in significance by its duration and small sample size with respect to the conclusions that can be drawn about the prevalence and types of dermatologic conditions. This study illustrates that teledermatology is a viable means of providing dermatologic care to those in an underserved area of Honduras, where a lack of or limited access to general healthcare or specialty dermatologic care exists. The data offers insights to draw conclusions and recommendations on the potential for similar models to be implemented in underserved areas throughout Honduras and other similar regions. / Ph. D.

Teleradiology has far-reaching implications for the health of remote and underserved populations. With coordination of radiographic evaluation and diagnosis from a distance, teleradiology has the potential to raise the standard of patient care throughout the world. Perhaps the safest and most cost-effective mode of teleradiology today is telesonography. The current research determined that telesonography improves the standard of care at a rural, government-run primary clinic within the Dominican Republic. The work reported herein is intended to compare the use of telesonography to the current standard of sonographic examination which is referral to government hospital 60km from the clinic. the following research questions were addressed: When compared to the standard of care, (1) To what extent does the use of asynchronous telesonography increase the percentage of received sonographic reports based on the total number of ultrasound referrals (sonographic reports / total number of referrals)? (2) To what extent does the use of asynchronous telesonography increase the rate of successful follow-up visits based on the total number of ultrasound referrals? (3) To what extent does the elapsed time between ultrasound referral and sonographic report delivery decrease with the use of asynchronous telesonography? (4) To what extent does the elapsed time between ultrasound referral and patient follow-up decrease with the use of asynchronous telesonography? Research methodology included randomly assigning 100 patients with clinical indications for sonographic examination into experimental and control groups during a 9-week implementation period. Findings from this study indicate that the implemented telesonography system, along with patient awareness of such a system, while not having an appreciable effect on the time to patient follow-up, provided a 4-fold increase in the proportion of patient follow-ups and a 6-fold increase in the proportion of returned radiological reports, and delivered those reports to the referring physician 6-times faster than in the control group. This study demonstrates the feasibility of utilizing a store-and forward telesonography system within this setting. Additional research focusing on the impact of telesonography on patient outcomes within this setting is recommended. / Ph. D.

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.