Patients in rural areas in the United States do not have adequate health care facilities for illnesses and injuries not serious enough for emergency care, but telemedicine could have a positive impact both economically and medically to control rapidly rising health care costs, which is a significant percentage of the gross national product. The purpose of this case study was to explore the barriers physicians encountered in telemedicine implementation. Participants included 4 physicians who took part in face-to-face interviews in a clinical setting in Ohio to explore strategies used in implementing telemedicine. The results of these interviews, coupled with observations and document reviews, were analyzed. Complex adaptive systems theory was used to conceptualize the existing association between individual behavioral patterns and the social system in which the patterns take place. Significant themes showed (a) how physicians utilize the technology and (b) how the application allows physicians to build relationships with patients. The characterization strategies aimed to mitigate barriers in adopting telemedicine technology in rural markets were consistent with the study findings and the literature review. The results of this research study might contribute to positive social change through economic and health benefits to rural inhabitants by reducing the distance barrier to physicians' offices and increasing timely and effective patient diagnosis in the selected location.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation.

No description available.

No description available.

No description available.

The increasing prevalence of autism in the United States is a growing concern, with access to evidence-based services failing to keep pace with the demand. Families located in rural or remote areas are further hindered in attempts to access services due to both location and general lack of medical and behavioral healthcare providers. A major advancement in spreading the reach of interventions, such as applied behavior analysis, has been the development and refinement of telehealth. With growing interest in using technology to reach a wider client base, research on telehealth-based parent training for families impacted by autism has begun to increase. Despite the increase in research, many areas remain underdeveloped; therefore, this project sought to contribute to the literature by investigating the effectiveness of and expanding upon a manualized, behaviorally based parent-training program designed specifically for telehealth delivery. Procedures in Study 1 examined the relationship between standardized, parent-report measures of child problem behavior and an observational measure delivered via telehealth using Pearson Correlation Coefficients. Results of this study suggested using a combination of standardized measures and comprehensive observation-based data collection methods may enhance remote monitoring of child problem behavior. Procedures in Study 2 replicated and extended previous research to evaluate the Online and Applied System for Intervention Skills (OASIS-D) parent-training program as a method for increasing parent knowledge and skill in delivering applied behavior analytic (ABA) services to their child with autism. Effectiveness of the training program was evaluated in a multiple baseline across family dyad design. The results indicated that telehealth delivery of the OASIS-D program increases parent skill and knowledge in delivering ABA services, with four of four participants showing similar effects. Furthermore, the results indicated that telehealth-based training programs could benefit individuals in rural and remote areas. These studies provide needed information and support for increasing the availability and continued access of telehealth-delivered interventions when providing treatments to families impacted by autism.

Objective: To determine the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. Methods: This is a systematic review and meta-analysis studies comparing the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 through December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases. Articles were screened using PRISMA guidelines, following a review for quality assessment using the JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the mada package. A descriptive analysis of the sensitivity, specificity, DOR, and confidence intervals were performed with respective forest plots. Heterogeneity was assessed using Cochrane Q and Higgin’s I2 tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect, and the summary diagnostic odds ratio reported. Results: A total of 12 studies met the inclusion criteria and were reviewed and meta-analyzed. The range of diagnostic parameter were sensitivity (45.6-88.3%), specificity (55.2-98.3%), PPV (79-92%), NPV (48-97%), accuracy (70-96%), and kappa (0.46-0.89) in teledentistry modalities. Test for equality of sensitivities and specificities were significant (p-value = <2e-16). The studies were not heterogenous with Cochran's Q: 14.502 (p = 0.206) and Higgins' I2 of 24% The multivariable analysis of the univariate measures showed a diagnostic odds ratio based on DerSimonian-Laird random effect t was 35.14. This implies that the odds of caries detected via tele dentistry is 35 times true positive than the odds that it is false positive. Conclusions: Diagnosis of caries via teledentistry effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries. Further research should establish a definitive threshold for the diagnostic parameters in detecting caries. / Oral Biology

Music therapists have utilized technology in their clinical work for decades. Yet music therapy delivered in a telehealth model – telemusic therapy – has rarely been described in the literature until recently. This study stems from telemusic therapy services the researcher-interventionist was contracted to provide to adult acquired brain injury (ABI) survivors. The existing literature has primarily reported on synchronous telemusic therapy conducted via internet-based videoconference platforms with individual clients or groups who were colocated but not face-to-face with the clinician. Technological issues were cited as limitations. Only one article described small group telemusic therapy where participants were each located at their individual homes; no literature was found for large groups of non-colocated participants. Further, the telemusic therapy literature very rarely reports empirical data. This thesis presents the results of a pilot study exploring the feasibility and effectiveness of telemusic therapy on well-being for adult brain injury survivors who participate independently from their homes. This retrospective study utilized a quasi-experimental, pre/post-session repeated measures design to examine data from a 20-session, 10-week, group telemusic therapy program (N = 15). Clinician-developed pre/post measures of well-being were administered each session. A Qualtrics Likert scale survey exploring audiovisual quality, emotional support, the therapeutic relationship, and social-emotional connection between participants was issued during the 5th and 10th weeks. Results: Mean and median difference of pre/post measures were significant for increasing well-being at α = 0.5. Frequency distributions of the survey ratings of more than or very much adequate for quality of audio and video: 78.6% – 85.7%; ratings of more than or very much adequate for emotional support, formation of a therapeutic relationship and creating connections with other participants, respectively: 85.7%, 78.6%, 92.9 %. The results support the feasibility and effectiveness of group telemusic therapy for increasing well-being in adult ABI survivors who attend from their individual homes. Study limitations include small N, low return rate for surveys, and unvalidated measures.It is noteworthy that in each session, the music therapy group successfully engaged in real-time active music making with all members playing and all microphones on. No audio delay was detected. This phenomenon has been described in the literature as improbable. The cause of such low latency is unknown. These findings demonstrate that participants using personal computers or laptops and residential broadband Internet experience the audio and visual components of synchronous music therapy as more than adequate. A real-time telehealth model is a viable means for providing group music therapy. / Music Therapy

This study was conducted to first evaluate the effects caregivers’ fidelity of the Cool Versus Not Cool (CNC) intervention using remote behavioral skills training (BST) and second, to evaluate subsequent treatment effects when caregivers implement intervention with their child with ASD. The components of behavioral skills training used were instruction, modeling, role-playing, and feedback. Past research has not evaluated the effects of the CNC intervention on children with ASD’s social skills when implemented by their caregivers. Thus, this research was needed to evaluate the effectiveness of remote based BST and the effectiveness of caregiver-implemented CNC intervention. Results suggested that remote-based BST is a useful training strategy to train caregivers and to support caregiver-implemented CNC to improve children with ASD’s social skills. During follow up and generalization conditions across dyads, caregiver and child skills maintained. During generalization, caregiver skills maintained when teaching new social skills for Caregiver 1 and Caregiver 2, but not entirely for Caregiver 3. / Applied Behavioral Analysis

Despite legal and technological advances, women still face barriers to abortion care in legally restricted or low-resource settings. The advent of medication abortion using misoprostol with or without mifepristone, has enabled women to self-manage their abortions outside of the formal healthcare system. Self-managed abortions are often assisted by telemedicine services, which provide women with evidence-based guidance on managing the abortion process on their own. This thesis explores two separate abortion telemedicine services operating in legally restricted and/or low resource settings – a global online telemedicine service and an abortion support hotline in Venezuela – and evaluates the outcomes associated with each. By interviewing counsellors at a Venezuelan abortion support hotline and the women who used the service, we gained a stronger understanding of the hotline’s successes, barriers, and areas for improvement. We conclude that abortion telemedicine services provide effective and acceptable care, in general, and we recommend greater access to misoprostol in Venezuela.