This policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth.

La integración de tecnologías de la información y comunicación (TIC) en la práctica médica ha dado lugar a la telemedicina, permitiendo la superación de barreras geográficas entre médicos y pacientes. Aunque se reconoce su importancia, la producción científica peruana en telemedicina aún no ha sido evaluada, motivando este estudio bibliométrico. Objetivo: Analizar la producción científica peruana en telemedicina. Métodos: Se realizó un estudio observacional bibliométrico en publicaciones peruanas de telemedicina. Se extrajeron datos de Scopus aplicando una estrategia de búsqueda con términos relacionados a telemedicina que tenían a Perú como país de filiación. Los resultados fueron procesados utilizando software especializado para análisis de redes de colaboración y los indicadores que se obtuvieron fueron de productividad, colaboración e impacto a través del H index por campo. Resultados: Se incluyeron 254 publicaciones científicas en el estudio . El principal autor es Jaime Miranda, la institución con mayor producción científica fue la universidad Cayetano Heredia; el país con mayor colaboración fue Estados Unidos. En la Revista Peruana de Medicina Experimental y Salud Pública se han publicado más documentos que otras revistas. Las tendencias temáticas se relacionan al VIH y las emergentes fueron Covid-19 junto a salud mental. Conclusión: El análisis bibliométrico revela el estado de la investigación en telemedicina en Perú en Scopus. Aunque hay avances, hay rezagos. La colaboración internacional y las implicaciones para la salud pública son destacadas. / The integration of information and communication technologies (ICT) into medical practice has led to telemedicine, allowing for the overcoming of geographical barriers between doctors and patients. Despite its acknowledged importance, the scientific output of Peru in telemedicine has yet to be evaluated, prompting this bibliometric study. Aim: To analyze Peru's scientific output in telemedicine. Methods: An observational bibliometric study was conducted on Peruvian telemedicine publications. Data were extracted from Scopus using a search strategy with telemedicine-related terms and Peru as the country of affiliation. The results were processed using specialized software for collaboration network analysis, with indicators including productivity, collaboration, and impact measured through the H index by field. Results: The study included 254 scientific publications. The lead author was Jaime Miranda, and Cayetano Heredia University emerged as the institution with the highest scientific output; the United States was the top collaborating country. The Peruvian Journal of Experimental Medicine and Public Health has published more documents than other journals. Thematic trends focused on HIV, with emerging trends encompassing Covid-19 and mental health. Conclusion: The bibliometric analysis sheds light on the state of telemedicine research in Peru on Scopus. While progress has been made, certain areas are still lagging behind. The study underscores the importance of international collaboration and the implications for public health.

The transgender and gender diverse (TGD) patient population consists of a diverse group of people with unique needs who have, unfortunately, been underserved by the medical community. These individuals share a disproportionate burden of discrimination and disease when compared to cisgender persons. However, despite this, they continue to receive inequitable treatment, and transgender health topics still comprise just a small portion of medical education training. While efforts to improve awareness and training regarding transgender health care needs are underway, these take time to gain traction. It also relies heavily on changing medical providers’ own biases. Telemedicine has been proposed as a way to potentially bridge the gap and increase the access and availability of quality, informed medical care to this community. Although telemedicine has demonstrated its ability to do this in other areas of medicine, the existing research on whether it has the capacity to do so for transgender health care delivery is scant. The majority of the existing literature on the topic consists of retrospective qualitative feedback provided during a time where telemedicine was still emerging as a commonplace medium through which medical care is provided. Therefore, this thesis proposes to perform a randomized controlled trial investigating whether instituting a hybrid telemedicine approach has the capability to expand the accessibility of specialty transgender health care services as compared to fully in person medical care while maintaining a high standard of health care quality and patient satisfaction. This study would have the capacity to help inform future health care policy and provide support for continued telemedicine offerings and reimbursement moving forward.

Purpose - This thesis strives to conduct a service quality evaluation of the telemedicine provider KRY to find out what factors in telemedicine service are influencing the performance the most. The research uses KRY as a reference point to find the factors in said service provider but also to help the entire industry of digital healthcare. Research design, data, and methodology - This thesis is a quantitative study that uses Parasuraman's SERVQUAL model. The thesis is conducted through the use of a questionnaire by snowball sampling 33 participants who have utilized the telemedicine provider KRY. Analysis was conducted by extracting the data ratings of the likert-scaled questionnaire and conducting a paired t-test on the data. Result - This thesis found Kry to be performing very well in terms of service quality, meeting patient expectations on all dimensions and exceeding expectations in the tangibility dimension

Despite concerted efforts to decrease costs and increase public health, the embattled U.S. health care system continues to struggle to alleviate these widespread issues. Because the problem of hospital utilizations among patients with heart failure is posited to increase as the population ages, innovative methodologies need to be explored to mitigate adverse events. Remote monitoring harnesses the strength of advanced information and communication technology to affect positive changes in health care quality and cost. By reaching across geographical boundaries, remote monitoring may support increased access to less costly services and improve the quality of home health care. The purpose of the study was to examine the home care quality effects of remote monitoring technology in patients with heart failure and to provide an economic justification for its adoption and diffusion. It compared remote monitoring as a potential intervention strategy to a standard no-intervention group (without remote monitoring). Specifically, it analyzed remote monitoring as a viable strategy to decrease hospital readmissions and emergency department visits. It also compared the cost of remote monitoring against the current standard-of-care. The theoretical framework of Donabedian's Quality Model was used in the evaluation of remote monitoring. A retrospective posttest only, case control study design was used to test the degree which remote monitoring was effective in promoting health care quality (hospital readmissions and decreased emergency department visits). Retrospective chart reviews were performed using electronic medical records (EMR). Analysis of Variance, Path Analysis, Automatic Interaction Detector Analysis (Dtreg), and Cost Outcomes Ratio were used to test the hypotheses and validate the proposed theoretical model. No significant difference was noted in remote monitoring and usual care groups. Results suggested that remote monitoring does not statistically lead to a decrease in heart failure-related hospital readmissions and all-cause emergency department visits. Results of the cost ratio analysis suggested that there was no statistically significant difference in the net income between usual care and remote monitoring; however, data suggest that there were significant increases in cost and intensity of nursing utilization for the remote monitoring intervention. The Automatic Interaction Detector Analysis showed that the unfavorable results in hospital readmissions were due to a decrease in collaborative care and patient education prior to the recommendation for hospitalization. The role of nursing care, whether in hospital or community-based care, in heart failure management is critical to quality outcomes. As the field continues to consider the use of technology in health care, decision makers should think through the process of patient care such that preventable hospital readmissions are decreased and patients received quality care.

Purpose: With the start of the SARS-COV-2 pandemic in March 2020, Canadian primary care practices temporarily shifted from in-person to virtual care. The purpose of this thesis was to understand whether the pandemic impacted the primary care management of older adults with varying levels of frailty and multimorbidity in terms of care modality, volume of encounters, and visits for anxiety/depression. It also aimed to identify which patients comparatively experienced greater reductions in frequencies of routine preventive care and monitoring activities. Methods: A research database from a sub-set of MUSIC family practice for patients ≥ 65 years of age (n=1813) was employed. Patient demographics, clinician-assessed frailty status, encounters, and chronic disease management information were retrieved. Changes from 14 months pre to 14 months since (peri) the pandemic were described and associations between patient characteristics and the extent of changes in outcomes from pre- to peri-pandemic were analyzed using regression models. Results: The mean age was 74 years, with a mean of 2.5 chronic conditions (26% hypertension, 14% diabetes). 2.1% of patients experienced high frailty levels. The mean number of encounters increased peri-pandemic overall (peri: 10.4 (SD 11.1) vs. pre: 7.1 (SD 5.5)) and for anxiety/depression, with most visits becoming virtual. Increasing numbers of overall visits were significantly associated with female sex, increasing frailty level, and having 4+ conditions. While the frequency of routine preventive and monitoring activities related to chronic conditions decreased, the mean values (e.g., lab results) did not considerably change. In the adjusted models, generally older patients, with increasing levels of frailty, and numbers of conditions tended to receive more care, however most associations were not statistically significant. Conclusion: Overall encounters and visits related to anxiety/depression increased peri-pandemic. Despite concerns about pandemic-related care disruptions, common elements of primary care among higher risk older patients were not notably impacted. / Thesis / Master of Health Sciences (MSc) / Many adults ≥65 years of age live with chronic conditions or frailty, requiring ongoing monitoring. Primary care physicians are fundamental in providing this continuous care. With the COVID-19 pandemic, healthcare access was restricted, many doctors switched to temporarily providing virtual care, and there were concerns about patients’ mental health. Questions arose regarding possible gaps in primary care and where efforts should be focused post-pandemic. The objectives of this thesis were 1) to understand how the pandemic impacted the management of this population and the changes in care patterns (modality, encounter numbers overall and for anxiety/depression, and chronic condition management); and 2) identify patient characteristics associated with changes. There was an overall virtual care driven increase in encounters peri-pandemic and for visits relating to anxiety/depression. Frequencies of chronic condition care activities dropped, however older patients and those with increasing levels of frailty and numbers of conditions tended to be better monitored.

No description available.

No description available.

No description available.

No description available.