Does telemedicine reduce the carbon footprint of healthcare? A systematic review

Authors: Amy Purohit,A James SmithB and Arthur HibbleC

ABSTRACT

       In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70–372 kg CO2e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.

KEYWORDS: telemedicine, sustainability, e-health, carbon footprint

DOI: 10.7861/fhj.2020-0080

Telemedicine: challenges and opportunities

Sang-goo Lee 1, Seong K. Mun, Prakash Jha, Betty A. Levine and Duk-Woo Ro Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University Medical Center, Washington, DC 20007, USA E-mail: {lee, mun, jhap, levine, ro}@isis.imac.georgetown.edu

Abstract

       Telemedicine is many things to many people. Only until a few years ago, telemedicine was equated to video teleconferencing between physicians, while nowadays, perhaps the most active area in telemedicine is the store-and-forward model. There is a big shift from private and dedicated modes of communications to connectivity through the Internet. Presented is a collection of applications that provide snapshots of this diversity. The key technical challenges identified from these experiences are connectivity and integration. Also, at issue are the evolution process through which a telemedicine application evolves and the ability to choose the right set of technology for the diverse type of telemedicine applications. With the projected improvements in speed and quality of the Internet, wireless communication, and personal computational devices, it is expected that various concepts of telemedicine will develop into standard practices in tomorrow’s health care.

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Arvind Kumar, MS, Siddhartha Sinha, MS, Javed Jameel, MS and Sandeep Kumar, MS *

Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India

Received 22 June 2021; revised 13 August 2021; accepted 3 September 2021; Available online 18 October 2021

Abstract

Objectives: In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice.

Methods: We systematically searched the database of Thomson Reuters Web of Science for telemedicinerelated articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review.

Results: Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review.

Conclusion: Telemedicine can satisfactorily cover a major proportion of patients’ visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.

Keywords: Bibliometric analysis; COVID-19; Orthopaedics; Telemedicine; Trends

Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial)

M. Augestad1,2,4 , A. M. Sneve3 and R.-O. Lindsetmo3

1Department of Surgery, Sandnessjøen Hospital, Sandnessjøen, and 2Department of Quality and Research and 3Division of Surgery and Women’s Health, University Hospital of North Norway, Tromsø, Norway, and 4Department of Colorectal Surgery, Columbia University Hospital, New York, USA Correspondence to: Dr K. M. Augestad, Department of Quality and Research, University Hospital of North Norway, 9037 Breivika, Tromsø, Norway (e-mail: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)

Background: A stoma has severe impact on the patient’s quality of life (QoL). Postoperative home community follow-up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL.

Methods: A university hospital and five district medical centres participated. Patients with a stoma were randomized to follow-up by either TC (intervention) or hospital (control). Stoma nurses performed the clinical examination at the TC studio, aided remotely by hospital nurses and surgeons. The primary endpoint was the EQ-5D™ index score; secondary endpoints were the Stoma Quality-of-Life Scale, the OutPatient Experiences Questionnaire, and use of hospital resources.

Results: A total of 110 patients were randomized to hospital (58 patients) or TC (52) follow-up; 64 patients (hospital 38, TC 26) were followed for more than 12 months and 246 consultations (hospital 151, TC 95) were performed. There were no differences in QoL: EQ-5D™ index score (P = 0⋅301) and EQ-5D™ visual analogue scale (VAS) score (P = 0⋅775); Work/Social Function (P = 0⋅822); Sexuality/Body Image (P = 0⋅253) and Stoma Function (P = 0⋅074). Hospital follow-up performed better for organization of care (staff collaboration, P = 0⋅004; met same persons, P = 0⋅003) and communication (surgeon understandable, P < 0⋅001; surgeon caring P = 0⋅003). TC did not increase the number of hospital consultations (P = 0⋅684) and reduced the number of journeys of more than 8 h (P = 0⋅007).

Conclusion: Telemedicine follow-up by stoma nurses did not improve the QoL of patients, but decreased the readmission rate and burden of travel. Registration number NCT01600508 (https://www. clinicaltrials. gov).

Presented to the Annual Meeting of the Norwegian Surgical Association, Oslo, Norway, October 2019

Paper accepted 5 December 2019

Published online 26 February 2020 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.11491

Telemedicine barriers and challenges for persons with disabilities: COVID-19 and beyond

Thiru M. Annaswamy, MD MA a, * , Monica Verduzco-Gutierrez, MD b, Lex Frieden, MA, LLD c

a VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX, USA

b The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

c University of Texas Health Science Center at Houston, Houston, TX, USA

abstract

       The COVID-19 pandemic has forced a rapid adoption of telemedicine over traditional in-person visits due to social restrictions. While telemedicine improves access and reduces barriers to healthcare access for many, several barriers and challenges remain for persons with disabilities, and novel challenges have been exposed, many of which may persist long-term.

       The challenges and barriers that need to be systematically addressed include: Infrastructure and access barriers, operational challenges, regulatory barriers, communication barriers and legislative barriers.

       Persons with disabilities are a vulnerable population and little attention has been placed on their healthcare access during the pandemic. Access and communication during a healthcare encounter are important mediators of outcomes for persons with disabilities. Significant, long-term changes in technological, regulatory, and legislative infrastructure and custom solutions to unique patient and health system needs are required to address these barriers going forward in order to improve healthcare access and outcomes for persons with disabilities.

ARTICLE  INFO

Article history:

Received 6 June 2020 Received in revised form 22 June 2020 Accepted 29 June 2020

Keywords:

Telemedicine  Telerehabilitation  Health services accessibility  Health legislation  Disability studies

Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial

Kamran Azma1,2, Zahra RezaSoltani2 , Farid Rezaeimoghaddam2 , Afsaneh Dadarkhah2 and Sarasadat Mohsenolhosseini2

Abstract

Introduction: Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite being effective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming. We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with knee osteoarthritis.

Methods: In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate in either a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the mean change from the baseline until 1 and 6 month’s post-intervention in scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis of variance for the repeated measure statistical test.

Results: A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2  7.41 years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months postintervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPT groups in any of the studied scales.

Discussion: The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis. Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older population living in remote sites.

Keywords

Tele-rehabilitation, efficacy, middle-aged, knee, osteoarthritis, pain measurement, Iran