People with chronic diseases can benefit from consulting their doctors in online visits
Recently, the Health Ministry in Jerusalem announced the promotion and implementation of telemedicine as one of its goals.
Telemedicine in the treatment of chronic diseases is no less safe, accessible, and effective than a visit to the doctor, according to a study at Soroka-University Medical Center in Beersheba. According to the researchers, phone, computer, and video visits don't harm the quality of medical care, and they may even reduce hospitalizations and emergency room visits.
The study, just published in the Journal of Medical Internet Research under the title 'Evaluating Clinical Outcomes and Physician Adoption of Telemedicine for Chronic Disease Management: Population-Based Retrospective Cohort Study,' found that the use of telemedicine for the management of chronic diseases leads to medical outcomes as good as face-to-face visits and doesn't elevate the rate of emergency room visits or hospitalizations, even among patients with several such conditions.
Although telemedicine has demonstrated benefits in diverse clinical settings and patient populations, its implementation did not significantly accelerate until the COVID-19 pandemic, which led to its widespread adoption around the world. In addition, other factors that emerged in the last decade as contributing to the growth in the use of telemedicine included widespread high-speed Internet access, the use of mobile devices, advances in information and communication technology, and the growing adoption of electronic health records.
Recently, the Health Ministry in Jerusalem announced the promotion and implementation of telemedicine as one of its goals. The study was promoted by hospital director-general Dr. Shlomi Codish.
'Understanding the effectiveness, strengths, and shortcomings of telemedicine for various chronic diseases and patient populations can inform decision makers of health care policy on how best to implement and maximize its benefits,' they wrote. This encouraged the researchers to go ahead.
'We aimed to compare the use of telemedicine for outpatient visits versus in-person visits across different medical specialties; assess its association with clinical outcomes; and examine the influence of patient and physician characteristics on telemedicine use in a large, tertiary, teaching hospital,' said Dr. Ido Peles, a medical data analyst and epidemiologist at the hospital and the chief researcher in an interview with The Jerusalem Post.
The records of 32,445 Jewish and Arab adult patients who had been treated in five medical fields – psychiatry, hemato-oncology, gastroenterology, endocrinology, and nephrology between 2019 until the beginning of 2020. Telemedicine used during the period of 2019 to 2021 was the researchers' main interest, and the main outcomes were emergency department (ED) referrals and hospitalizations.
The analysis used models and analyses by patient demographic characteristics, chronic disease medical fields, and the characteristics of the doctors. 'Fully 75% of those using telemedicine were in touch by phone, and the rest by their computer or phone. We have a large Bedouin population, however, and telemedicine is less used by them,' Peles added.
'It won't replace doctors or coming to the clinic; it's an extra tool that especially benefits those living in the periphery and those who have a difficult time reaching the clinic. Such patients need not fear that they aren't getting good medical treatment if they don't see their doctors in person. Physicians are getting more skilled in telemedicine, and this benefits the patient. Telemedicine techniques are not taught in medical schools, but when students go to hospitals for clinical work, they see doctors using the tool to check up on patients who are at home.
'It would be a good idea for it to be included in medical school curricula,' suggested Peles, who, with his team, spent three years on the study and wants to do another one in about a year.
In 2019, a total of 99.6% (83,000) of visits were in person, and by 2020 to 2021, a total of 22.6% of patients had used telemedicine. Those who were followed up by telemedicine were slightly older and with more chronic illnesses than in-person patients or patients who did not visit their doctors during that time.
Peles and his team found no evidence of worsening outcomes for telemedicine users relative to in-person care. Health care providers with higher telemedicine use even had reduced rates of emergency department referrals (and hospitalizations than providers with lower telemedicine use.
The development of telemedicine over the years has been remarkable, the team said.
'In the US, telemedicine adoption in hospitals rose from 46% in 2017 to 72% in 2021, driven primarily by larger teaching hospitals leading the transformation. In China, for example, a regional telemedicine platform experienced substantial growth in remote consultations, providing critical benefits to underserved regions and older adults.
These trends reflect a broader recognition of telemedicine's potential to revolutionize health care delivery.
'The American College of Cardiology and other medical societies have declared that telemedicine not only improves access to care but also enhances patient satisfaction, reduces manpower requirements, and fosters equity in health care delivery. Nevertheless, alongside the potential benefits of telemedicine, there are challenges, including the lack of a physical examination, which is an inherent part of the visit and diagnosis.'
The researchers stressed that telemedicine should be tailored to the individual needs of patients and physicians and consider the nature of the patient's disease.
Although the timing of infectious pandemics is unpredictable, their recurrence is likely, they concluded.
'It is evident that telemedicine has a critical role in emergency responses, underscoring its importance. Our findings emphasize the importance of integrating telemedicine into health care systems and policies to ensure consistent patient outcomes across various situations and optimize health care resource allocation.
Sign up for the Health & Wellness newsletter >>
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
15 minutes ago
- Medscape
GLP-1 Users Should Fast 24 Hours Before Anesthesia
Patients taking the new class of weight-loss drugs do not need to stop these medications prior to procedures requiring anesthesia, but they should adhere to longer preoperative fasting times, according to a new multidisciplinary consensus statement. The statement, led by the Society for Perioperative Assessment and Quality Improvement, recommends patients without significant gastrointestinal symptoms associated with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) should fast from solid foods for 24 hours and stick to clear liquids prior to a procedure requiring anesthesia. This extended fasting time can help mitigate aspiration risk in these patients with delayed gastric emptying while retaining the benefits of continuing GLP-1 RAs, such as improved glycemic control. The statement is 'the first to provide recommendations for perioperative management of patients taking GLP-1 RAs based on an in-depth systematic literature review of both clinical perioperative studies and gastric emptying data,' Adriana Oprea, MD, the first author of the document, and her colleagues wrote. Changing Guidance In June 2023, the American Society of Anesthesiologists (ASA) released the first guidance statement regarding preoperative management of patients on GLP-1 RAs, after some case reports documented aspiration events in these patients. While the number of these events is generally low and rates of aspiration appear to be similar between patients on GLP-1 RAs and the general population, 'people got really worried with these drugs because of [the] delayed gastric emptying,' Oprea, an associate professor of anesthesiology at Yale School of Medicine in New Haven, Connecticut, told Medscape Medical News . The 2023 ASA guidance recommended holding GLP-1 RAs for one half-life — a week for patients on long-acting medication and a day for short-acting GLP-1s. Due to a lack of adequate evidence at the time, the document suggested these patients should follow the standard ASA fasting guidelines of 8 hours after a full meal. However, evidence suggests stopping GLP-1s for one half-life is not enough for the effects on gastric emptying to subside, according to the new statement. For longer-acting drugs like dulaglutide, semaglutide, and tirzepatide, patients would need to discontinue these medications for several weeks to restore normal gastrointestinal motility. For patients with type 2 diabetes, discontinuation of these medications over this period could lead to poor glycemic control, which is linked to worse postoperative outcomes. For patients taking GLP-1 RAs for weight loss, restarting these medications can result in increased gastrointestinal symptoms, Oprea said, such as nausea, vomiting, diarrhea, or constipation. 'Because adverse effects are more prevalent at higher GLP-1 RA doses, discontinuation of these medications might lead to a high likelihood of side effects upon medication reinitiation or require reinitiation of therapy at lower doses followed by dose reescalation,' Oprea's group wrote. 'This is logistically difficult for both patients and treating clinicians.' In October 2024, the ASA, along with other professional societies, published updated practice guidance stating GLP-1 RAs may be continued preoperatively in patients without an elevated risk for delayed gastric emptying and aspiration. Those defined as 'higher risk' included patients in the escalation phase, on weekly dosing, on higher doses, and with gastrointestinal symptoms. The guidance advised these patients at higher risk for delayed stomach emptying can help mitigate aspiration risk by following a 24-hour liquid diet. This updated guidance also received some criticism. 'As of yet, no studies have reported a difference in the incidence of increased residual gastric content that would justify treating patients differently on the basis of dose regimen and/or treatment phase,' wrote Glenio B. Mizubuti, MD, PhD, of the Kingston General Hospital, in Kingston, Ontario, Canada, and his colleagues in a letter to Anesthesiology . 'Similarly, the absence of ongoing digestive symptoms, while somewhat reassuring, should not be taken as a definitive sign of an empty stomach in GLP-1 RA users,' they wrote. Continue Meds, Extend Fasting Times This new consensus statement, published last month in the British Journal of Anaesthesia , recommends patients doing well on GLP-1 RAs should continue these medications preoperatively and follow a clear liquid diet for 24 hours before procedures requiring anesthesia. The recommendations were based on a systematic review of 112 studies and a modified Delphi process and were co-sponsored and endorsed by the American Association of Clinical Endocrinology. 'From our review of the literature, we feel that the fasting times are the most important factor that could decrease the risk of having residual gastric content in the stomach in a patient on GLP-1 RAs when they're scheduled to have a procedure that requires anesthesia,' Oprea said. The consensus also recommends patients on GLP-1s fast from high-carbohydrate-content clear liquids (containing 10% or more glucose) for 8 hours before and stop drinking any liquids four hours before these procedures. Inpatient and outpatients can restart GLP-1 RAs when they resume their original diets. Patients with significant gastrointestinal symptoms including severe nausea, vomiting, and inability to tolerate oral intake should postpone elective procedures that require anesthesia and refer to their prescribing physician for diet and medication modifications to manage symptoms, the authors advised. 'Our recommendation for a clear liquid diet for 24 hours preprocedurally might appear overly restrictive. However, evidence points to the safety of this approach in patients on GLP-1 RAs,' they wrote.
Wall Street Journal
33 minutes ago
- Wall Street Journal
A New Shot Prevents HIV—and Breathes New Life Into a Stagnant Biotech
Later this month, the Food and Drug Administration is widely expected to approve a groundbreaking twice-yearly injection to prevent HIV—a milestone in the decadeslong fight against a once-devastating disease. For Gilead Sciences GILD -0.28%decrease; red down pointing triangle, the dominant player in HIV treatment, the breakthrough is doing what years of splashy but underwhelming acquisitions failed to achieve: It has Wall Street paying attention again. Since reporting last June that just two annual shots of lenacapavir prevented all HIV infections in a study of women and girls, shares have surged 73%.
Wall Street Journal
34 minutes ago
- Wall Street Journal
Humana to Back Curbs to Medicare Advantage Billing Practices
Humana HUM -1.11%decrease; red down pointing triangle, the second-biggest Medicare insurer, has told congressional staffers that it will support moves that would curtail billing practices worth billions in extra payments to the industry, according to staffers and a document viewed by The Wall Street Journal. The stance by a leader in the Medicare Advantage business—in which insurers offer privately run Medicare plans—represents an important development in a growing debate over how the companies are paid in the $460 billion program.
