Latest news with #telemedicine
Medscape
a day ago
- Business
- Medscape
Teleneurology Bests Onboard Stroke Care Model
HELSINKI, Finland — Using telemedicine-based neurologist assessments in mobile stroke units proves to be safer and more resource-efficient than using traditional models in which a neurologist is on board the ambulance, new research shows. The trial, conducted across 10 tertiary hospitals in Melbourne, Australia, is the first prospective, head-to-head comparison of these two models of stroke care delivery. 'There's been a long-standing assumption that having a neurologist physically on board is the gold standard for mobile stroke unit care, but our trial shows that telemedicine delivers comparable outcomes in key operational domains,' said principal investigator Vignan Yogendrakumar, MD. Although the median time from arrival on scene to treatment decision was about 4 minutes longer in the telemedicine arm, this was deemed to be offset by a significant reduction in resource use. Among the 18% of patients who received thrombolysis or were transported for endovascular therapy, there was no difference in functional outcomes at 90 days. 'When we put everything together, we found that there was no difference in safety between the telemedicine and neurologist on-board arms. There was a small difference in the time position favoring the on-board arm, but there was significant resource utilization favoring the telemedicine arm. 'So the overall evaluation favors the telemedicine arm when it comes to balancing resource utilization with time to treatment and safety,' Yogendrakumar, assistant professor at the University of Ottawa, Ottawa, Ontario, Canada, and a senior research fellow at the University of Melbourne, Melbourne, Australia, told Medscape Medical News . The findings of the MSU-TELEMED trial were presented on May 23 at European Stroke Organization Conference (ESOC) 2025. Hierarchical Composite Outcome Yogendrakumar noted that telemedicine is the standard practice across many healthcare systems worldwide and is widely used for acute stroke management in hospital emergency departments. However, until now, there was no formal head-to-head comparison between telemedicine and models that rely on an onboard neurologist in mobile stroke units. The MSU-TELEMED trial assessed whether a telemedicine neurologist model can provide superior resource efficiency without compromising safety or timely delivery of care than a traditional on-board model of care. The prospective, randomized, open-label, blinded endpoint, parallel-arm trial enrolled 275 patients with suspected stroke who presented to a mobile stroke unit within 24 hours of symptom onset or last known well and who had undergone a full assessment by mobile stroke unit staff. The study used a single mobile stroke unit active in Melbourne, which could take patients to 10 different receiving hospitals. The randomization was done by day, so on some days the mobile stroke unit would have a neurologist on board, and on other days it would operate with a telemedicine service communicating with a neurologist at the main hospital. The researchers used a hierarchical composite outcome that integrated safety, time to treatment decision, and resource efficiency. They applied a win-odds approach, which allows multiple outcomes to be assessed at different levels of priority by comparing each patient with every other patient in the study. Safety was the first priority outcome. For each patient comparison, researchers determined whether a safety event had occurred — such as symptomatic hemorrhage or any form of clinical deterioration — which was then counted as a win or loss for either the telemedicine or onboard intervention. If no safety event occurred, the next endpoint — time to treatment decision — was evaluated. A difference of 15 minutes or more between interventions was considered a win or loss for the corresponding group. Time to Thrombolysis If there was no meaningful difference in time to treatment decision, the final endpoint — resource utilization — was assessed. This was measured by the productive percentage time, defined as the time actively spent caring for the patient divided by the total time dedicated to the case. A difference of more than 10% in favor of one group was considered a win for that intervention and a loss for the other. Finally, if there was no difference in productive percentage time between the two arms in a given pairwise comparison, the result was considered a tie. The overall findings were then summarized using a win-odds measure — the odds that a participant in the telemedicine arm would have a better outcome than the one in the on-board arm. Results showed a number/proportion of telemedicine wins of 14, 618 (76%); ties occurred in 692 cases (4%) and on-board wins in 3590 cases (20%), giving a stratified win odds of 3.5 (95% CI, 2.4-5.1; P < .001). More specifically, safety events occurred in 17 patients in each group — 13% in the telemedicine group vs 12% in the on-board group. The median time from arrival on scene to a definitive treatment decision was 19 minutes in the telemedicine group vs 13 minutes in the on-board group. In addition, the percentage of neurologist 'productive' time was 100% in the telemedicine group vs 33% in the on-board group. Of the 275 participants in the trial, about half were ultimately diagnosed with an ischemic stroke. Among those who received thrombolysis, the median time from arrival on scene to needle was 8.2 minutes longer in the telemedicine group. 'While every minute delay is important, this is a relatively small proportion of the time saved by mobile stroke unit care and needs to be balanced against the efficiency advantages achieved,' said Yogendrakumar. 'We were able to show that a telemedicine model is better able to utilize resources without sacrificing safety or delivery of care, and that will likely translate to cost savings,' he added. A formal cost-effective analysis from this study is planned. A Safe, Effective, Efficient Model Yogendrakumar suggested that these findings could help inform the design of stroke care systems in various regions. For example, in Melbourne, a second mobile stroke unit is now being introduced, with both units connected via telemedicine to a single neurologist. During the discussion following the MSU-TELEMED trial presentation, Guillaume Turc, MD, professor of neurology at Sainte-Anne Hospital in Paris, France, praised the study's innovative design, particularly its use of a hierarchical outcome structure and the win-ratio method. He noted that the findings were highly positive, supporting the safety of telemedicine-based neurologist assessments and highlighting their greater efficiency in resource use. Simona Sacco, MD, professor of neurology at the University of L'Aquila in L'Aquila, Italy, and current president of the European Stroke Organisation, added that this approach could be especially valuable in rural areas, where staffing ambulances with neurologists is often a significant challenge. She described the study as a welcome development and an important advancement in the field.
Yahoo
3 days ago
- Health
- Yahoo
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 >>
Bloomberg
4 days ago
- Business
- Bloomberg
Telehealth Firm Hims Cuts Over 4% of Staff in Strategy Shift
Hims & Hers Health Inc. is cutting more than 4% of its workforce as it pivots away from selling cheap copycat versions of popular weight-loss drugs. The San Francisco-based telehealth company employs more than 1,600 staff. The moves will affect 68 people across various divisions, a spokesperson said. The company didn't say which positions will be affected.
Medscape
5 days ago
- Business
- Medscape
Physician Associates Continue to Embrace Telehealth
The use of telehealth continues to grow across the healthcare industry, including among physician associates (PAs). As noted in the American Academy of Physician Associates' (AAPA's) 2025 Salary Report, an annual survey that explores PA pay and practice insights, a remarkable 49% of PAs reported using telemedicine applications as part of their clinical work in the past year. Sean Kolhoff, senior research analyst with AAPA, said these results were not surprising, per se, but do show that there is now a growing acceptance of the efficacy of telehealth in PA practice. 'Compared to pre-COVID estimates of telehealth use among PAs — 9.6% in 2019 — it appears that PAs have been able to adapt the technology to best meet their specific practice needs,' he explained. 'This is emphasized by the specialties that have generally continued to use telehealth post-pandemic: 76.2% in primary care and 56.6% in internal medicine. These specialties perform many tasks, like initial diagnoses and patient follow-ups, that can effectively utilize telehealth.' About Medscape Data Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, Medscape's Top 10 Telemedicine-Friendly States 2025 found that States have continued to update telehealth policies since the pandemic. A state's telehealth success also includes available connectivity for patients. States continue to invest in digital infrastructure to enhance connectivity. Tele-social work, tele-rehabilitation, and tele-occupational health are also on the rise. Dane Thomas, PA-C, MMS, a PA who specializes in hematology and oncology, said telemedicine use skyrocketed during the COVID-19 pandemic — and showed its value to healthcare providers and patients alike. 'The rapid adoption of these tools, which were accelerated just out of necessity, helped us see the benefits,' he explained. 'You see that a lot of patients like the flexibility and convenience of telehealth. And, as a provider, it's nice to be easily connected with patients through telehealth. It really gives us more flexibility. When we can see patients from home or from the office a couple days of the week, it lends itself to a better work-life balance.' Critics of telehealth sometimes say that nothing can beat the quality of an in-person appointment. Yet, research studies, particularly in primary care, suggest its use does not negatively affect patient outcomes. And with continuing workforce shortages, as well as concerns about patient access to care, telehealth applications provide a way for PAs, as well as physicians and nurse practitioners, to reach more people. 'I'd love to see it expand more in rural medicine,' said Thomas. 'I think we can give better access to care to patients who live in rural areas with telemedicine. Not just with primary care but also with specialty medicine. As it is, it's just really hard to get doctors in those areas.' Yet, as healthcare organizations consider the best ways to implement telemedicine, Tiffany Ryder, PA-C, said, 'The devil is in the details.' Ryder, who does not use telemedicine in her current role but did conduct appointments online regularly during the pandemic, said many health plans and hospitals are looking at how to best increase access to medical care without sacrificing quality. So, in her nonclinical role, advising those organizations about how to strike such a balance, telehealth, she said, comes up again and again. 'When telehealth should be used really comes down to the details and nuance of the situation you are trying to address,' she said. 'It's definitely not a one-size-all tool that can replace in-person visits.' For example, she said telemedicine works best when there is continuity of care. For patients who have a chronic medical condition and see the same primary care provider regularly, telehealth applications can be of great benefit. 'When you know your provider and they know you, you don't always need to come into the office to have a question answered or a prescription filled,' Ryder explained. 'That not only is more convenient for the patient but it also increases a PA's availability to see other patients who may be coming to urgent care or the emergency room [ER] for a more acute issue.' Furthermore, she said, telemedicine can also act as a 'super-educated triage nurse' to help determine where to best allocate provider resources in emergency and urgent care settings. 'If you are a parent, and your child falls off a bunk bed and hits their head, you don't have the knowledge or skills to make a decision about whether your kid needs to go to the ER,' she said. 'But if you can connect via telehealth with a PA on your way to the ER, tell that person what happened and let them ask those important red flag questions; they can then tell you whether you need to come in or whether you can go home and monitor the situation. You can better manage your provider resources, and I think that's a really great place where telemedicine can shine.' Thomas, for his part, hopes that more organizations will work to identify both the positives and negatives of telehealth use to make sure it is deployed in the right scenarios to enhance patient care. And, as Ryder said, the devil may be in the details of its continued use; both she and Thomas agreed that telehealth adoption will continue to grow in the future. Kolhoff added the AAPA's finding that telehealth use continues to increase speaks to the fact that 'PAs are adaptable to new and emerging technology that can improve the patient's experience and ability to access high-quality healthcare in a timely manner.' 'What the future may look like, no one knows,' he said. 'What we do know is that PAs will continue to adapt to new technologies as needed to ensure that patient needs are being met.'
CBS News
24-05-2025
- Health
- CBS News
Planned Parenthood affiliate to close 4 clinics in Minnesota and 4 in Iowa over federal funding cuts
Four Planned Parenthood clinics in Minnesota and four of the six in Iowa will shut down in a year, the Midwestern affiliate operating them said Friday, blaming a freeze in federal funds, budget cuts proposed in Congress and state restrictions on abortion. Two of the Minnesota clinics closing are in the Twin Cities area, in Apple Valley and Richfield. The others are in Alexandria and Bemidji. According to Planned Parenthood North Central States, the four closing in Iowa include the only Planned Parenthood facility in the state that provides abortion procedures, in Ames, home to Iowa State University. The others are in Cedar Rapids, Sioux City and the Des Moines suburb of Urbandale. The Planned Parenthood affiliate said it would lay off 66 employees and ask 37 additional employees to move to different clinics. The organization also said it plans to keep investing in telemedicine services and sees 20,000 patients a year virtually. The affiliate serves five states — Iowa, Minnesota, Nebraska, North Dakota and South Dakota. "We have been fighting to hold together an unsustainable infrastructure as the landscape shifts around us and an onslaught of attacks continues," Ruth Richardson, the affiliate's president and CEO, said in a statement. Of the remaining 15 clinics operated by Planned Parenthood North Central States, six will provide abortion procedures — five of them in Minnesota. The other clinic is in Omaha, Nebraska. The affiliate said that in April, the Trump administration froze $2.8 million in federal funds for Minnesota to provide birth control and other services, such as cervical cancer screenings and testing for sexually transmitted diseases. While federal funds can't be used for most abortions, abortion opponents have long argued that Planned Parenthood affiliates should not receive any taxpayer dollars, saying the money still indirectly underwrites abortion services. Planned Parenthood North Central States also cited proposed cuts in Medicaid, which provides health coverage for low-income Americans, as well as a Trump administration proposal to eliminate funding for teenage pregnancy prevention programs. In addition, Republican-led Iowa last year banned most abortions after about six weeks of pregnancy, before many women know they are pregnant, causing the number performed there to drop 60% in the first six months the law was in effect and dramatically increasing the number of patients traveling to Minnesota and Nebraska. After the closings, Planned Parenthood North Central States will operate 10 brick-and-mortar clinics in Minnesota, two in Iowa, two in Nebraska, and one in South Dakota. It operates none in North Dakota, though its Moorhead, Minnesota, clinic is across the Red River from Fargo, North Dakota. contributed to this report.
