BACKGROUND

The Philippine General Hospital (PGH) is a tertiary government hospital that serves as the national referral center for Filipinos from across the country. In partnership with Latter-Day Saint Charities (LDSC), PGH has been serving patients in need of mobility devices, such as wheelchairs, through in-person services from screening to assessment, measurement, assembly, fitting, and mobility training. Given the patients’ barriers to in-person follow-up consultations, regular healthcare provision has been challenging. The use of telerehabilitation, a form of telemedicine, has emerged as a practical and innovative solution, but it needs further evaluation.

The study aimed to determine the wheelchair recipients’ perceived barriers to in-person and virtual follow-up consultations.

This cross-sectional study involved a purposive sample of 413 patients who received a wheelchair from the LDSC through PGH. An original survey was prepared to determine patients’ perceived barriers to actual in-person and potential virtual follow-up consultations. Consent was obtained prior to data collection. After the pretest and pilot testing were conducted, the final version of the survey was administered either electronically or through individual phone interviews. Descriptive statistics was used to analyze and present the data.

A total of 113 wheelchair recipients participated, with an average of 42.9 years of age. The majority resided outside Metro Manila (53.1%), and 86.7% were within the income bracket of less than PhP 9,520 per month. The majority received a standard type of wheelchair (85.8%). The top 3 reasons hindering compliance to in-person consultation follow-ups were accessibility issues (82.3%), costs of travel (79.6%), and distance to hospital/wheelchair assessor (71.7%). With respect to potential virtual follow-ups, 72% expressed willingness to experience telemedicine/telerehabilitation in the future, despite having neither prior awareness (50.4%) nor experience (74.3%) of it. The majority had access to mobile phones (98.2%), and 67% had stable internet access.

The main barriers to in-person follow-ups were related to accessibility, costs, and travel. Telehealth or telerehabilitation in particular, despite patients’ interest and willingness to try it, still has yet to be optimized in our country. Internet connectivity can still be improved, as well as our stakeholders’ level of telehealth awareness. Future efforts to improve and sustain the uptake of telehealth solutions are recommended, as well as studies comparing the cost-effectiveness of in-person versus virtual consultations especially among persons with lived experiences of disability.

OBJECTIVE: To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. METHODS: During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. RESULTS: Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42–68 years). Pain diminished from a baseline value of 64 mm (range, 40–80 mm) to 16 mm (range, 0–30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51–66 points) to 85 points (range, 70–100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). CONCLUSION: Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.
Female ; Humans ; Joints ; Male ; Non-Randomized Controlled Trials as Topic ; Pathology ; Rehabilitation ; Remote Consultation ; Rotator Cuff* ; Shoulder ; Tears* ; Telemedicine ; Telerehabilitation*

BACKGROUND AND OBJECTIVE

COVID-19 pandemic gave rise to an increase in demand for pneumococcal and influenza vaccines. Several approaches to improve vaccination rates among different populations were investigated to address this need. Social media may be used as a platform to promote and improve vaccination rates. The study aimed to determine the effect of social media promotion, on the number of patients requesting vaccination in a government tertiary hospital.

The study was conducted using a quasi-experimental design. A telehealth-based vaccination delivery system was established. The need for vaccination against flu and pneumonia was then promoted on a social media platform during the first month of the study. Posters on the risk of not being vaccinated and safety profile of vaccines were added on the second month. The number of requests for vaccination for each month was compared. Social media metrics of the two months of the study were likewise described.

A total of 23 requests for vaccination were recorded, 11 on the first month and 12 on the second month. When a boost in advertising for the posts was implemented, twice as many requests were made during the third week of the second month as compared to the previous month (5 vs 10). Social media promotion with poster showed higher average in reach, engagement and comments per week than without poster. The mean differences among the social media metrics, however, were not statistically significant.

Promotion with posters resulted in a slight increase in number of vaccination requests. Further increase in requests may require a more refined social media promotional strategy.

BACKGROUND

Telemedicine offers a solution to healthcare access issues, especially during the COVID-19 pandemic when physical distancing limited in-person visits. It can also be used by the Doctors-to-the-Barrios (DTTBs), who are often newly licensed physicians who have not undergone residency training yet, to remotely consult specialists and assist them in providing better healthcare recommendations to their patients. Understanding the acceptance of telemedicine particularly among DTTBs is crucial to optimizing its implementation, as local studies on this topic are lacking.

The purpose of this study is to determine the factors affecting acceptance of telemedicine by the DTTBs.

This study employed a descriptive and analytical cross-sectional research design from 2021 to 2022. Ethical approval was obtained prior to study implementation. Informed consent form was sent to all enrolled master’s students in the DTTB program. The study adapted the questionnaire utilized by Zailani et al. using a five-point Likert scale to identify the determinants of acceptance of telemedicine based on the following constructs: government policy, external supplier’s capacity, project team’s capacity, top management support, perceived usefulness, attitude, self-efficacy, acceptance of telemedicine, and organizational culture. Linear regression was performed to identify significant constructs that determine acceptance of telemedicine. All data were reported at 95% confidence interval.

Total of 116/180 DTTBs participated in the study. Attitude (β = 0.5849, p < 0.01) and self-efficiency (β = 0.5327, p < 0.01) together with organizational culture had a significant positive impact on the acceptance of telemedicine.

This study shows the current state of acceptance of telemedicine by our DTTBs. It highlights their positive attitude and self-efficiency towards telemedicine and the lack of support they receive from the government in funding and implementing telemedicine efforts despite its potential to address healthcare access issues.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective: This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods: The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results: The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Health Services Administration ; Telemedicine ; Telecommunications ; Remote Consultation ; COVID-19

The coronavirus disease 2019 (COVID-19) epidemic is evolving in Latin America despite implementation of government measures. We report a familial cluster in Lima, Peru, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Two young and two middle-aged adults with a wide range of COVID-19 manifestations experienced successful management under telehealth outpatient monitoring. Telehealth monitoring was scheduled as suggested by Peruvian Ministry of Health Guidelines and was performed by a designated physician who assessed the patients and prescribed treatment. On May 14, 2020, a 25-year-old male, who worked treating COVID-19 patients, reported constitutional symptoms and tested positive for SARS-CoV-2. Clinical improvement was achieved with azithromycin and ivermectin therapy. He had been in contact with his parents (Cases 2 and 3) and his sister (Case 4). Cases 2 and 3 developed moderate pulmonary compromise requiring oxygen supplementation and pharmacological therapy, including corticosteroids and anticoagulation, under home medical assessment and telehealth monitoring. Case 4 developed mild symptoms and periorbital rash, an atypical dermatological finding. To our knowledge this represents the first report of a familial cluster with COVID-19 that was successfully managed under scheduled telehealth outpatient monitoring in Latin America.
SARS-CoV-2 ; COVID-19 ; Telemedicine ; Remote Consultation

The suspension of facility-based rehabilitation services and restricted mobility at the onslaught of the coronavirus disease 2019 (COVID-19) pandemic forced healthcare workers to explore new methods of providing patient care. This case report presents a 40-year-old female who underwent osteotomy with iliac crest bone graft and intramedullary nailing with quadricepsplasty to correct the leg length discrepancy and knee extension contracture that developed secondary to multiple bone injuries sustained in a vehicular accident 17 months before admission. The in-hospital postoperative rehabilitation was prematurely terminated due to the COVID-19 lockdown. The client was discharged with pain and swelling of the right lower limb, knee flexion of 0–25°, and an ankle plantar flexion contracture. She had moderate to severe difficulty in walking, bathing, toileting, and lower garment dressing, needing assistance to complete these tasks. Telerehabilitation was done over three months using both synchronous and asynchronous methods. Gains from the remote program were independence in all the self-care activities with no difficulty in performing them. The patient was able to return to work. Gains in knee and ankle mobility were minimal. Telerehabilitation using available technologies can be used to continue patient care amidst barriers to face-to-face rehabilitation in a low-resource country
Telerehabilitation ; Telemedicine ; COVID-19 ; Osteotomy

Background: Catalyzed by the coronavirus disease 2019 (COVID-19) pandemic that restricted non-essential travel, awareness of the value of telehealth increased among healthcare providers and consumers. Telerehabilitation, a subset of telehealth and telemedicine, refers explicitly to the remote provision of rehabilitation services. However, since the majority were new to the concept of telerehabilitation, which was commonly interchanged with other related terms (e.g., telehealth, telemedicine, teletherapy, telecare, telepractice, etc.), and relevant internationally recognized guidelines were not available pre-pandemic, many turned to online resources to learn more about it. However, such might create confusion with the terminologies. Objective: This infodemiological study aimed to examine the trends of global online interest in telehealth, telemedicine, telerehabilitation, and related search terms. The authors hypothesized an abrupt rise in stakeholders' awareness regarding the virtual method of delivering or accessing healthcare, including rehabilitation services, during the pandemic. Method: Using Google Trends™, we obtained and analyzed the trends of global online interest in telehealth, telemedicine, telerehabilitation, and other related search terms from 2004 to October 2020. Results: The frequencies of searches for “telehealth,” “telemedicine,” and “telerehabilitation” peaked in March 2020, which coincided with the lockdown in many countries, including the Philippines. The term “telehealth” was more frequently searched in western countries, while “telemedicine” was relatively common in eastern countries. Among the terms synonymous with telerehabilitation, “teletherapy” was most commonly used worldwide, with “teletherapy speech” being the most searched related topic. The Philippines had the most significant number of times the term “telerehabilitation” was searched in the past decade. Conclusion During the COVID-19 pandemic, there is an overall global demand for the acquisition of knowledge related to telehealth, telemedicine, telerehabilitation, and related search terms. Of particular interest, tele rehabilitation, however, varied in terminologies across countries, with “teletherapy” mainly being used worldwide and “telerehabilitation” being primarily searched in the Philippines. Therefore, arriving at a consensus across professional societies and operationally defining different interrelated terms could help streamline our current or future guidelines and programs.
Telemedicine ; Telerehabilitation ; COVID-19 ; Infodemiology

BACKGROUDN: Telemedicine has the potential to reform the delivery system of dermatologic health care. OBJECTIVE: The purpose of this study was to investigate the concordance and accuracy of diagnosis and the management plan of dermatologist's teleconsultation and traditional clinic-based consultation. METHODS: Eighty-eight lesions of 77 patients were examined by digital image and clinic-based consultation by one dermatologist. The reliability and accuracy of the dermatologist's diagnoses and the reliability of the management recommendations were compared. RESULTS: The concordance of diagnosis between telemedicine and clinic-based consultation showed high levels(complete agreement, 92.05%; complete + partial agreement, 97.73%). The agreement on management recommendations was variable. The diagnostic confidence and the image quality affected the agreement. CONCLUSION: The digital image consultations result in reliable diagnostic outcomes when compared with the traditional clinic-based consultaion. And it is necessary to investigate the accuracy of teledermatology and to identify clinical conditions inappropriate for teleconsultation.
Delivery of Health Care ; Dermatology* ; Diagnosis ; Humans ; Referral and Consultation ; Remote Consultation* ; Telemedicine

PURPOSE: In elderly and patients with underlying diseases, mortality rate is increased when compared to rib fractures which occurred in other patients. Because there is a shortage of emergency physicians or real-time consultation with radiologists in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad, which was highly portable, with that of liquid crystal display (LCD) monitor. METHODS: Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians. A total of 108 cases were divided 1st to 54th and 55th to 108th. Two sessions were separated with a four-week interval. If the reviewer interpreted the 1st to 54th with iPad, they did 55th to 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured ribs, and diagnostic confidence of 5-scale. RESULTS: The interobserver agreement among reviewers in LCD and iPad was 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools for each reviewer was 0.410-0.859 (Mean=0.628+/-0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810- 0.966 (Mean=0.879+/- 0.054) in LCD, 0.828-1.000 (Mean=0.898+/-0.052) in iPad. The specificity was 0.520- 0.860 (Mean=0.750+/-0.117) in LCD and 0.560-0.880 (Mean=0.708+/-0.111) in iPad. Therefore, remote consultation of X-ray by iPad with a specialist was possible with minimized temporal and spatial limits in the emergency room. CONCLUSION: In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, remote consultation of X-ray by iPad with a specialist in the emergency room was possible, with temporal and spatial limits by iPad.
Aged ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Liquid Crystals ; Mortality ; Remote Consultation ; Rib Fractures* ; Ribs* ; Sensitivity and Specificity ; Specialization ; Teleradiology