Community Engagement in The Telehealth Service for Aged People with Diabetes: COVID-19 response in Bangladesh

Purpose: The purpose of this study is to present a better understanding of the specialized telehealth service in Bangladesh from the service provider and service recipients by aged people Method: Both quantitative and qualitative methods were used to collect data from Diabetes Mellitus (DM) patients. Data were collected by online telephone interviewing with an interview schedule. A total of 100 aged people with diabetes were selected purposively for a quantitative interview and 10 In-depth Interviews (IDIs) & Key Informant Interviews (KIIs) were conducted. Result: The majority of patients aged was between 61 to 68 years with a mean age of 63.6 ± 7.01years. The difference of age of DM patients by sex was found statistically significant (x2 = 39.49, df = 31; Cramer’s V = .032; P=<.003). The main source of information about digital health was: relatives (55%), neighbors (31%), television (12%), newspaper (10%), social media (9%), and healthcare providers (6%). Strong relationship was found between age of respondents and sources of information (x2= 77.08; Cramer’s V= .032, df = 13; Sig; P= < .009). About 59% of DM patients were benefited from telehealth services during COVID-19, however; they encountered some difficulties like effective access to digital technology, cost, and diagnosis facilities. About 83% of respondents suggest formalizing community engagement programs to extend the digital health services during a health emergency. The common barriers to the engagement of community people in digital health care are lack of social awareness, lack of peer group support, and gender disparities. Poor counseling, language barrier, bad internet signal, and lack of family members' support were the key barriers during teleconsultation services. Conclusion: Telehealth has the potential to address critical health issues of aged people and effective community engagement may be the best option to reach older people with diabetes in Bangladesh during any health emergency.

Evolution of Telehealth Technology, Evaluations, and Therapy: Effects of the COVID-19 Pandemic on Pediatric Speech-Language Pathology Services

Purpose: Telehealth services experienced exponential growth during the COVID-19 pandemic. This survey examined the resulting evolution in the technology, connectivity, implementation of services, and attitudes of pediatric speech-language pathology clinicians using synchronous videoconferencing. Method: The Telehealth Services: Pediatric Provider Survey participants were 259 speech-language clinicians in a variety of employment settings from across the country and abroad. Analyses identified telehealth barriers eliminated and those that persisted during the pandemic, advantages, and disadvantages of remote delivery of evaluation and treatment services, the most common telehealth technology used by clinicians and their clients to access care, and clinicians' predictions about the optimization and future of telehealth. Results: Elimination of regulatory and insurance hurdles allowed children from varying socioeconomic backgrounds living in rural, suburban, and urban areas access to telehealth. Telehealth technology shifted from computers with external hardware and specialized software to commercially available equipment, such as handheld portable devices with built-in audiovisual components and publicly available videoconferencing platforms. However, connectivity of these devices continued to be problematic, and lack of technology prevented some children from accessing care. Judgments about the appropriateness and effectiveness of evaluations and treatments varied based on the age and communication disorder of a child. Although some participants expressed uncertainty about the effectiveness of telehealth compared with in-person care, telehealth was widely recognized as a viable delivery method. Conclusions: Although clinicians reported many advantages of telehealth, some barriers identified reported prior to COVID-19 still persist. Clinicians anticipate that new developments have the potential to continue improving telehealth service delivery, bolstering the viability of telehealth long after the COVID-19 pandemic is gone. Supplemental Material https://doi.org/10.23641/asha.16959361

Communication Bridge™-2 (CB2): A NIH Stage 2 randomized control trial of a speech-language intervention for communication impairments in individuals with mild to moderate primary progressive aphasia

Background : Primary Progressive Aphasia (PPA) is a clinical dementia syndrome. Impairments in language (speaking, reading, writing, and understanding) are the primary and persistent symptoms. These impairments progress insidiously and devastate communication confidence, participation, and quality of life for persons living with PPA. Currently, there are no effective disease modifying treatments for PPA. Speech-language interventions hold promise for mitigating communication challenges and language symptoms. However, evidence regarding their efficacy in PPA is of low quality and there are currently no rigorous randomized control trials. Method : Communication Bridge™-2 (CB2) is a Stage 2, superiority, single-blind, randomized, parallel group, active-control, behavioral clinical trial delivered virtually within a telehealth service delivery model to individuals with PPA. Ninety carefully characterized participants with clinically confirmed PPA will be randomized to one of two speech-language intervention arms: 1) Communication Bridge™ a dyadic intervention based in communication participation therapy models that incorporates salient training stimuli or 2) the control intervention a non-dyadic intervention based in impairment therapy models addressing word retrieval and language production that incorporates fixed stimuli. The superiority of Communication Bridge™ over the Control arm will be evaluated using primary outcomes of communication confidence and participation. Other outcomes include accuracy for trained words and scripts. Participants complete two therapy blocks over a 12-month period. Outcomes will be measured at baseline, at each therapy block, and at 12-months post enrollment. Discussion : The CB2 trial will supply Level 2 evidence regarding the efficacy of the Communication Bridge™ intervention delivered in a telehealth service delivery model for individuals with mild to moderate PPA. An important by-product of the CB2 trial is that these data can be used to evaluate the efficacy of speech-language interventions delivered in both trial arms for persons with PPA. The impact of these data should not be overlooked as they will yield important insights examining why interventions work and for whom, which will advance effectiveness trials for speech-language interventions in PPA. Trial Registration: The CB2 trial was registered prospectively with ClinicalTrials.gov (NCT03371706) on December 13, 2017. Registered at https://clinicaltrials.gov/ct2/show/NCT03371706

Telehealth for consultation and shoulder rehabilitation: a preliminary study on the perspectives of 30 patients during the COVID-19 lockdown

Background: What are the perspectives of a patient cohort that underwent telehealth consultation and shoulder rehabilitation during coronavirus disease 2019 (COVID-19)? Are there any differences in the patients’ perspectives with the two different telehealth video applications (apps) used in the study?Methods: This is a prospective study carried out during the COVID lockdown period of April to July 2020. Thirty consecutive patients from the orthopedics department of a tertiary institute in India underwent their first-ever session of a video app-based (Zoom or WhatsApp) telehealth consultation with shoulder rehabilitation exercises on a handheld mobile, tablet, or laptop device. After the virtual consultation, the patients were sent a validated telehealth usability questionnaire (TUQ) to evaluate their perspectives. Scores obtained from the TUQ were the primary outcome measure.Results: The study was completed by 30 patients (16 men and 14 women) with an average age of 56 years (range, 20–77 years). The patients who contacted us during the lockdown period with either a stiff shoulder or a conservatively treated shoulder fracture were included in the study. The average TUQ score was 13.6 (median, 14.5; range, 6–21) out of a maximum of 21 points. Eighty percent of the patients were satisfied and found the telehealth service useful. Use of the Zoom app scored significantly higher (median, 17; average, 15.6) than the WhatsApp app (median, 8.5; average, 9.6; p=0.004). Conclusions: Patients who received telehealth consultation and shoulder rehabilitation were overall satisfied. Telehealth appss with advanced video calling features such as Zoom should be preferred for higher patient satisfaction.

The Determinants of Telehealth Provision: Empirical Evidence from OECD Countries

Health services provided through the telecommunications system aim to improve the population’s health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries’ experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3–5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population’s health could be improved, which in turn would possibly increase productivity and social welfare.