James T. McElligott

Lessons learned from the usability assessment of home-based telemedicine systems.

At-home telemedicine visits are quickly becoming an acceptable alternative for in-person patient visits. However, little work has been done to understand the usability of these home-based telemedicine solutions. It is critical for user acceptance and real-world applicability to evaluate available telemedicine solutions within the context-specific needs of the users of this technology. To address this need, this study evaluated the usability of four home-based telemedicine software platforms: Doxy.me, Vidyo, VSee, and Polycom. Using a within-subjects experimental design, twenty participants were asked to complete a telemedicine session involving several tasks using the four platforms. Upon completion of these tasks for each platform, participants completed the IBM computer system usability questionnaire (CSUQ) and the NASA Task Load Index test. Upon completing the tasks on all four platforms, the participants completed a final post-test subjective questionnaire ranking the platforms based on their preference. Of the twenty participants, 19 completed the study. Statistically significant differences among the telemedicine software platforms were found for task completion time, total workload, mental demand, effort, frustration, preference ranking and computer system usability scores. Usability problems with installation and account creation led to high mental demand and task completion time, suggesting the participants preferred a system without such requirements. Majority of the usability issues were identified at the telemedicine initiation phase. The findings from this study can be used by software developers to develop user-friendly telemedicine systems.

Practice Patterns and Guideline Adherence in the Management of Attention Deficit/Hyperactivity Disorder

Background. Current data are limited on compliance with guidelines for the treatment of attention deficit/hyperactivity disorder (ADHD). Methods. A survey assessing compliance with ADHD guidelines for diagnosis and management was distributed to pediatricians in a practice research network. Comparisons were made by practitioner characteristics. Results. In all, 42/76 surveys were returned (55%). Respondents largely adhered to American Academy of Pediatrics (AAP) guidelines. A lower percentage reported compliance for rescreening with a standardized tool (80%), use of electrocardiograms (78% rarely use), and the use of routine additional testing (80% rarely use). Academic practitioners were more likely to rescreen (100% vs 79%, P < .05). Private practitioners more often used newer therapeutic agents (7% vs 44%, P < .01). Older graduates were more comfortable diagnosing at a young age (93% vs 56%, P < .01) and were more comfortable using sleep agents (60% vs 15%, P < .01). Conclusion. Pediatricians largely adhered to AAP guidelines. These findings support changes made to the guidelines in 2011. Differences in practice patterns exist by practitioner experience, location, and practice type.

Prevalence of intestinal protozoa in communities along the Lake Victoria region of Uganda.

The objective of this study was to assess water-borne parasite point prevalence in communities in close proximity to Lake Victoria in Uganda prior to the implementation of a clean water intervention, and to investigate possible associations of water source and latrine access with protozoan prevalence. Utilizing a rapid antigen test, parasite prevalence for Giardia lamblia and Entamoeba histolytica/dispar was determined from stool samples of individuals living in six Ugandan communities. Stool sample test results were stratified by the independent variables of gender, age, community, water source (improved or lake), and presence of a latrine. The impact of the independent variables on parasite prevalence was investigated with bivariable and multivariable analyses. The prevalence of Giardia (12%) was influenced by age and community of residence. The prevalence of Entamoeba (10%) did not significantly vary by the independent variables. The prevalence of intestinal protozoan parasites is significant in Ugandan communities bordering Lake Victoria. Interventions to continue to improve water sources remain a high priority. Rapid antigen testing is likely to be useful in the monitoring of water-borne parasite prevalence.

Variation in fruit juice consumption among infants and toddlers: associations with WIC participation.

Objectives Juice is a common component of a child’s diet. Excessive juice consumption may lead to adverse nutritional and dental outcomes. The objective of the study was to evaluate consumption patterns and parental perception regarding juice in a sample of children from families participating or not participating in Women, Infants, and Children (WIC) services. Methods Parents of children aged 12 months to 5 years completed a survey consisting of questions about beverage intake and related opinions. Practices were selected to provide a mix of families who do and do not use WIC services. Comparisons were made by WIC use and by quantity of juice consumption. Results Of 173 surveys, 51% of participants had received benefits from the WIC program. Overall, children who drank larger quantities of fruit juice drank less milk. One-third of all of the parents who responded to the survey reported that they believed that juice was at least as healthy as fresh fruit, with WIC parents reporting this belief more often (56% vs 9%; P < 0.01) than non-WIC parents. Two-thirds of all of the parents surveyed (66%) introduced juice before their child reached age 12 months, and this was more likely in WIC families (78% vs 54%; P < 0.05). Overall, 81% would prefer to receive fresh fruit as part of the WIC package. Conclusions Higher juice consumption is associated with decreased milk consumption. Many parents expressed a belief that juice was at least as healthful as fresh fruit. Being a WIC recipient was associated with an earlier introduction of juice into a child’s diet and a greater perception that juice was healthful.

Improving Immunization Rates at 18 Months of Age: Implications for Individual Practices

Objective. We sought to model the effect that a targeted immunization visit at 18 months of age could have on immunization rates of preschool-aged children in a sample of pediatric practices. Methods. We conducted retrospective chart reviews in six practices of all active patients aged 18–30 months. Up-to-date (UTD) status was defined as receipt of four diphtheria-tetanus-acellular pertussis, three polio, one measles-mumps-rubella, three hepatitis B, and one varicella vaccines. Haemophilus influenza tybe b vaccine was not included due to a shortage in vaccine supply during the time of the study. Practice vaccination rates were determined at 17 months, 18 months, and the age at assessment. Of those not UTD at 17 months, the percentage of children who could be brought UTD with one visit was calculated for each practice. This calculated rate was compared with the measured rate at 18 months of age and at the age of assessment. Results. At each practice, we reviewed 183–616 charts (median = 382). Observed UTD immunization rates at 17 months ranged from 26% to 64% (median = 38%) and increased 3 to 27 percentage points (median = 6) from age 17 months to 18 months and 9 to 39 percentage points (median = 17) from age 17 months to the age at assessment. A simulated vaccination visit at 18 months of age could improve the UTD rates from 27 to 61 percentage points (median = 44). Conclusion. Practice-based interventions aimed at encouraging an 18-month well-child visit that emphasizes delivery of vaccines have the potential to substantially increase timely vaccination rates among individual practices.

An Investigation of the Usability Issues of Home-based Video Telemedicine Systems with Geriatric Patients:

Telemedicine is the use of technology to provide and support healthcare when distance separates the clinical service and the patient. This system is rapidly replacing the conventional method of in-person clinical visits. More than seventy percent of the geriatric population is predicted to need long-term healthcare; telemedicine could potentially support their increased healthcare needs. However, for increased user acceptance, it is important to investigate the usability of telemedicine systems. This study aims to investigate the usability issues associated with geriatric patients using home-based video telemedicine systems. Four home-based video telemedicine systems were chosen for this study: (1) Doxy.me, (2) Polycom, (3) Vidyo and (4) VSee. Using a between-subjects experimental design, 20 participants were randomly assigned to one of these four conditions. They were asked to complete a demographic questionnaire, followed by the completion of representative tasks on the telemedicine platform. This is followed by a retrospective think-aloud session at the end of which, the participants completed a NASA-TLX workload survey, an IBM Computer System Usability Questionnaire (IBM-CSUQ), and a post-test subjective questionnaire. Issues faced by the participants include downloading application plug-ins, locating icons and the size of the icons.

Health Care Utilization Patterns for Young Children in Rural Counties of the I‐95 Corridor of South Carolina

OBJECTIVE The objective of this study was to assess health care utilization patterns for young children with Medicaid insurance in the rural counties of the I-95 corridor in South Carolina relative to other regions of the state. We hypothesize that young children received less well care and higher levels of tertiary care in the rural counties along the I-95 corridor (I-95) of South Carolina. DESIGN/METHODS A Medicaid cohort of children less than 3 years of age was used to compare Early, Periodic, Diagnosis, Screening and Treatment (EPSDT) visits; preventable emergency department (ED) visits; and inpatient visits between I-95, other rural and urban county groupings. RESULTS The adjusted odds of a child having had 80% of the recommended EPSDT visits were reduced for I-95 compared to other rural counties. The odds of a preventable inpatient or ED visit were increased for all rural counties, with the highest rates in the other rural counties. CONCLUSIONS Children accessed well care less in the I-95 corridor compared to other rural areas of South Carolina. Rural children accessed tertiary care more often than urban children, a finding most prominent outside the I-95 corridor, likely attributable to more available access of tertiary care in rural counties outside the I-95 corridor.

Patient preferences for direct-to-consumer telemedicine services: a nationwide survey

BackgroundDirect-to-consumer (DTC) telemedicine providers has the potential to change the traditional patient-physician relationship. Professional medical organizations recommend that telemedicine exist within the medical home. This study aims to understand patients’ preferences and desires for DTC telemedicine.MethodsWe conducted a nationwide survey of 4345 survey respondents demographically balanced to represent the United States adult population. The survey consisted of questions assessing the respondents’ attributes and their willingness and comfortability using telemedicine as well as the importance and desired attributes of a provider providing care via telemedicine.ResultsRelatively few respondents (3.5%) had ever had an online video visit with their care provider. Respondents were more willing to see their own provider via telemedicine than unwilling (52% vs. 25%). Additionally, respondents were less willing to use telemedicine to see a different provider from the same healthcare organization (35%) and were least willing to see a different provider from a different organization (19%). Forty-one percent of respondents felt it was unimportant that their current provider offer telemedicine, and only 15% would consider leaving their current provider to a new provider who offers telemedicine as an option. More than half (56%) of respondents felt it was important to have an established relationship with a provider they’re having a telemedicine visit with. Nearly two-thirds of respondents (60%) felt it was important for a telemedicine provider to have access to their health records.ConclusionsPatients prefer to use telemedicine with their own doctor with whom they have an established relationship.

Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas

Objectives This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed. Methods Medicaid claims data from 2012 for children in three South Carolina counties, categorized as urban, rural high resource, and rural low resource, were used to identify those who had been diagnosed as being overweight/obese during any encounter. Logistic and Poisson regressions were performed to predict whether overweight/obese children in each county would receive an overweight/obesity visit diagnosis and to calculate the mean rate of total office visits with an overweight/obesity diagnosis in each county. Results A total of 1233 children enrolled in Medicaid were diagnosed as being overweight/obese at any encounter in the designated counties. Well visits with overweight/obesity diagnosed varied significantly, with 42.6%, 28%, and 11% in urban, rural high-resource counties, and rural low-resource counties, respectively (P < 0.01). In the logistic regression rural high-resource children (adjusted odds ratio 0.58, 95% confidence interval 0.38–0.88) and rural low-resource children (adjusted odds ratio 0.16, 95% confidence interval 0.09–0.28) were less likely than urban children to be diagnosed as being overweight/obese at a well visit. All of the children had a low number of total office visits with overweight/obesity diagnosed. When comparing the counties, urban children (1.22 visits per year) had more visits than rural low-resource children (0.75 visits per year, P < 0.01) and rural high-resource children (0.89 visits per year, P < 0.01). Conclusions Overweight/obesity is underdiagnosed in rural children enrolled in Medicaid in South Carolina, which affects the number of children who receive help to manage their weight. Interventions to overcome barriers of diagnosis and management are necessary to address childhood obesity properly.

Feasibility of developing a pediatric telehealth network in Honduras with international consultation support

INTRODUCTION Honduras is the second poorest country in Central America, and roughly 50% of the population lives in rural areas. A telehealth network linking these areas to larger health centers may improve patient access to care, and physician access to educational opportunities. This pilot study assessed the feasibility of establishing a pediatric telehealth network between underserved clinics in Honduras and the Medical University of South Carolina (MUSC). METHODS Two underserved Honduran clinics were identified and invited to participate in the telehealth network. Providers from these clinics connected remotely to educational conferences at MUSC, and received teleconsults from MUSC physicians and physicians from the other Honduran site. Honduran providers completed five-point Likert scale satisfaction surveys following participation in the conferences and teleconsults. RESULTS Survey feedback was positive, with 100% of respondents stating they would utilize telemedicine in the future. Dissatisfaction was expressed subjectively in the survey comments with regards to poor Internet connectivity and unreliable electrical power. CONCLUSIONS The establishment of a telehealth network between Honduras and MUSC is feasible, and rural providers were receptive to the clinical and educational opportunities this network provides. Future projects will expand telehealth capabilities to other Honduran sites and focus on intra-country collaboration to ensure sustainability.