Inclusive innovation in telehealth

Noel, Kimberly; Ellison, Brooke

doi:10.1038/s41746-020-0296-5

Cited by 37 publications

(32 citation statements)

References 4 publications

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“…We note telemedicine might appear to be a solution to connect the more vulnerable and less mobile to healthcare providers, patients may be excluded by the infrastructure of available telecommunications networks at sufficient speeds, or by lack of digital literacy or access to equipment. Those who could see the greatest benefit through this shift towards telehealth offerings, such as the elderly and disabled, paradoxically could be less likely to be able to access these services [18] .…”

Section: Discussionmentioning

confidence: 99%

Safety of video-based telemedicine compared to in-person triage in emergency ophthalmology during COVID-19

Thomas

Kilduff

et al. 2021

EClinicalMedicine

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Background the need for social distancing midst the COVID-19 pandemic has forced ophthalmologists to innovate with telemedicine. The novel process of triaging emergency ophthalmology patients via videoconsultations should reduce hospital attendances. However, the safety profile of such services were unknown. Methods in this retrospective cohort study, we reviewed case notes of 404 adults who used our videoconsultation service from 20/04/2020 to 03/05/2020. We compared these to 451 patient who attended eye casualty in person at the same time who were deemed not to require same day ophthalmic examination. Findings patients seen by videoconsultations tended to be younger (Median = 43 years, Inter-quartile range = 27 vs Median= 49 years, Inter-quartile range = 28)'. More males used the face-to-face triage (55%) while more females used videoconsultation (54%)%. Fewer patients seen by videoconsultations required specialist review compared to face-face triage [ X 2 (1, N = 854) = 128.02, p <0.001)]. 35.5% of the patients initially seen by videoconsultation had unplanned reattendance within 1 month, compared to 15.7% in the group initially seen in person. X 2 (1, N = 234) = 7.31, p = 0.007). The rate of actual harm was no different (at 0% for each method), with perfect inter-grader correlation when graded independently by two senior ophthalmologists. 97% of patients seen on the video platform surveyed were satisfied with their care. Interpretation we demonstrate comparable patient safety of videoconsultations at one-month follow-up to in person review. The service is acceptable to patients and reduces the risk of COVID-19 transmission. We propose that videoconsultations are effective and desirable as a tool for triage in ophthalmology. Funding the research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology who fund PT and DS's time to conduct research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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Section: Discussionmentioning

confidence: 99%

Safety of video-based telemedicine compared to in-person triage in emergency ophthalmology during COVID-19

Thomas

Kilduff

et al. 2021

EClinicalMedicine

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“…99 100 For instance, the European Disability Forum recommends that all information is provided in plain, easy-to-read language, alternative methods are provided for those who communicate by different means or who do not have access to certain technologies (eg, video, telephone, email/messaging services), and the accessibility needs of different groups (including younger children) are considered—for example, appropriate sign language interpretation or captioning and symbols. 101 Some of these recommendations require that the care provider has specialist training on supporting autistic people and those with intellectual disability, and all require future research into their efficacy in everyday clinical practice.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 health and social care access for autistic people: European policy review

et al. 2021

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BackgroundThe global COVID-19 pandemic has had an unprecedented impact on European health and social care systems, with demands on testing, hospital and intensive care capacity exceeding available resources in many regions. This has led to concerns that some vulnerable groups, including autistic people, may be excluded from services.MethodsWe reviewed policies from 15 European member states, published in March–July 2020, pertaining to (1) access to COVID-19 tests; (2) provisions for treatment, hospitalisation and intensive care units (ICUs); and (3) changes to standard health and social care. In parallel, we analysed survey data on the lived experiences of 1301 autistic people and caregivers.ResultsAutistic people experienced significant barriers when accessing COVID-19 services. First, despite being at elevated risk of severe illness due to co-occurring health conditions, there was a lack of accessibility of COVID-19 testing. Second, many COVID-19 outpatient and inpatient treatment services were reported to be inaccessible, predominantly resulting from individual differences in communication needs. Third, ICU triage protocols in many European countries (directly or indirectly) resulted in discriminatory exclusion from lifesaving treatments. Finally, interruptions to standard health and social care left over 70% of autistic people without everyday support.ConclusionsThe COVID-19 pandemic has further exacerbated existing healthcare inequalities for autistic people, probably contributing to disproportionate increases in morbidity and mortality, mental health and behavioural difficulties, and reduced quality of life. An urgent need exists for policies and guidelines on accessibility of COVID-19 services to be updated to prevent the widespread exclusion of autistic people from services, which represents a violation of international human rights law.

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“…For instance, the European Disability Forum recommends that: all information is provided in plain, easy-read language; alternative methods are provided for those who communicate by different means or who do not have access to certain technologies (e.g. video, telephone, email/ messaging services); and the accessibility needs of different groups (including younger children) are consideredfor example, appropriate sign language interpretation/ captioning and symbols (114). Some of these recommendations require that the care provider has specialist training on supporting autistic people and those with ID and all require future research into their efficacy in everyday clinical practice.…”

Section: Access To Treatment Hospitalisation and Intensive Carementioning

confidence: 99%

COVID-19 health and social care access for autistic people and individuals with intellectual disability: A European policy review.

Oakley¹,

Tillmann²,

Ruigrok³

et al. 2020

Preprint

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Background: The global COVID-19 pandemic has had an unprecedented impact on European health and social care systems, with demands on testing, hospital and intensive care capacity exceeding available resources in many regions. This has led to concerns that some groups, including autistic people/ those with intellectual disability (ID), may become excluded from services. Methods: We reviewed policies from 15 European member states, published March-July 2020, pertaining to: 1) accessibility of COVID-19 testing; 2) provisions for treatment, hospitalisation and intensive care units (ICU); and 3) changes to standard health and social care. In parallel, we analysed survey data on the lived experiences of 1,301 autistic people and caregivers.Results: Autistic people/ those with ID experienced significant barriers accessing COVID-19 services. First, despite these groups being at elevated risk for severe illness due to co-morbid health conditions, there was a lack of access to COVID-19 testing. Second, many COVID-19 outpatient and inpatient treatment services were reported to be inaccessible - predominantly resulting from individual differences in communication needs. Third, ICU triage protocols (directly or indirectly) resulted in discriminatory exclusion from lifesaving treatments. Last, interruptions to standard health and social care left over 70% of autistic people without everyday support.Conclusions: The COVID-19 pandemic has further emphasised healthcare inequalities for autistic people/ those with ID, likely contributing to disproportionate increases in morbidity and mortality in these groups. Current policies and guidelines regarding the accessibility of COVID-19 services require urgent revision to prevent the widespread exclusion of autistic people and those with ID from services, which represents a violation of international human rights law.

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Inclusive innovation in telehealth

Cited by 37 publications

References 4 publications

Safety of video-based telemedicine compared to in-person triage in emergency ophthalmology during COVID-19

Safety of video-based telemedicine compared to in-person triage in emergency ophthalmology during COVID-19

COVID-19 health and social care access for autistic people: European policy review

COVID-19 health and social care access for autistic people and individuals with intellectual disability: A European policy review.

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