Telemedicine in haemophilia during COVID-19 and beyond: a comprehensive review

Abstract

Introduction Patients with haemophilia require regular assessments and physical examinations. The COVID-19 pandemic has resulted in the rapid adoption of telemedicine to enable virtual consultations and reduce hospital visits. However, the process of virtual consultations is new to many haemophilia clinics. A better understanding of best practices in telemedicine is important to ensure optimal quality of care for patients with haemophilia. Objectives To summarise the current literature on the use of direct-to-consumer telemedicine for patients with haemophilia and to describe the effectiveness and potential limitations of the technology and methods used. Methods A comprehensive search was conducted in MEDLINE and EMBASE databases using terms referring to the concepts “haemophilia” AND “telemedicine” and their synonyms. There were no time or language restrictions. Title, abstracts, and full texts were screened. Included articles involved telemedicine interventions to facilitate clinical services directly between patients and providers without the use of third-party personnel. The primary outcome was the satisfaction of providers and patients. Secondary outcomes included economic considerations and clinical outcomes. Information was extracted based on study-specific, patient-specific, intervention-specific, and outcome-specific data. Results Of the 925 articles screened, six were identified and summarised. Three described telemedicine within the context of COVID-19. Technologies used included telephone calls, videoconferencing, text messaging, and email. All studies involved a multidisciplinary team. Telemedicine in haemophilia care was found to positively impact the patient experience. Providers were satisfied with telemedicine. It was also suggested to be economically beneficial and positively impacted patient outcomes. However, none of the articles reported on how telemedicine was specifically used to perform assessments during the virtual consultation process. Conclusions There is preliminary evidence that telemedicine may be beneficial in haemophilia care. Overall, patients and providers reported high satisfaction with the usage of direct-to-consumer telemedicine. This positive reception warrants improvements in standardisation of reporting and quality of study design to better assess its clinical and economic impact. Developing a standard guideline for virtual consultations would support healthcare practitioners in how to best incorporate telemedicine to improve quality of care.

Does the method of telehealth delivery affect the physiotherapy management of adults with bleeding disorders? A comparison of audioconferencing and videoconferencing

“…Both methods present different advantages and limitations relating to cost, equipment, technical knowledge, clinical information gathered, continuity of care, confidentiality and building of rapport 19–21 . In particular, the use of videoconferencing can be limited by lack of expertise, lack of education, technical difficulties, legal barriers, lack of resources, and patient/practitioner preferences 9,17,18 …”

“…Telehealth is defined as medical information transferred electronically from one site to another to improve a patient's health 6 . This technology has emerged as a means to improve health outcomes for those with bleeding disorders by addressing barriers to specialized services 7–9 . These barriers are largely related to geographics, due to the limitation of specialist treatment centres to major metropolitan areas 10,11 .…”

“…[19][20][21] In particular, the use of videoconferencing can be limited by lack of expertise, lack of education, technical difficulties, legal barriers, lack of resources, and patient/practitioner preferences. 9,17,18 There is limited research directly comparing audioconferencing and videoconferencing in the physiotherapy management of bleeding disorders. In a survey of physiotherapists involved in haemophilia care, Flannery et al 16 reported anecdotal evidence suggesting videoconferencing altered management and improved patient outcomes when compared to audioconferencing.…”

“…6 This technology has emerged as a means to improve health outcomes for those with bleeding disorders by addressing barriers to specialized services. [7][8][9] These barriers are largely related to geographics, due to the limitation of specialist treatment centres to major metropolitan areas. 10,11 Other barriers to access relate to the recent COVID-19 pandemic restrictions, as well as economic, environmental, and societal factors.…”