@Article{info:doi/10.2196/63260, author="Hansson, Helena and Castor, Charlotte and Larsen, B{\ae}kgaard Hanne and Topperzer, Krogh Martha and Olesen, Linnet Mette", title="Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals", journal="JMIR Pediatr Parent", year="2025", month="Mar", day="13", volume="8", pages="e63260", keywords="pediatrics", keywords="digital", keywords="interventions", keywords="eHealth", keywords="home care", keywords="intravenous infusion", keywords="qualitative research", abstract="Background: With the provision of home infusion therapy in children with acute or long-term illness on the rise, eHealth technologies have the potential to bridge the transition between hospital and home. However, eHealth interventions intended to support parents in managing home infusion therapy are sparse. Gaining insight into the needs and experiences of parents and health care professionals is crucial to developing feasible and sustainable eHealth interventions that target their needs. This study describes the first phase of a research study designed to develop and evaluate an eHealth intervention to support home infusion therapy. Objective: This study aimed to identify the experiences and needs of parents and health care professionals during home infusion therapy and their preferences for digital features in a future eHealth intervention. Methods: A qualitative study was conducted at 3 pediatric departments at a university hospital in Denmark. We individually interviewed 17 parents of 14 children who had received home infusion therapy with a portable pump. In addition, 5 focus groups were conducted with 15 health care professionals. We conducted a qualitative content analysis of the data, which we collected from February to July 2020. Results: We identified 6 subthemes that we merged into 3 main themes: increasing safe self-management at home; adapting information and responsibility to individual changing needs; and requesting digital features to ensure skill level, safety, and quality of care. The analysis showed that parents and health care professionals had corresponding needs and preferences, for example, a need for a high sense of safety and easier ways to communicate during home infusion therapy. Both groups emphasized the need for digital features to improve problem-solving and communication as a supplement to existing care to promote a safe environment, self-management, and quality of care. A vital issue was that an eHealth intervention should be aligned with the workflow of health care professionals and comply with regulations regarding confidentiality in communication and data sharing. Conclusions: Our study highlights the needs that parents and health care professionals have for increased safety and easier access to communication when receiving and providing home infusion therapy. The findings will be used to help develop an eHealth intervention supporting home infusion therapy tailored to individual needs. ", doi="10.2196/63260", url="https://pediatrics.jmir.org/2025/1/e63260" } @Article{info:doi/10.2196/65751, author="Asan, Onur and Super, Ilse and Percy, Stephen and Clouser, N. Katharine", title="The Effect of COVID-19 on Health Care Utilization Among Children with Medical Complexity: Retrospective Chart Review Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="28", volume="8", pages="e65751", keywords="children with medical complexity", keywords="pediatric", keywords="children", keywords="health care utilization", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="COVID-19", keywords="SARS-COV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="pandemic", keywords="chart review", keywords="chart review study", keywords="retrospective chart review", keywords="retrospective chart review study", doi="10.2196/65751", url="https://pediatrics.jmir.org/2025/1/e65751" } @Article{info:doi/10.2196/57702, author="Pathak, R. Priya and Stockwell, S. Melissa and Lane, M. Mariellen and Robbins-Milne, Laura and Friedman, Suzanne and Pethe, Kalpana and Krause, C. Margaret and Soren, Karen and Matiz, Adriana Luz and Solomon, B. Lauren and Burke, E. Maria and Bracho-Sanchez, Edith", title="Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="17", volume="7", pages="e57702", keywords="telemedicine", keywords="telehealth", keywords="pediatric primary care", keywords="COVID-19 pandemic", keywords="disparities", keywords="primary care", keywords="pediatrics", keywords="portals", keywords="access", keywords="accessibility", keywords="accessible", keywords="use", keywords="demographics", keywords="low income", keywords="Latino", keywords="Hispanic", keywords="Spanish", keywords="mobile phone", abstract="Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. Methods: A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. Results: There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4\% (n=8959) of the population. Nearly all patients (n=10,830, 87.5\%) had an activated portal, and 33.8\% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95\% CI 0.51-0.76; 5-11 years: aOR 0.28, 95\% CI 0.23-0.32; 12-14 years: aOR 0.29, 95\% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95\% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95\% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95\% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95\% CI 0.74-0.89 and aOR 0.71, 95\% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1\%), dermatology (n=1287, 19.5\%), gastrointestinal (n=771, 11.7\%), well and follow-up care (n=459, 7\%), and other specialty-related care (n=415, 6.3\%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. Conclusions: The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations. ", doi="10.2196/57702", url="https://pediatrics.jmir.org/2024/1/e57702" } @Article{info:doi/10.2196/60610, author="Wagenaar, Josephine and Mah, Crystal and Bodell, Fredrik and Reiss, Irwin and Kleinsmann, Maaike and Obermann-Borst, Sylvia and Taal, Rob H.", title="Opportunities for Telemedicine to Improve Parents' Well-Being During the Neonatal Care Journey: Scoping Review", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="2", volume="7", pages="e60610", keywords="telemedicine", keywords="telehealth", keywords="neonatal care", keywords="parental well-being", keywords="family-centered care", keywords="pediatrics", keywords="neonates", keywords="newborns", keywords="parents", keywords="neonatal intensive care unit", keywords="NICU", abstract="Background: Neonatal intensive care unit admissions of newborns are emotional and stressful for parents, influencing their mental and physical well-being and resulting in high rates of psychological morbidities. Significant research has been undertaken to understand and quantify the burden of a newborn's medical journey on parents' well-being. Simultaneously, an increase has been observed in the development and implementation of telemedicine interventions, defined as the remote delivery of health care. Telemedicine is used as an overarching term for different technological interventions grouped as real-time audio-visual communication, remote patient monitoring, and asynchronous communication. Various telemedicine interventions have been proposed and developed but scarcely with the primary goal of improving parental well-being during their newborn's medical journey. Objective: This study aims to identify telemedicine interventions with the potential to improve parents' well-being and to present the methods used to measure their experience. Methods: A scoping review was conducted, including empirical studies evaluating telemedicine in neonatal care that either measured parental well-being or included parents in the evaluation. Abstract and title screening, full-text screening, and data extraction were performed by three researchers. Two researchers were needed to reach decisions on both the inclusion and extraction of articles. Results: The review included 50 out of 737 screened articles. Telemedicine interventions focused mainly on daily visits at the neonatal intensive care unit and discharge preparedness for parents. Surveys were the primary tool used for outcome measurement (36/50, 72\%). Aspects of parents' well-being were evaluated in 62\% (31/50) of studies. Telemedicine interventions developed to provide education and support showed a potential to improve self-efficacy and discharge preparedness and decrease anxiety and stress when they included a real-time telemedicine component. Conclusions: This scoping review identified specific telemedicine interventions, such as real-time audio-visual communication and eHealth apps, that have the potential to improve parental well-being by enhancing self-efficacy and discharge preparedness, and reducing anxiety and stress. However, more insights are needed to understand how these interventions affect well-being. Parents should be included in future research in both the development and evaluation stages. It is important to not only measure parents' perceptions but also focus on the impact of a telemedicine intervention on their well-being. ", doi="10.2196/60610", url="https://pediatrics.jmir.org/2024/1/e60610" } @Article{info:doi/10.2196/57814, author="Wang, Yipei and Zhang, Pei and Xing, Yan and Shi, Huifeng and Cui, Yunpu and Wei, Yuan and Zhang, Ke and Wu, Xinxia and Ji, Hong and Xu, Xuedong and Dong, Yanhui and Jin, Changxiao", title="Telemedicine Integrated Care Versus In-Person Care Mode for Patients With Short Stature: Comprehensive Comparison of a Retrospective Cohort Study", journal="J Med Internet Res", year="2024", month="Nov", day="19", volume="26", pages="e57814", keywords="telemedicine", keywords="telemedicine integrated care mode", keywords="short stature", keywords="clinical outcomes", keywords="health-seeking behaviors", keywords="cost analysis", keywords="in-person care", keywords="mobile health", keywords="mHealth", keywords="telehealth", keywords="eHealth", keywords="video virtual visit", keywords="access to care", keywords="children", keywords="pediatrics", keywords="China", keywords="accessibility", keywords="temporal", keywords="spatial constraints", keywords="chronic disease", abstract="Background: Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent. Objective: This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China. Methods: Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43\% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase. Results: In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group ($\Delta$zTIC=0.74) was more substantial than that for the IPC group ($\Delta$zIPC=0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group's visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits. Conclusions: We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results. ", doi="10.2196/57814", url="https://www.jmir.org/2024/1/e57814" } @Article{info:doi/10.2196/58663, author="Carter, Michela and Linton, C. Samuel and Zeineddin, Suhail and Pitt, Benjamin J. and De Boer, Christopher and Figueroa, Angie and Gosain, Ankush and Lanning, David and Lesher, Aaron and Islam, Saleem and Sathya, Chethan and Holl, L. Jane and Ghomrawi, MK Hassan and Abdullah, Fizan", title="Impact of Consumer Wearables Data on Pediatric Surgery Clinicians' Management: Multi-Institutional Scenario-Based Usability Study", journal="JMIR Perioper Med", year="2024", month="Nov", day="12", volume="7", pages="e58663", keywords="postoperative care", keywords="telehealth", keywords="consultation", keywords="remote", keywords="appendectomy", keywords="pediatric hospital", keywords="children", keywords="wearable device", keywords="minimally invasive surgery", keywords="pediatric surgery", keywords="remote simulation study", abstract="Background: At present, parents lack objective methods to evaluate their child's postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent's subjective assessment of the child's health status and the child's ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment. Objective: This multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians' management. Methods: In total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children's hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making. Results: In total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76\% (19/25) to 88\% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations. Conclusions: The addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians' remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use. ", doi="10.2196/58663", url="https://periop.jmir.org/2024/1/e58663" } @Article{info:doi/10.2196/48664, author="Gulzar, Saleema and Rahim, Shirin and Dossa, Khadija and Saeed, Sana and Agha, Insiyah and Khoja, Shariq and Karmaliani, Rozina", title="Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="12", volume="8", pages="e48664", keywords="teleconsultation", keywords="digital health", keywords="school health", keywords="child health", keywords="information technology", keywords="eConsultation", keywords="telehealth", abstract="Background: In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3\%, 233/393). Only 1.24\% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. ", doi="10.2196/48664", url="https://formative.jmir.org/2024/1/e48664" } @Article{info:doi/10.2196/52557, author="Reynaud, Danielle and Bouscaren, Nicolas and Cartron, Emmanuelle and Marimoutou, Catherine", title="Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="1", volume="7", pages="e52557", keywords="sexual health", keywords="adolescent", keywords="young adults", keywords="web application", keywords="contraception prescription", keywords="contraception", keywords="teleconsultation", keywords="telemedicine", keywords="youth", keywords="usage", keywords="e-consultation", keywords="web based", abstract="Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36\%), receive an initial birth control prescription (12/22, 55\%), and inquire about condom prescriptions (2/22, 9\%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. ", doi="10.2196/52557", url="https://pediatrics.jmir.org/2024/1/e52557" } @Article{info:doi/10.2196/54598, author="McCullough, May Julie Elizabeth and Sinclair, Marlene and Gillender, Jonathan and McCrossan, Brian and Slater, F. Paul and Browne, Rosie and Casey, Frank", title="Touching Technology---Parents' Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="22", volume="7", pages="e54598", keywords="congenital heart disease", keywords="pediatric cardiology", keywords="pediatric cardiologist", keywords="pediatric", keywords="parent", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="remote consultation", keywords="telephone consultation", keywords="video consultation", keywords="remote patient monitoring", keywords="technology acceptance", keywords="videoconferencing consultations", abstract="Background: Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. Objective: This project aimed to investigate parents' experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. Methods: This study's design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual's intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents' experiences were explored using recorded interviews and analyzed thematically. Results: In total, 29 children aged 4?1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents' prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child's medical team. Furthermore, parents noted the savings on time, money, and childcare. Conclusions: While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents. ", doi="10.2196/54598", url="https://pediatrics.jmir.org/2024/1/e54598" } @Article{info:doi/10.2196/59246, author="Hughes Lansing, Amy and Cohen, B. Laura and Glaser, S. Nicole and Loomba, A. Lindsey", title="Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Oct", day="21", volume="8", pages="e59246", keywords="type 1 diabetes", keywords="children", keywords="family support", keywords="family dynamics", keywords="web-based intervention", keywords="feasibility", keywords="acceptability", keywords="self-guided", keywords="intervention", keywords="diabetes", keywords="RCT", keywords="randomized controlled trial", keywords="psychosocial", keywords="well-being", keywords="caregiver", keywords="communication", abstract="Background: Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. Objective: We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. Methods: We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. Results: A total of 31 (84\%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81\%) completed some content and 15 (48\%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83\%) chose to have all sessions delivered at once and 3 (17\%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. Conclusions: In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. Trial Registration: ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912 ", doi="10.2196/59246", url="https://formative.jmir.org/2024/1/e59246" } @Article{info:doi/10.2196/63858, author="Wisniewski, Payson and Depuy, Julia and Kim, Cassandra and Garrison, Olivia and Jerome, J. Gerald", title="Supporting Weight Loss Among Parents of Children With a Disability: Lessons Learned From a Single-Arm Pilot Study", journal="JMIR Form Res", year="2024", month="Oct", day="7", volume="8", pages="e63858", keywords="weight loss", keywords="obesity", keywords="disability", keywords="parent", keywords="family", keywords="child", keywords="weight loss intervention", doi="10.2196/63858", url="https://formative.jmir.org/2024/1/e63858", url="http://www.ncbi.nlm.nih.gov/pubmed/39374058" } @Article{info:doi/10.2196/58579, author="Ferber, Christopher and Mittelman, D. Steven and Moin, Tannaz and Wilhalme, Holly and Hicks, Rebecca", title="Impact of Telemedicine Versus In-Person Pediatric Outpatient Type 1 Diabetes Visits on Immediate Glycemic Control: Retrospective Chart Review", journal="JMIR Diabetes", year="2024", month="Oct", day="1", volume="9", pages="e58579", keywords="diabetes", keywords="type 1 diabetes", keywords="pediatrics", keywords="continuous glucose monitoring", keywords="time in range", keywords="glucose management indicator", keywords="telemedicine", keywords="screening labs", abstract="Background: Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic. Objective: To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence. Methods: A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined. Results: A total of 269 outpatient visits (41.2\% telemedicine) were included. Mean time in range increased by 1.63\% and 1.35\% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07\% and 0.06\% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze. Conclusions: Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment. ", doi="10.2196/58579", url="https://diabetes.jmir.org/2024/1/e58579" } @Article{info:doi/10.2196/59475, author="Loo, Theoren and Altman, Myra and Grodberg, David and La Guardia, Jennifer and Bravata, Dena", title="Telebehavioral Health for Caregivers of Children With Behavioral Health Needs to Address Caregiver Strain: Cohort Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="26", volume="7", pages="e59475", keywords="adolescent", keywords="child", keywords="caregiver", keywords="family health", keywords="resilience", keywords="psychological", keywords="mental health", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="children", keywords="youth", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="strain", keywords="burden", keywords="caregiving", keywords="caregivers", keywords="carer", keywords="carers", keywords="informal care", keywords="family care", keywords="spousal care", keywords="telehealth", keywords="telemedicine", keywords="technology-enabled", keywords="mobile phone", abstract="Background: Behavioral health conditions among children have worsened over the past decade. Caregivers for children with behavioral health conditions are at risk for two types of caregiver strain: (1) an objective strain, that results directly from the child's condition and (2) subjective strain, that arises from the caregiver's feelings regarding these events. Objective: This study aimed to evaluate the impact of a technology-enabled pediatric and family behavioral health service on caregivers' strain among a commercially insured population. We also explore the common symptom clusters of caregiver strain to better understand the caregiver presentation to inform future care planning. Methods: We examined changes in caregiver strain using the Caregiver Strain Questionnaire-Short Form 7 over the course of their child's web-based behavioral health care between 2021 and 2023 using a pre-post study design. Common caregiver strain symptom clusters were identified using Ward hierarchical agglomerative clustering. Results: The majority of children were White 60.8\% (1002/1647), female 53.6\% (882/1647), and aged between 5 and 9 years (33.7\%, 555/1647). Families fall broadly into 4 groups based on what drives caregiver strain the most, namely those experiencing (1) disrupted family relationships and time interruption, (2) missed work, (3) worried about their child's future and feeling tired and sad, and (4) financial strain. Caregiver strain, which was associated with the child's disease severity (P<.001), decreased significantly in all therapeutic groups. Conclusions: Web-based family-oriented behavioral health care can improve caregiver strain and reduce family and time disruptions, missed work, and financial strain. Sources of caregiver strain vary and may be overlooked when relying on the conventional scoring of the Caregiver Strain Questionnaire-Short Form 7. ", doi="10.2196/59475", url="https://pediatrics.jmir.org/2024/1/e59475" } @Article{info:doi/10.2196/54942, author="Oppelaar, C. Martinus and Emond, Yvette and Bannier, E. Michiel A. G. and Reijers, E. Monique H. and van der Vaart, Hester and van der Meer, Renske and Altenburg, Josje and Conemans, Lennart and Rottier, L. Bart and Nuijsink, Marianne and van den Wijngaart, S. Lara and Merkus, M. Peter J. F. and Heinen, Maud and Roukema, Jolt", title="Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care", journal="J Med Internet Res", year="2024", month="Aug", day="6", volume="26", pages="e54942", keywords="telemonitoring", keywords="digital health", keywords="chronic respiratory diseases", keywords="telespirometry", keywords="interviews", keywords="mixed methods", keywords="qualitative study", keywords="remote monitoring", keywords="evaluation", keywords="cystic fibrosis", keywords="pediatrics", keywords="mixed method", keywords="observational study", keywords="health care professionals", keywords="semistructured interview", keywords="psychosocial", keywords="clinicians", keywords="researchers", keywords="policy makers", keywords="telehealth", abstract="Background: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). Objective: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. Methods: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. Results: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65\% (24/37) of HCPs and 89\% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61\%; HCPs: 21/24, 88\%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92\%) and HCPs (22/24, 92\%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17\% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82\%) and HCPs (22/24, 92\%) wanted to keep using the RMP in future, with 79\% (19/24) of HCPs and 75\% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. Conclusions: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs. ", doi="10.2196/54942", url="https://www.jmir.org/2024/1/e54942", url="http://www.ncbi.nlm.nih.gov/pubmed/39106098" } @Article{info:doi/10.2196/51538, author="Zhang, Kun and Huang, Qiyuan and Wang, Qiaosong and Li, Chengyang and Zheng, Qirong and Li, Zhuoyue and Xu, Dan and Xie, Cuiling and Zhang, Mingqi and Lin, Rongjin", title="Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Jul", day="9", volume="26", pages="e51538", keywords="telemedicine", keywords="digital health", keywords="web-based", keywords="type 1 diabetes mellitus", keywords="children", keywords="adolescents", keywords="glycemic control", keywords="chronic disease management", keywords="randomized controlled trials", keywords="meta-analysis", keywords="mobile phone", abstract="Background: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. Objective: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. Methods: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. Results: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5\% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95\% CI --0.33 to --0.10; P<.001; I2=35\%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95\% CI --0.72 to 1.80; P=.40; I2=67.8\%) and the incidence of hypoglycemia (MD --0.15, 95\% CI --0.57 to 0.27; P=.49; I2=70.7\%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non--youth-specific quality of life (MD --0.24, 95\% CI --0.45 to --0.02; P=.04; I2=0\%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD --0.41, 95\% CI --0.62 to --0.20; P<.001), studies that lasted <6 months (MD --0.32, 95\% CI --0.48 to --0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD --0.37, 95\% CI --0.53 to --0.21; P<.001), and studies with medication dose adjustment (MD --0.25, 95\% CI --0.37 to --0.12; P<.001). Conclusions: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life. ", doi="10.2196/51538", url="https://www.jmir.org/2024/1/e51538" } @Article{info:doi/10.2196/51743, author="G{\'o}mez-Valverde, J. Juan and S{\'a}nchez-Jacob, Ram{\'o}n and Rib{\'o}, Luis Jos{\'e} and Schaaf, Simon H. and Garc{\'i}a Delgado, Lara and Hernanz-Lobo, Alicia and Capell{\'a}n-Mart{\'i}n, Daniel and Lancharro, {\'A}ngel and Augusto, Orvalho and Garc{\'i}a-Basteiro, L. Alberto and Santiago-Garc{\'i}a, Bego{\~n}a and L{\'o}pez-Varela, Elisa and Ledesma-Carbayo, J. Mar{\'i}a", title="Chest X-Ray--Based Telemedicine Platform for Pediatric Tuberculosis Diagnosis in Low-Resource Settings: Development and Validation Study", journal="JMIR Pediatr Parent", year="2024", month="Jul", day="1", volume="7", pages="e51743", keywords="telemedicine", keywords="telehealth", keywords="pediatric tuberculosis", keywords="tuberculosis", keywords="screening", keywords="chest radiograph", keywords="usability", keywords="low-resource settings", abstract="Background: Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. Objective: This study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. Methods: The platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. Results: The platform's usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3\%-28.2\%) but high specificity (91.1\%-98.2\%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification ($\chi$21>20.38, P<.001). The study found varying levels of interreader agreement, with moderate/substantial agreement for air space opacification ($\kappa$=0.54-0.67) and pleural effusion ($\kappa$=0.43-0.72). Conclusions: Our findings support the promising role of telemedicine platforms such as BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies. ", doi="10.2196/51743", url="https://pediatrics.jmir.org/2024/1/e51743", url="http://www.ncbi.nlm.nih.gov/pubmed/38949860" } @Article{info:doi/10.2196/57849, author="So, Hei Jeffrey Tsz and Nambiar, Smita and Byrne, Rebecca and Gallegos, Danielle and Baxter, A. Kimberley", title="Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops", journal="JMIR Pediatr Parent", year="2024", month="May", day="30", volume="7", pages="e57849", keywords="co-design", keywords="fathers", keywords="child nutrition", keywords="child feeding", keywords="intervention design", keywords="digital delivery", keywords="parenting", keywords="participatory", keywords="videoconference", keywords="communication technology", abstract="Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation--Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. ", doi="10.2196/57849", url="https://pediatrics.jmir.org/2024/1/e57849", url="http://www.ncbi.nlm.nih.gov/pubmed/38815260" } @Article{info:doi/10.2196/49943, author="Castillo-Rodenas, Marta and Vicente G{\'o}mez, {\'A}ngel Jos{\'e} and Fuster-Casanovas, A{\"i}na and Mir{\'o} Catalina, Queralt and Vidal-Alaball, Josep and L{\'o}pez Segu{\'i}, Francesc", title="Impact of COVID-19 on the Pediatric Primary Care Model in Catalonia: Analysis of Changes in the Number and Type of Face-to-Face and Remote Visits", journal="JMIR Pediatr Parent", year="2024", month="Mar", day="15", volume="7", pages="e49943", keywords="COVID-19", keywords="remote consultation", keywords="primary health care", keywords="digital health", keywords="pediatric", keywords="face-to-face", keywords="telemedicine", abstract="Background: The outbreak of COVID-19 has turned the care model of health systems around the world upside down. The health care crisis has led to opportunities for digital health to deliver quality care, and the system has been redirected toward telemedicine. In Catalonia, Spain, as of March 2020, the pattern of visits in primary care pediatric consultations changed, such that face-to-face visits decreased in favor of non--face-to-face visits. Objective: This study aimed to analyze variations in the types of pediatric visits in primary care centers in Catalonia before and after the onset of COVID-19. Methods: This was a descriptive observational study based on administrative data. The number and type of visits to primary care pediatric services in Catalonia between January 2019 and December 2022 were studied. Results: A drop of more than 80\% in face-to-face visits and an increase of up to 15 times in remote visits were observed as of March 2020 compared to the previous year. Subsequently, the face-to-face attendance rate began to recover, although it did not reach the same rate as before COVID-19. Non--face-to-face visits were maintained, representing more than 20\% of the total after more than 2 years of the pandemic. Conclusions: COVID-19 has been the trigger for a transition in the types of visits to primary care pediatric services. The COVID-19 pandemic was a clear catalyst for the integration of telemedicine in Catalan pediatric health care. In this context, although face-to-face consultations have recovered in absolute numbers, after the pandemic period, the weight of telemedicine has increased. ", doi="10.2196/49943", url="https://pediatrics.jmir.org/2024/1/e49943" } @Article{info:doi/10.2196/46637, author="Fischer-Grote, Linda and F{\"o}ssing, Vera and Aigner, Martin and Fehrmann, Elisabeth and Boeckle, Markus", title="Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis", journal="JMIR Ment Health", year="2024", month="Feb", day="5", volume="11", pages="e46637", keywords="COVID-19 pandemic", keywords="online/digital mental health intervention", keywords="e-mental health", keywords="anxiety", keywords="social functioning", keywords="depression", keywords="well-being", keywords="psychological distress", keywords="eating disorder", keywords="COVID-19 symptoms", abstract="Background: The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. Objective: This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. Methods: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. Results: We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95\% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95\% CI --0.68 to --0.17) and a large significant effect for depression (SMD=1.31, 95\% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19--related symptoms were found. Conclusions: The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required. ", doi="10.2196/46637", url="https://mental.jmir.org/2024/1/e46637", url="http://www.ncbi.nlm.nih.gov/pubmed/38315524" } @Article{info:doi/10.2196/49170, author="Burns, K. Sarah and Krishnamurti, Tamar and Doan, T. Tran and Hanmer, Janel and Hoberman, Alejandro and Kahn, M. Jeremy and Schweiberger, Kelsey and Ray, N. Kristin", title="Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study", journal="JMIR Pediatr Parent", year="2024", month="Jan", day="16", volume="7", pages="e49170", keywords="telemedicine", keywords="telehealth", keywords="acute care", keywords="acute", keywords="pediatrics", keywords="pediatric", keywords="family medicine", keywords="family-centered", keywords="child", keywords="children", keywords="parent", keywords="parents", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="expectation", keywords="expectations", abstract="Background: Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). Objective: This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. Methods: We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Results: Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7\% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7\% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). Conclusions: In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care--based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care. ", doi="10.2196/49170", url="https://pediatrics.jmir.org/2024/1/e49170", url="http://www.ncbi.nlm.nih.gov/pubmed/38227360" } @Article{info:doi/10.2196/45896, author="van der Kamp, R. Matti{\`e}nne and Hengeveld, S. Vera and Brusse-Keizer, J. Marjolein G. and Thio, J. Boony and Tabak, Monique", title="eHealth Technologies for Monitoring Pediatric Asthma at Home: Scoping Review", journal="J Med Internet Res", year="2023", month="Jul", day="21", volume="25", pages="e45896", keywords="telemedicine", keywords="wearable electronic devices", keywords="asthma", keywords="child", keywords="pediatrics", keywords="internet-based interventions", keywords="monitoring", keywords="computers", keywords="hand-held device", keywords="medication", keywords="spirometry", abstract="Background: eHealth monitoring technologies offer opportunities to more objectively assess symptoms when they appear in daily life. Asthma is the most common chronic disease in childhood with an episodic course, requiring close follow-up of pediatric asthma control to identify disease deterioration, prevent exacerbations, and enhance quality of life. eHealth technologies in pediatric asthma care show promising results regarding feasibility, acceptability, and asthma-related health outcomes. However, broad systematic evaluations of eHealth technologies in pediatric asthma are lacking. Objective: The objective of this scoping review was to identify the types and applications of eHealth technologies for monitoring and treatment in pediatric asthma and explore which monitoring domains show the most relevance or potential for future research. Methods: A scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic and comprehensive search was performed on English papers that investigated the development, validation, or application of eHealth technologies for home monitoring or treatment of pediatric asthma in the following databases: PubMed, Cochrane Library, IEEE, Scopus, CINAHL, PsycINFO, and ACM Digital Library. Two authors independently assessed eligibility and extracted data. Data were presented by a descriptive analysis of characteristics and a narrative report for each eHealth domain. Results: The review included 370 manuscripts. The following 10 monitoring domains were identified: air quality, airway inflammation markers, lung function, physical activity, sleep, audiovisual, other physiological measurements, questionnaires, medication monitoring, and digital environment (ie, digital platforms, applications, websites, and software tools to monitor or support monitoring). Rising numbers of studies were seen, and the numbers accelerated in the last few years throughout most domains, especially medication monitoring and digital environment. Limited studies (35/370, 9.5\%) of multiparameter monitoring strategies, using three or more domains, were found. The number of monitoring validation studies remained stable, while development and intervention studies increased. Intervention outcomes seemed to indicate the noninferiority and potential superiority of eHealth monitoring in pediatric asthma. Conclusions: This systematic scoping review provides a unique overview of eHealth pediatric asthma monitoring studies, and it revealed that eHealth research takes place throughout different monitoring domains using different approaches. The outcomes of the review showed the potency for efficacy of most monitoring domains (especially the domains of medication monitoring, lung function, and digital environment). Future studies could focus on modifying potentially relevant hospital-based diagnostics for the home setting to investigate potential beneficial effects and focus on combining home-monitoring domains to facilitate multiparameter decision-making and personalized clinical decision support. ", doi="10.2196/45896", url="https://www.jmir.org/2023/1/e45896", url="http://www.ncbi.nlm.nih.gov/pubmed/37477966" } @Article{info:doi/10.2196/45585, author="van der Kamp, Mattienne and Hengeveld, Vera and Willard, Nico and Thio, Boony and de Graaf, Pascal and Geven, Inge and Tabak, Monique", title="Remote Patient Monitoring and Teleconsultation to Improve Health Outcomes and Reduce Health Care Utilization of Pediatric Asthma (ALPACA Study): Protocol for a Randomized Controlled Effectiveness Trial", journal="JMIR Res Protoc", year="2023", month="Jul", day="3", volume="12", pages="e45585", keywords="asthma", keywords="children", keywords="telemedicine", keywords="home monitoring", keywords="randomized controlled trial", keywords="health care utilization", keywords="health care costs", keywords="protocol", keywords="spirometry", keywords="adherence", keywords="nebulizer", keywords="pediatric care", keywords="utilization", keywords="remote monitoring", keywords="asthma care", abstract="Background: Childhood asthma is imposing a great financial burden on the pediatric health care system. Asthma costs are directly related to the level of asthma control. A substantial part of these costs may be preventable by the timely and adequate assessment of asthma deterioration in daily life and proper asthma management. The use of eHealth technology may assist such timely and targeted medical anticipation. Objective: This paper describes the Ambulatory Pediatric Asthma Care (ALPACA) study protocol to investigate the effectiveness of an eHealth intervention consisting of remote patient monitoring and teleconsultation integrated into the daily clinical care of pediatric patients with asthma. This intervention aims to reduce health care utilization and costs and improve health outcomes compared to a control group that receives standard care. In addition, this study aims to improve future eHealth pediatric asthma care by gaining insights from home-monitoring data. Methods: This study is a prospective randomized controlled effectiveness trial. A total of 40 participants will be randomized to either 3 months of eHealth care (intervention group) or standard care (control group). The eHealth intervention consists of remote patient monitoring (spirometry, pulse oximetry, electronic medication adherence tracking, and asthma control questionnaire) and web-based teleconsultation (video sharing, messages). All participants will have a 3-month follow-up with standard care to evaluate whether the possible effects of eHealth care are longer lasting. During the entire study and follow-up period, all participants will use blinded observational home monitoring (sleep, cough/wheeze sounds, air quality in bedroom) as well. Results: This study was approved by the Medical Research Ethics Committees United. Enrollment began in February 2023, and the results of this study are expected to be submitted for publication in July 2024. Conclusions: This study will contribute to the existing knowledge on the effectiveness of eHealth interventions that combine remote patient monitoring and teleconsultation for health care utilization, costs, and health outcomes. Furthermore, the observational home-monitoring data can contribute to improved identification of early signs of asthma deterioration in pediatric patients. Researchers and technology developers could use this study to guide and improve eHealth development, while health care professionals, health care institutions, and policy makers may employ our results to make informed decisions to steer toward high-quality, efficient pediatric asthma care. Trial Registration: ClinicalTrials.gov NCT05517096; https://clinicaltrials.gov/ct2/show/NCT05517096 International Registered Report Identifier (IRRID): PRR1-10.2196/45585 ", doi="10.2196/45585", url="https://www.researchprotocols.org/2023/1/e45585", url="http://www.ncbi.nlm.nih.gov/pubmed/37399066" } @Article{info:doi/10.2196/47358, author="Kuschke, Silva and Moodie, Sheila and Kirubalingam, Keshinisuthan and O'Hagan, Robin and Glista, Danielle", title="Parents' Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework", journal="JMIR Pediatr Parent", year="2023", month="Jun", day="6", volume="6", pages="e47358", keywords="audiology", keywords="care", keywords="child engagement", keywords="children", keywords="concept mapping", keywords="cost", keywords="hearing aid", keywords="hearing loss", keywords="hearing", keywords="integration", keywords="parents", keywords="pediatric audiology", keywords="pediatric", keywords="remote hearing aid support", keywords="support", keywords="virtual care", abstract="Background: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. Objective: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. Methods: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. Conclusions: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries. ", doi="10.2196/47358", url="https://pediatrics.jmir.org/2023/1/e47358", url="http://www.ncbi.nlm.nih.gov/pubmed/37279061" } @Article{info:doi/10.2196/46513, author="Cyranka, Katarzyna and Juza, Anna and Kwiendacz, Hanna and Nabrdalik, Katarzyna and Gumprecht, Janusz and Ma?ecki, Maciej and Klupa, Tomasz and Matejko, Bart?omiej", title="Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study", journal="JMIR Form Res", year="2023", month="May", day="29", volume="7", pages="e46513", keywords="young adults", keywords="type 1 diabetes", keywords="transitioning care", keywords="psychological", keywords="diabetes", keywords="cross-sectional study", keywords="anxiety", keywords="socioeconomic", keywords="validation", keywords="anger", keywords="depression", keywords="outpatient", keywords="chronic disease", keywords="pediatric", keywords="adulthood", keywords="coping mechanism", abstract="Background: The transition period of patients with type 1 diabetes from pediatric to adult-oriented health care is associated with poorer glycemic control and less frequent clinic attendance. Fears and anxiety about the unknown, care approach differences in adult settings, and sadness about leaving the pediatric provider all contribute to a patient's reluctance to transition. Objective: This study aimed to evaluate the psychological parameters of young patients with type 1 diabetes transitioning to an adult outpatient clinic during the first visit. Methods: We examined 50 consecutive patients (n=28, 56\% female) transitioning from March 2, 2021, to November 21, 2022, into adult care (3 diabetes centers from 3 regions in southern Poland: A, n=16; B, n=21; and C, n=13) and their basic demographic information. They completed the following psychological questionnaires: State-Trait Anxiety Inventory (STAI), Generalized Self-Efficacy Scale, Perceived Stress Scale, Satisfaction with Life Scale, Acceptance of Illness Scale, Multidimensional Health Locus of Control Scale Form C, Courtauld Emotional Control Scale, and Quality of Life Questionnaire Diabetes. We compared their data with those for the general healthy population and patients with diabetes from Polish Test Laboratory validation studies. Results: During the first adult outpatient visit, patients' mean age was 19.2 (SD 1.4) years, with a diabetes duration of 9.8 (SD 4.3) years and BMI of 23.5 (SD 3.1) kg/m2. Patients came from diverse socioeconomic backgrounds: 36\% (n=18) live in villages, 26\% (n=13) live in towns with ?100,000 inhabitants, and 38\% (n=19) live in bigger cities. Regarding therapy type, 68\% (n=34) were treated with insulin pump therapy, whereas 32\% (n=16) were treated with multiple daily injections. Patients from center A had a mean glycated hemoglobin level of 7.5\% (SD 1.2\%). There was no difference regarding the level of life satisfaction, perceived level of stress, and state anxiety between the patients and reference populations. Patients had similar health locus of control and negative emotions control to the general population of patients with diabetes. Most patients (n=31, 62\%) believe that control over their health depends on themselves, whereas 52\% (n=26) believe that it depends mostly on others. Patients had higher levels of suppression of negative emotions---anger, depression, and anxiety---than the age-matched general population. Additionally, the patients were characterized by a higher acceptance of illness and higher level of self-efficacy compared to the reference populations: 64\% (n=32) had a high level of self-efficacy and 26\% (n=13) had a high level of life satisfaction. Conclusions: This study indicated that young patients transitioning to adult outpatient clinics have good psychological resources and coping mechanisms, which might result in adequate adaptation and adult life satisfaction including future metabolic control. These result also disprove the stereotypes that young people with chronic disease have worse life perspectives when entering adulthood. ", doi="10.2196/46513", url="https://formative.jmir.org/2023/1/e46513", url="http://www.ncbi.nlm.nih.gov/pubmed/37247225" } @Article{info:doi/10.2196/39704, author="Olateju, Adetola and Cervantes, Marbella and Dowshen, Nadia and Kuhns, M. Lisa and Dhar, Priya Cherie", title="Acceptability of Telemedicine Among Parents of Adolescent Patients in an Adolescent Clinic: Cross-sectional Survey Study", journal="JMIR Pediatr Parent", year="2022", month="Dec", day="21", volume="5", number="4", pages="e39704", keywords="adolescent medicine", keywords="telemedicine", keywords="acceptability", keywords="privacy", keywords="confidentiality", keywords="satisfaction", keywords="caregivers", abstract="Background: Since the beginning of the COVID-19 pandemic, new literature has described the perceptions of adolescent patients on the use of telemedicine for their health care, but less attention has been devoted to parents' and caregivers' perspectives on telemedicine usage for their adolescents. Parents' perspectives are important, as they undoubtedly influence how children learn to make decisions about their health care. Objective: This study describes the level of acceptability (measured based on accessibility and satisfaction) expressed by caregivers of adolescent patients with regard to telemedicine visits in an urban adolescent medicine practice. Methods: A cross-sectional survey was sent electronically to parents and guardians of patients aged <18 years who completed outpatient telemedicine visits to an adolescent medicine practice in Chicago, Illinois, from March 2020 to February 2021. The questions focused on accessibility and satisfaction. The data were analyzed to describe response frequencies. Results: Among a sample of 71 survey respondents, the vast majority reported that telemedicine was very easy to use (58/71, 82\%) and was at least as convenient as in-person visits (70/71, 99\%). Over 90\% of respondents reported that their adolescents' needs were addressed (69/69, 100\%) and that they were at least as comfortable with the level of privacy and the confidential conversations between their adolescents and medical providers in telemedicine visits (65/71, 92\%) as they were with those in in-person visits. Conclusions: Our findings suggest that parents and guardians find telemedicine to be an acceptable way for their children and adolescents to receive appropriate health care. ", doi="10.2196/39704", url="https://pediatrics.jmir.org/2022/4/e39704", url="http://www.ncbi.nlm.nih.gov/pubmed/36542447" } @Article{info:doi/10.2196/32520, author="Drapalik, N. Krista and Grodberg, David and Ventola, Pamela", title="Feasibility and Acceptability of Delivering Pivotal Response Treatment for Autism Spectrum Disorder via Telehealth: Pilot Pre-Post Study", journal="JMIR Pediatr Parent", year="2022", month="Sep", day="6", volume="5", number="3", pages="e32520", keywords="autism spectrum disorder", keywords="ASD", keywords="pivotal response treatment", keywords="PRT", keywords="telehealth", keywords="parent-implemented intervention", keywords="parent training", keywords="pediatrics", keywords="autism", keywords="children", keywords="digital health", keywords="online modules", keywords="online health", keywords="online treatment", keywords="pilot study", keywords="communication", abstract="Background: Pivotal response treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in autistic individuals. Objective: The aim of this study was to assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health, a telehealth platform that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their autistic children. Methods: Male and female autistic children, aged 2-7 years with single-word to phrase-level speech, and their parents were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Credibility Questionnaire (CCQ) at week 2 and at the study endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at the study endpoint to assess parental expectancies, and treatment acceptability and effectiveness. Results: Nine of 14 participants completed the study curriculum in the online parent training condition, and 6 of 12 participants completed the control condition. Thus, a total of 58\% (15/26) participants across both groups completed the study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ total scores, from 25.38 (SD 3.25) at baseline to 27.5 (SD 3.74) at study endpoint (P=.04); mean CCQ confidence scores, from 6.0 (SD 1.07) at baseline to 6.75 (SD 0.89) at study endpoint (P=.02); and mean CCQ other improvement scores, from 5.25 (SD 0.89) at baseline to 6.25 (SD 1.28) at study endpoint (P=.009). Within the control condition, a modest increase in mean CCQ scores was noted (Confidence, difference=+0.25; Recommend, difference=+0.25; Total Score, difference=+0.50), but the differences were not statistically significant (Confidence P=.38, Recommend P=.36, Total Score P=.43). Among the 11 parents who completed the BIRS at the study endpoint, 82\% (n=9) endorsed that they slightly agree or agree with over 93\% of the Acceptability factor items on the BIRS. Conclusions: The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores, as well as strong ratings on the BIRS. This study's small sample size limits the conclusions that can be drawn; however, the PRT MindNest Health platform holds promise to support parents of autistic children who are unable to access traditional, in-person parent-mediated interventions for their child. ", doi="10.2196/32520", url="https://pediatrics.jmir.org/2022/3/e32520", url="http://www.ncbi.nlm.nih.gov/pubmed/36066927" } @Article{info:doi/10.2196/33981, author="Zachrison, S. Kori and Hayden, M. Emily and Boggs, M. Krislyn and Boyle, P. Tehnaz and Gao, Jingya and Samuels-Kalow, E. Margaret and Marcin, P. James and Camargo Jr, A. Carlos", title="Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study", journal="J Med Internet Res", year="2022", month="Jun", day="20", volume="24", number="6", pages="e33981", keywords="telehealth", keywords="telemedicine", keywords="emergency care", keywords="stroke", keywords="pediatric care", abstract="Background: Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. Objective: Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. Methods: We used the 2016 National Emergency Department Inventory--USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. Results: Of the 442 EDs surveyed, 378 (85.5\%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1\% (45/320) of EDs with telestroke services reported weekly use versus 2.9\% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6\%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was ``improving level of clinical care.'' Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8\%) than for pediatric telehealth adoption (1/272, 0.4\%; P=.003). Conclusions: In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care. ", doi="10.2196/33981", url="https://www.jmir.org/2022/6/e33981", url="http://www.ncbi.nlm.nih.gov/pubmed/35723927" } @Article{info:doi/10.2196/34115, author="McCrady, Emma and Strychowsky, E. Julie and Woolfson, P. Jessica", title="Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study", journal="JMIR Pediatr Parent", year="2022", month="Jun", day="15", volume="5", number="2", pages="e34115", keywords="virtual care", keywords="web-based care", keywords="COVID-19", keywords="pediatrics", keywords="pandemic", keywords="physicians", keywords="digital health", keywords="pediatricians", keywords="telehealth", abstract="Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. Methods: This study took place at the Children's Hospital at London Health Sciences Centre, a children's hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. Results: Survey response rate was 52.1\% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10\% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50\% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50\% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4\% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care. ", doi="10.2196/34115", url="https://pediatrics.jmir.org/2022/2/e34115", url="http://www.ncbi.nlm.nih.gov/pubmed/35666938" } @Article{info:doi/10.2196/31628, author="Adroher Mas, Cristina and Esposito Catal{\`a}, Candela and Batlle Boada, Astrid and Casadevall Llandrich, Ricard and Millet Elizalde, Marta and Garc{\'i}a Garc{\'i}a, Jos{\'e} Juan and del Castillo Rey, Manel and Garc{\'i}a Cuy{\`a}s, Francesc and Pons Serra, Miquel and L{\'o}pez Segu{\'i}, Francesc", title="Pediatric Tele--Home Care Compared to Usual Care: Cost-Minimization Analysis", journal="JMIR Pediatr Parent", year="2022", month="Jan", day="20", volume="5", number="1", pages="e31628", keywords="cost analysis", keywords="pediatric tele--home care", keywords="home care service", keywords="health economics", keywords="telehealth", keywords="economic evaluation", keywords="telemedicine", keywords="pediatrics", abstract="Background: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de D{\'e}u in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. Objective: The aim of this study is to compare the average cost of a discharge by tele--home care with the usual care and to analyze the main drivers of the differential costs of both care models. Methods: A cost-minimization analysis is conducted under a hospital's perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. Results: A 24-hour stay at the hospital costs US \$574.19, while the in-home hospitalization costs US \$301.71 per day, representing a saving of almost half (48\%) of the cost compared to usual care. The main saving drivers were the personnel costs (US \$102.83/US \$284.53, 35.5\% of the total), intermediate noncare costs (US \$6.09/US \$284.53, 33.17\%), and structural costs (US \$55.16/US \$284.53, 19.04\%). Home hospitalization involves a total stay 27.61\% longer, but at almost half the daily cost, and thus represents a saving of US \$176.70 (9.01\%) per 24-hour stay. Conclusions: The cost analysis conducted under a hospital perspective shows that pediatric tele--home care is 9\% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction. ", doi="10.2196/31628", url="https://pediatrics.jmir.org/2022/1/e31628", url="http://www.ncbi.nlm.nih.gov/pubmed/35049513" } @Article{info:doi/10.2196/28610, author="Bele, Sumedh and Cassidy, Christine and Curran, Janet and Johnson, W. David and Bailey, Michelle J. A.", title="Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary--Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study", journal="J Med Internet Res", year="2021", month="Dec", day="22", volume="23", number="12", pages="e28610", keywords="telemedicine", keywords="eHealth", keywords="pediatric care", keywords="inpatient", keywords="regional", keywords="rural", keywords="Canada", keywords="Theoretical Domains Framework", keywords="qualitative", abstract="Background: Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children's hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children's Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. Objective: The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. Methods: This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. Results: Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers' motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary--regional relationships. Conclusions: This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers' and family members' perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. International Registered Report Identifier (IRRID): RR2-10.1186/s12913-018-3859-2 ", doi="10.2196/28610", url="https://www.jmir.org/2021/12/e28610", url="http://www.ncbi.nlm.nih.gov/pubmed/34941561" } @Article{info:doi/10.2196/32708, author="Wood, M. Sarah and Pickel, Julia and Phillips, W. Alexis and Baber, Kari and Chuo, John and Maleki, Pegah and Faust, L. Haley and Petsis, Danielle and Apple, E. Danielle and Dowshen, Nadia and Schwartz, A. Lisa", title="Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="15", volume="4", number="4", pages="e32708", keywords="telehealth", keywords="telemedicine", keywords="adolescent", keywords="COVID-19", keywords="acceptability", keywords="feasibility", keywords="young adult", keywords="teenager", keywords="cross-sectional", keywords="patient experience", keywords="experience", keywords="efficiency", keywords="equity", keywords="survey", abstract="Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5\% (55/268) for AYA and 21.8\% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22\% vs 3/118, 2.5\%, P<.001). One-quarter (14/55) of the AYA patients and 31.7\% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. ", doi="10.2196/32708", url="https://pediatrics.jmir.org/2021/4/e32708", url="http://www.ncbi.nlm.nih.gov/pubmed/34779782" } @Article{info:doi/10.2196/27999, author="Milne-Ives, Madison and Lam, Ching and Meinert, Edward", title="Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials", journal="JMIR Pediatr Parent", year="2021", month="Sep", day="17", volume="4", number="3", pages="e27999", keywords="asthma", keywords="disease management", keywords="child", keywords="adolescent", keywords="telemedicine", abstract="Background: Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. Objective: This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. Methods: This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. Results: A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70\%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67\% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56\% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. Conclusions: A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways. ", doi="10.2196/27999", url="https://pediatrics.jmir.org/2021/3/e27999", url="http://www.ncbi.nlm.nih.gov/pubmed/34533463" } @Article{info:doi/10.2196/31240, author="Gilkey, B. Melissa and Kong, Yi Wei and Huang, Qian and Grabert, K. Brigid and Thompson, Peyton and Brewer, T. Noel", title="Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals", journal="J Med Internet Res", year="2021", month="Sep", day="10", volume="23", number="9", pages="e31240", keywords="adolescent health", keywords="primary care", keywords="telemedicine", keywords="health communication", keywords="health services", keywords="telehealth", keywords="adolescent", keywords="young adult", keywords="teenager", keywords="COVID-19", keywords="survey", keywords="policy", keywords="access", abstract="Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs' recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71\%), advanced practice providers (177/1047, 17\%), and nurses (123/1047, 12\%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40\%, 286/1047, 27\%, and 219/1047, 21\%, respectively); only 11\% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69\%) and enables them to provide high-quality care (560/1047, 53\%). Few believed that adolescent telehealth takes too much time (142/1047, 14\%) or encourages health care overuse (157/1047, 15\%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65\%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82\%). Approximately two-thirds (702/1047, 67\%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. ", doi="10.2196/31240", url="https://www.jmir.org/2021/9/e31240", url="http://www.ncbi.nlm.nih.gov/pubmed/34406974" } @Article{info:doi/10.2196/25873, author="Khairat, Saif and McDaniel, Phillip and Jansen, Matthew and Francis, Tia and Edson, Barbara and Gianforcaro, Robert", title="Analysis of Social Determinants and the Utilization of Pediatric Tele--Urgent Care During the COVID-19 Pandemic: Cross-sectional Study", journal="JMIR Pediatr Parent", year="2021", month="Aug", day="30", volume="4", number="3", pages="e25873", keywords="telehealth", keywords="pediatrics", keywords="social", keywords="determinants", keywords="COVID-19", keywords="use", keywords="children", keywords="infant", keywords="consultation", keywords="telemedicine", keywords="urgent care", keywords="vulnerable population", keywords="cross-sectional", keywords="minority", abstract="Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele--urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele--urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele--urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele--urgent care visits, 388 (66.4\%) visits occurred in 2020 during the pandemic compared to 196 (33.6\%) visits in 2019. Among 808 North Carolina zip codes, 181 (22\%) consisted of a high concentration of vulnerable populations, where 17.7\% (56/317) of the tele--urgent care visits originated from. The majority (215/317, 67.8\%) of tele--urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele--urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele--urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19--confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. ", doi="10.2196/25873", url="https://pediatrics.jmir.org/2021/3/e25873", url="http://www.ncbi.nlm.nih.gov/pubmed/34459742" } @Article{info:doi/10.2196/24634, author="van der Kamp, Mattienne and Reimering Hartgerink, Pamela and Driessen, Jean and Thio, Bernard and Hermens, Hermie and Tabak, Monique", title="Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study", journal="JMIR Form Res", year="2021", month="Jul", day="26", volume="5", number="7", pages="e24634", keywords="telemedicine", keywords="feasibility studies", keywords="child", keywords="self-management", keywords="asthma", keywords="patient acceptance of health care", keywords="ambulatory care", keywords="remote sensing technology", keywords="cost-benefit analysis", keywords="health care costs", abstract="Background: Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. Objective: The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. Methods: We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. Results: Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75\% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80\% gross reduction (from {\texteuro}71,784 to {\texteuro}14,018, US \$1={\texteuro}0.85) in health care utilization, 8.6\% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0\% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4\% improved (from 71.2 to 76.8, P=.02) therapy adherence. Conclusions: eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care. ", doi="10.2196/24634", url="https://formative.jmir.org/2021/7/e24634", url="http://www.ncbi.nlm.nih.gov/pubmed/34309568" } @Article{info:doi/10.2196/27504, author="Milne-Ives, Madison and Neill, Sarah and Bayes, Natasha and Blair, Mitch and Blewitt, Jane and Bray, Lucy and Carrol, D. Enitan and Carter, Bernie and Dawson, Rob and Dimitri, Paul and Lakhanpaul, Monica and Roland, Damian and Tavare, Alison and Meinert, Edward and ", title="Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2021", month="Jun", day="30", volume="10", number="6", pages="e27504", keywords="acute disease", keywords="telemedicine", keywords="child", keywords="pediatrics", keywords="childhood disease", keywords="childhood illness", keywords="health education", keywords="health literacy", keywords="help-seeking behavior", keywords="child health", keywords="digital intervention", keywords="mHealth", keywords="primary care", keywords="sick child", abstract="Background: Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child's symptoms is one of many factors that play a role in parents' decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents' knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. Objective: The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home. Methods: The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references' titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported. Results: The systematic review will commence during 2021. Conclusions: This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/27504 ", doi="10.2196/27504", url="https://www.researchprotocols.org/2021/6/e27504", url="http://www.ncbi.nlm.nih.gov/pubmed/34228628" } @Article{info:doi/10.2196/24908, author="Huygens, J. Martine W. and Voogdt-Pruis, R. Helene and Wouters, Myrah and Meurs, M. Maaike and van Lettow, Britt and Kleijweg, Conchita and Friele, D. Roland", title="The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands", journal="J Med Internet Res", year="2021", month="May", day="3", volume="23", number="5", pages="e24908", keywords="eHealth", keywords="telemonitoring", keywords="self-management", keywords="telemedicine", keywords="telehealth", abstract="Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2\% (18/161) in 2014 to 19.6\% (36/184) in 2019 ($\chi$24=12.3; P=.02). In 2019, telemonitoring was used by 5.8\% (28/485) of people with chronic disease. This was 18.2\% (41/225) in GP organizations and 40.4\% (44/109), 38.0\% (78/205), and 8.9\% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10\% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were ``comfort'' (421/1043, 40.4\%) and ``living at home for longer/more comfortably'' (334/1047, 31.9\%). Health care professionals added ``improvement of self-management'' (63/176, 35.8\% to 57/71, 80.3\%), ``better understanding of the patient's condition'' (47/176, 26.7\% to 42/71, 59.2\%), ``reduction of workload'' (53/134, 39.6\% of nurses in elderly care), ``better tailoring of care plan to the patient's situation'' (95/225, 42.2\% of GPs), and ``saves time for patients/caregivers'' (61/176, 34.7\% of medical specialists). Disadvantages mentioned by professionals were that ``it takes time to monitor data'' (13/130, 10\% to 108/225, 48.0\%), ``it takes time to follow up alerts'' (15/130, 11.5\% to 117/225, 52.0\%), and ``it is difficult to estimate which patients can work with telemonitoring'' (22/113, 19.5\% to 94/225, 41.8\%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. ", doi="10.2196/24908", url="https://www.jmir.org/2021/5/e24908", url="http://www.ncbi.nlm.nih.gov/pubmed/33938808" } @Article{info:doi/10.2196/25106, author="Monzon, Alexandra and Kahhan, Nicole and Marker, Arwen and Patton, Susana", title="Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic", journal="JMIR Pediatr Parent", year="2021", month="Apr", day="23", volume="4", number="2", pages="e25106", keywords="type 1 diabetes", keywords="parents", keywords="children", keywords="diabetes distress", keywords="fear of hypoglycemia", keywords="COVID-19", keywords="telehealth", keywords="diabetes", keywords="challenge", keywords="youth", keywords="young adults", doi="10.2196/25106", url="https://pediatrics.jmir.org/2021/2/e25106", url="http://www.ncbi.nlm.nih.gov/pubmed/33848256" } @Article{info:doi/10.2196/22696, author="Shah, C. Aashaka and Badawy, M. Sherif", title="Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials", journal="JMIR Pediatr Parent", year="2021", month="Feb", day="24", volume="4", number="1", pages="e22696", keywords="telemedicine", keywords="telehealth", keywords="pediatrics", keywords="COVID-19", keywords="coronavirus", keywords="pandemic", keywords="digital", keywords="eHealth", keywords="mHealth", keywords="mobile health", abstract="Background: Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). Objective: We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients' and care providers' satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. Methods: Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author's name, publication year, participants' characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. Results: In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73\%) or cluster randomized trials (3/11, 27\%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27\%), asthma (2/11, 18\%), mental health conditions (1/11, 9\%), otitis media (1/11, 9\%), skin conditions (1/11, 9\%), type 1 diabetes (1/11, 9\%), attention deficit hyperactivity disorder (1/11, 9\%), and cystic fibrosis--related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45\%), smartphone-based interventions (3/11, 27\%), telephone counseling (2/11, 18\%), and telemedicine-based screening visits (1/11, 9\%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. Conclusions: Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use. ", doi="10.2196/22696", url="https://pediatrics.jmir.org/2021/1/e22696", url="http://www.ncbi.nlm.nih.gov/pubmed/33556030" } @Article{info:doi/10.2196/24345, author="Schweiberger, Kelsey and Hoberman, Alejandro and Iagnemma, Jennifer and Schoemer, Pamela and Squire, Joseph and Taormina, Jill and Wolfson, David and Ray, N. Kristin", title="Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study", journal="J Med Internet Res", year="2020", month="Dec", day="18", volume="22", number="12", pages="e24345", keywords="telehealth", keywords="telemedicine", keywords="ambulatory pediatrics", keywords="health services research", keywords="ambulatory", keywords="pediatrics", keywords="health services", keywords="COVID-19", abstract="Background: Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15\% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. Objective: Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. Methods: We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. Results: Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28\%-36\% of visits) and dermatologic (15\%-28\%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, P=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, P=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. Conclusions: Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine. ", doi="10.2196/24345", url="http://www.jmir.org/2020/12/e24345/", url="http://www.ncbi.nlm.nih.gov/pubmed/33290244" } @Article{info:doi/10.2196/18835, author="Waqas, Ahmed and Teoh, Huat Soo and Lap{\~a}o, Velez Lu{\'i}s and Messina, Ary Luiz and Correia, C{\'e}sar Jorge", title="Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis", journal="J Med Internet Res", year="2020", month="Oct", day="2", volume="22", number="10", pages="e18835", keywords="telemedicine", keywords="scientometric analysis", keywords="evidence synthesis", keywords="health information technology", keywords="research", keywords="theme", abstract="Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. ", doi="10.2196/18835", url="https://www.jmir.org/2020/10/e18835", url="http://www.ncbi.nlm.nih.gov/pubmed/33006571" } @Article{info:doi/10.2196/20157, author="Ramtekkar, Ujjwal and Bridge, A. Jeffrey and Thomas, Glenn and Butter, Eric and Reese, Jennifer and Logan, Erica and Lin, Simon and Axelson, David", title="Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19", journal="JMIR Ment Health", year="2020", month="Sep", day="18", volume="7", number="9", pages="e20157", keywords="telepsychiatry", keywords="telebehavioral health", keywords="child and adolescent psychiatry", keywords="COVID-19", doi="10.2196/20157", url="https://mental.jmir.org/2020/9/e20157", url="http://www.ncbi.nlm.nih.gov/pubmed/32525485" } @Article{info:doi/10.2196/19924, author="Caze II, Todd and Knell, P. Gregory and Abt, John and Burkhart, O. Scott", title="Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis", journal="JMIR Pediatr Parent", year="2020", month="Aug", day="13", volume="3", number="2", pages="e19924", keywords="brain concussion", keywords="athletic injuries", keywords="sports injuries", keywords="telemedicine", keywords="eHealth", keywords="mHealth", keywords="telehealth", keywords="mobile health", keywords="adolescent", keywords="child", keywords="COVID-19", abstract="Background: Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US \$20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non--medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. Objective: The purposes of this paper are to describe a pediatric concussion specialty clinic's experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. Methods: The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. Results: The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6\% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. Conclusions: Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population. ", doi="10.2196/19924", url="https://pediatrics.jmir.org/2020/2/e19924", url="http://www.ncbi.nlm.nih.gov/pubmed/32634106" } @Article{info:doi/10.2196/17517, author="L{\'o}pez Segu{\'i}, Francesc and Batlle Boada, Astrid and Garc{\'i}a Garc{\'i}a, Jos{\'e} Juan and L{\'o}pez Ulldemolins, Ana and Achotegui del Arco, Ane and Adroher Mas, Cristina and Garc{\'i}a Cuy{\`a}s, Francesc", title="Families' Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia", journal="JMIR Pediatr Parent", year="2020", month="Mar", day="26", volume="3", number="1", pages="e17517", keywords="home health monitoring", keywords="pediatrics", keywords="telehomecare", keywords="videoconferencing", keywords="satisfaction with care", keywords="remote sensing technology", keywords="telemedicine", keywords="telehealth", abstract="Background: Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children's care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. Objective: This study aimed to assess families' degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. Methods: A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de D{\'e}u Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children's characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. Results: A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94\% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. Conclusions: Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents. ", doi="10.2196/17517", url="http://pediatrics.jmir.org/2020/1/e17517/", url="http://www.ncbi.nlm.nih.gov/pubmed/32213471" }