%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64886 %T Experiences of Birth Attendants on Upward Obstetric Emergency Referrals in Low- and Middle-Income Countries: Protocol for a Scoping Review %A Juqu,Final Z %A Baloyi,Olivia B %A Mbobnda Kapche,Esther L %A ten Ham-Baloyi,Wilma %A Chironda,Geldine %A Xulu-Kasaba,Zamadonda Nokuthula %+ School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Durban, 4001, South Africa, 27 031 260 1279, baloyio@ukzn.ac.za %K referral systems %K upward referral %K obstetric emergencies %K traditional birth attendants %K skilled birth attendants %K low- and middle-income countries %K birth attendants %K obstetric %K middle-income countries %K scoping review protocol %K pregnancy %K neonatal deaths %K deaths %K obstetric care %K health care %K medical education %K mortality %K Africa %K pregnant %K women’s health %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Every day, approximately 800 women die from pregnancy-related causes, alongside 2.6 million stillbirths and 2.8 million neonatal deaths annually. Inadequate referral by skilled birth attendants hinders timely access to necessary emergency obstetric care, challenging progress toward the maternal health Sustainable Development Goal (SDG) 3. The COVID-19 pandemic further disrupted care in low- and middle-income countries, forcing women to rely on traditional birth attendants, thereby affecting the referral system. It is crucial to understand the experiences of both skilled and traditional birth attendants regarding upward referrals in emergency obstetric care to identify barriers and facilitators within these systems in low- and middle-income countries. Objective: This study aims to map existing evidence on the experiences of skilled and traditional birth attendants regarding upward referral systems in emergency obstetric care within low- and middle-income countries. Methods: We will conduct a scoping review guided by the Joanna Briggs Institute’s methodological framework. Studies will be included if they report on experiences with upward referral in obstetrical emergencies. We will consider studies published in English and French from 2016 to July 2024. The literature search will be conducted in databases including PubMed, EBSCOhost (Academic Search Complete and CINAHL with full text), Scopus, Web of Science, and Google Scholar. Identified citations will be managed using EndNote version 21 (Clarivate Analytics) and Rayyan. Two independent reviewers will screen eligible studies and resolve disagreements through discussion with a third reviewer. Data will be extracted using a validated form and analyzed through content analysis, with findings presented narratively. This protocol aligns with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review will offer a comprehensive narrative of upward referral systems in obstetrical emergencies, focusing on transitions from traditional birth attendants to health care facilities and from lower to higher levels of health care. Results: The preliminary search was completed in August 2024, and the database search will be conducted within the next 6 months. Findings will be disseminated through medical education conferences and publications. Conclusions: This review contributes a comprehensive narrative of upward referral systems in obstetrical emergencies, aiming to enhance understanding and improve transitions from traditional birth attendants to health care facilities and between different health care levels. It could significantly impact maternal and neonatal care by identifying the referral experiences of both skilled and traditional birth attendants. The insights may inform interventions that integrate traditional birth attendants into health care systems, potentially reducing maternal and neonatal mortality. The results will guide future research aimed at developing a model to improve upward referrals for obstetric emergencies in sub-Saharan Africa. Trial Registration: Open Science Framework 4HAVZ; https://osf.io/4havz International Registered Report Identifier (IRRID): PRR1-10.2196/64886 %M 40209211 %R 10.2196/64886 %U https://www.researchprotocols.org/2025/1/e64886 %U https://doi.org/10.2196/64886 %U http://www.ncbi.nlm.nih.gov/pubmed/40209211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67047 %T Barriers and Determinants of Referral Adherence in AI-Enabled Diabetic Retinopathy Screening for Older Adults in Northern India During the COVID-19 Pandemic: Mixed Methods Pilot Study %A Chauhan,Anshul %A Goyal,Anju %A Masih,Ritika %A Kaur,Gagandeep %A Kumar,Lakshay %A Neha,­ %A Rastogi,Harsh %A Kumar,Sonam %A Singh,Bidhi Lord %A Syal,Preeti %A Gupta,Vishali %A Vale,Luke %A Duggal,Mona %K diabetic retinopathy %K diabetes %K gerontology %K geriatric %K old %K aging %K aged %K artificial intelligence %K retinopathy %K retinal %K referral %K screening %K optometry %K ophthalmology %K adherence %K barriers %D 2025 %7 31.3.2025 %9 %J JMIR Form Res %G English %X Background: Diabetic retinopathy (DR) is a leading cause of blindness globally. DR has increasingly affected both individuals and health care systems as the population ages. Objective: This study aims to explore factors and identify barriers associated with nonadherence to referral recommendations among older adult participants after DR screening (DRS) during the COVID-19 pandemic. Method: This paper presents findings from a pilot study on artificial intelligence–enabled DRS conducted in two districts in Punjab, India (Moga and Mohali) during the COVID-19 pandemic. The screenings were conducted from March to June 2022 at community health center Badhani Kalan in Moga and from March to June 2021 in community settings (homes) in Block Boothgarh, Mohali. Participants were referred to the district hospital for an ophthalmological review based on artificial intelligence–enabled screening. After 1 month, the participants were contacted by telephone to assess adherence to the referral recommendations. Participants who did not adhere to the referral were then interviewed alongside health care providers to understand the barriers explaining their nonadherence. Results: We aimed to recruit 346 and 600 older adult participants from 2 sites but enrolled 390. Key challenges included health facility closures due to COVID-19, low motivation among health personnel for recruitment, incomplete nonparticipation data, and high participant workloads. Approximately 45% of the participants were male and 55% female. Most participants (62.6%) were between 60 and 69 years old, while 37.4% were 70 or older, with a mean age of 67.2 (SD 6.2) years. In total, 159 participants (40.8%) were referred, while 231 participants (59.2%) were not. Only 23 (14.5%) of those referred followed through and visited a health facility for ophthalmological review, while 136 (85.5%) did not pursue further evaluation. Our analysis revealed no significant differences in the characteristics between adherent and nonadherent participants, suggesting that demographic and health factors alone do not predict adherence behavior in patients with DR. Interviews identified limited knowledge about DR, logistical challenges, financial constraints, and attitudinal barriers as the primary challenges. Conclusions: This study, conducted during the COVID-19 pandemic, showed suboptimal adherence to referral recommendations among older adult patients due to knowledge gaps, logistical challenges, and health system issues. Quantifying and understanding adherence factors are crucial for targeted interventions addressing barriers to referral recommendations after DRS. Integrating teleophthalmology into and strengthening infrastructure for artificial intelligence–enabled diabetic retinopathy screening to enhance access and outcomes. %R 10.2196/67047 %U https://formative.jmir.org/2025/1/e67047 %U https://doi.org/10.2196/67047 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58285 %T Impact of Changes in Criminal-Legal Practices During the COVID-19 Pandemic on the HIV Risk Behaviors of Women Who Use Drugs: Protocol for a Multimethods Qualitative Study %A Smoyer,Amy B %+ Department of Social Work, Southern Connecticut State University, 501 Crescent St, New Haven, CT, 06515, United States, 1 203 508 5356, SmoyerA1@southernct.edu %K HIV %K corrections %K women %K substance use %K COVID-19 %K criminal-legal systems %K carceral %K qualitative %K SARS-Cov-2 %K coronavirus %K pandemic %K drug %K women who use drugs %K psychosocial %K HIV risk %K health care %K qualitative method %K socio-demographic %K audio-recorded %K thematic analysis %D 2024 %7 20.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV risk behavior in women who use drugs is related to myriad psychosocial issues, including incarceration. The experience of incarceration elevates women’s HIV risk by disrupting social networks, housing, employment, and access to health care. During the COVID-19 pandemic, changes in criminal-legal practices resulted in decreased incarceration, especially among women. These changes may have largely altered HIV risk among women who use drugs, depending on their access to care in the community. Objective: This study seeks to build knowledge about the impact of shifts in criminal-legal practices during the COVID-19 pandemic on HIV risk behaviors of justice-involved women who use drugs. Methods: Qualitative methods are used to gather and analyze women’s narratives about their life experiences before and during the COVID-19 pandemic, with a focus on individual and structural determinants of HIV risk behaviors. Thirty formerly incarcerated women with a history of substance use are being recruited through collaboration with community partners. Each participant completes a sociodemographic survey and two interviews. The first interview uses a life history instrument that invites participants to reflect on key turning points in their lives. The second interview uses a calendar approach to gather information about participants’ lives during the first year of the COVID-19 pandemic (March 2020-March 2021). The interviews (1 hour each) are audio-recorded and transcribed for analysis. Rapid Qualitative Inquiry and thematic analysis are being used to manage, organize, and interpret the data. The study team will collaborate with a subset of participants to develop digital stories about their COVID-19 experiences, a process that allows for member-checking and triangulation. Findings will be disseminated to program and policy makers in academic venues, community settings, and social service agencies. Results: To date, 10 women’s data have been collected. In total, two themes have been identified in this preliminary data: (1)the chaos and instability of participants’ lives increased during the COVID-19 pandemic: participants reported a wide range of psychosocial and health problems and limited engagement with social service systems. Interaction with criminal-legal systems was rife with uncertainty; participants described living in a state of limbo, which was extremely stressful. (2) When asked to describe a “turning point” in their lives, many participants attributed their substance use to the traumatic loss of a child due to death, incarceration, or termination of parental rights. During the COVID-19 pandemic, participants’ struggles to cope with these unresolved experiences of grief and loss were intensified by the widespread death and dying of the pandemic. Conclusions: Preliminary findings suggest that HIV risk factors increased for participants during the COVID-19 pandemic and invite further investment in community-based harm reduction programs, especially housing, that support women who use drugs. Interventions that address experiences of maternal grief and loss may reduce women’s substance use. International Registered Report Identifier (IRRID): DERR1-10.2196/58285 %M 39705687 %R 10.2196/58285 %U https://www.researchprotocols.org/2024/1/e58285 %U https://doi.org/10.2196/58285 %U http://www.ncbi.nlm.nih.gov/pubmed/39705687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57580 %T Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study %A Ahmed,Nisar %A Hall,Alex %A Poku,Brenda %A McDermott,Jane %A Astbury,Jayne %A Todd,Chris %+ National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK, United Kingdom, 44 161306600, nisar.ahmed-2@manchester.ac.uk %K digital health and primary care services %K digital exclusion %K digital divide %K health inequalities %K older adults %K South Asian %K Black African %K Caribbean %K COVID-19 pandemic %K qualitative focus group study %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales—people of South Asian, Black African, and Caribbean backgrounds—in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. %M 39693146 %R 10.2196/57580 %U https://formative.jmir.org/2024/1/e57580 %U https://doi.org/10.2196/57580 %U http://www.ncbi.nlm.nih.gov/pubmed/39693146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53344 %T Reflections From the Pandemic: Is Connectivism the Panacea for Clinicians? %A Benjamin,Jennifer %A Pillow,Tyson %A MacNeill,Heather %A Masters,Ken %A Agrawal,Anoop %A Mehta,Neil %+ Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Houston, TX, 77030, United States, 1 832 824 1000 ext 3436, jennifer.benjamin@bcm.edu %K learning theory %K learning framework %K connectivism %K panacea %K COVID-19 %K generative artificial intelligence %K GAI %K health care community %K clinician %K health care %K airborne disease %K learning %K information %K misinformation %K autonomy %K diversity %D 2024 %7 3.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic and the recent increased interest in generative artificial intelligence (GenAI) highlight the need for interprofessional communities’ collaboration to find solutions to complex problems. A personal narrative experience of one of the authors compels us to reflect on current approaches to learning and knowledge acquisition and use solutions to the challenges posed by GenAI through social learning contexts using connectivism. We recognize the need for constructivism and experiential learning for knowledge acquisition to establish foundational understanding. We explore how connectivist approaches can enhance traditional constructivist paradigms amid rapidly changing learning environments and online communities. Learning in connectivism includes interacting with experts from other disciplines and creating nodes of accurate and accessible information while distinguishing between misinformation and accurate facts. Autonomy, connectedness, diversity, and openness are foundational for learners to thrive in this learning environment. Learning in this environment is not just acquiring new knowledge as individuals but being connected to networks of knowledge, enabling health professionals to stay current and up-to-date. Existing online communities with accessible GenAI solutions allow for the application of connectivist principles for learning and knowledge acquisition. %M 39625749 %R 10.2196/53344 %U https://www.jmir.org/2024/1/e53344 %U https://doi.org/10.2196/53344 %U http://www.ncbi.nlm.nih.gov/pubmed/39625749 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e47856 %T Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study %A Baxter-King,Ryan %A Naeim,Arash %A Huang,Tina Q %A Sepucha,Karen %A Stanton,Annette %A Rudkin,Aaron %A Ryu,Rita %A Sabacan,Leah %A Vavreck,Lynn %A Esserman,Laura %A Stover Fiscalini,Allison %A Wenger,Neil S %+ Division of General Internal Medicine and Health Services Research, UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942288, nwenger@mednet.ucla.edu %K breast cancer %K COVID-19 risk perception %K cancer screening %K anxiety %K cancer %K COVID-19 %K prevention %K medical care %K screening %K survey %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women’s breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI –0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. %M 39622037 %R 10.2196/47856 %U https://cancer.jmir.org/2024/1/e47856 %U https://doi.org/10.2196/47856 %U http://www.ncbi.nlm.nih.gov/pubmed/39622037 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59138 %T Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data %A Kang,Ji Ye %A Jung,Weon %A Kim,Hyun Ji %A An,Ji Hyun %A Yoon,Hee %A Kim,Taerim %A Chang,Hansol %A Hwang,Sung Yeon %A Park,Jong Eun %A Lee,Gun Tak %A Cha,Won Chul %A Heo,Sejin %A Lee,Se Uk %+ Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea, 82 2 3410 1878, seukemmd@gmail.com %K telemedicine %K public health %K medication adherence %K COVID-19 %K chronic diseases %D 2024 %7 20.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. %M 39566066 %R 10.2196/59138 %U https://publichealth.jmir.org/2024/1/e59138 %U https://doi.org/10.2196/59138 %U http://www.ncbi.nlm.nih.gov/pubmed/39566066 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46394 %T Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review %A Jefferies,Meryem %A Graham,Robert %A Tracy,Marguerite %A Read,Scott %A Eslam,Mohammed %A Douglas,Mark W %A George,Jacob %+ Drug Health, Western Sydney Local Health District, Building 83, Cumberland Hospital 5 Fleet Street, North Parramatta, NSW, Australia, 61 61 478 168518, Meryem.Jefferies@health.nsw.gov.au %K telehealth use %K emergency department admission %K substance use disorder %K drug addiction %K consent %K privacy %K professional indemnity %K confidentiality %K data security %D 2024 %7 12.11.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster. Objective: We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings. Methods: We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed. Results: In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD. Conclusions: Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of conduct, or suggestions for clinicians to consider, but there was little discussion or evidence of how legal considerations are being applied when providing telehealth consultations at drug health services. Clinicians should be aware of the medicolegal implications when providing health care via telehealth at drug health services. %M 39531642 %R 10.2196/46394 %U https://www.jmir.org/2024/1/e46394 %U https://doi.org/10.2196/46394 %U http://www.ncbi.nlm.nih.gov/pubmed/39531642 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51481 %T National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022 %A Kim,Yeji %A Kim,Soeun %A Lee,Somin %A Park,Jaeyu %A Koyanagi,Ai %A Smith,Lee %A Kim,Min Seo %A Fond,Guillaume %A Boyer,Laurent %A López Sánchez,Guillermo Felipe %A Dragioti,Elena %A Kim,Hyeon Jin %A Lee,Hayeon %A Son,Yejun %A Kim,Minji %A Kim,Sunyoung %A Yon,Dong Keon %+ Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K COVID-19 %K pandemic %K epidemiology %K South Korea %K unmet health care %K unmet dental care. %D 2024 %7 18.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. Objective: This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. Methods: We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. Results: From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (βdiff 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (βdiff 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the β difference during the pandemic increased compared with prepandemic values. Conclusions: Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs. %M 39293055 %R 10.2196/51481 %U https://publichealth.jmir.org/2024/1/e51481 %U https://doi.org/10.2196/51481 %U http://www.ncbi.nlm.nih.gov/pubmed/39293055 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56398 %T Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study %A Dziadzko,Mikhail %A Belhassen,Manon %A Van Ganse,Eric %A Heritier,Fabrice %A Berard,Marjorie %A Marant-Micallef,Claire %A Aubrun,Frederic %+ Hospices Civils de Lyon, Hôpital de la Croix Rousse, Département d’Anesthésie-Réanimation, Douleur, 103 Grande rue de la Croix Rousse, Lyon, 69004, France, 33 4 26 10 93 25, mikhail.dziadzko@chu-lyon.fr %K claims data %K COVID-19 infection %K France %K health care resource utilizationuse %K hospitalization %K mortality %K Post-Acute COVID-19 Syndrome %K PACS %K analysis %K COVID-19 %K health care %K infection %K infections %K pandemic %K descriptive study %K resource use %K outpatient care %K retrospective %K cohort study %K women %K female %K females %K population-based %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Little is known about post–hospital health care resource use (HRU) of patients admitted for severe COVID-19, specifically for the care of patients with postacute COVID-19 syndrome (PACS). Objective: A list of HRU domains and items potentially related to PACS was defined, and potential PACS-related HRU (PPRH) was compared between the pre– and post–COVID-19 periods, to identify new outpatient care likely related to PACS. Methods: A retrospective cohort study was conducted with the French National Health System claims data (SNDS). All patients hospitalized for COVID-19 between February 1, 2020, and June 30, 2020 were described and investigated for 6 months, using discharge date as index date. Patients who died during index stay or within 30 days after discharge were excluded. PPRH was assessed over the 5 months from day 31 after index date to end of follow-up, that is, for the post–COVID-19 period. For each patient, a pre–COVID-19 period was defined that covered the same calendar time in 2019, and pre–COVID-19 PPRH was assessed. Post- or pre- ratios (PP ratios) of the percentage of users were computed with their 95% CIs, and PP ratios>1.2 were considered as “major HRU change.” Results: The final study population included 68,822 patients (median age 64.8 years, 47% women, median follow-up duration 179.3 days). Altogether, 23% of the patients admitted due to severe COVID-19 died during the hospital stay or within the 6 months following discharge. A total of 8 HRU domains were selected to study PPRH: medical visits, technical procedures, dispensed medications, biological analyses, oxygen therapy, rehabilitation, rehospitalizations, and nurse visits. PPRs showed novel outpatient care in all domains and in most items, without specificity, with the highest ratios observed for the care of thoracic conditions. Conclusions: Patients hospitalized for severe COVID-19 during the initial pandemic wave had high morbi-mortality. The analysis of HRU domains and items most likely to be related to PACS showed that new care was commonly initiated after discharge but with no specificity, potentially suggesting that any impact of PACS was part of the overall high HRU of this population after hospital discharge. These purely descriptive results need to be completed with methods for controlling for confusion bias through subgroup analyses. Trial Registration: ClinicalTrials.gov NCT05073328; https://clinicaltrials.gov/ct2/show/NCT05073328 %M 39259961 %R 10.2196/56398 %U https://publichealth.jmir.org/2024/1/e56398 %U https://doi.org/10.2196/56398 %U http://www.ncbi.nlm.nih.gov/pubmed/39259961 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e41792 %T The Effect of the COVID-19 Pandemic on Non–COVID-19 Deaths: Population-Wide Retrospective Cohort Study %A Wai,Abraham Ka-chung %A Yip,Tsz Fung %A Wong,Yui Hang %A Chu,Chun Kit %A Lee,Teddy %A Yu,Ken Hung On %A So,Wang Leong %A Wong,Janet Y H %A Wong,Carlos King-ho %A Ho,Joshua W %A Rainer,Timothy %+ School of Biomedical Sciences, The University of Hong Kong, L4-44, Laboratory Block, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 6518 4979, jwkho@hku.hk %K excess death %K causal inference %K health care avoidance %K emergency department %K COVID-19 %K hospital avoidance behavior %K mortality %K epidemiology %K health care %K hospital care %K death rate %K death %K hospital %K avoidance %K population %K cohort %K death toll %K impact %K excess %K Hong Kong %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non–COVID-19 deaths. Objective: This study aimed to measure the impact of hospital avoidance on excess non–COVID-19 deaths in public hospitals in Hong Kong. Methods: This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. Results: Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non–COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non–COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non–DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. Conclusions: We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences. %M 38349717 %R 10.2196/41792 %U https://publichealth.jmir.org/2024/1/e41792 %U https://doi.org/10.2196/41792 %U http://www.ncbi.nlm.nih.gov/pubmed/38349717