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Review

Telehealth during COVID-19 pandemic era: a systematic review

  • Background 

    Across the globe, the coronavirus (COVID-19) pandemic has altered the delivery of healthcare services as patients must maintain their distance from caregivers, and still receive medical treatment. This has triggered a necessity for exploring means which minimizes the physical gap between patients and healthcare givers while offering health care and ensuring high medical protection at a reduced risk of exposure. Even though telehealth services are no replacement for conventional healthcare, its' usefulness in the coronavirus (COVID-19) pandemic is immense.

    Objective 

    This research reviews the ardent utilization, barriers and recommendations with telehealth services for healthcare delivery during the COVID-19 pandemic.

    Methods 

    An assessment of literature in five large digital databases; PubMed, Science Direct, Sage Pub, ProQuest, and Google Scholar was conducted. Inclusion criteria included studies defining telehealth/telemedicine, utilization, barriers and recommendations during the COVID-19 pandemic from January 2020 to July 2021, written in English and published in peer-reviewed journals. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies. Narrative synthesis was undertaken to summarize and report the findings.

    Results 

    Overall, the study discoveries which are most commonly stated as impediments for telehealth services' full utilization between patients and physicians beyond the scope of typical medical confinement are: infrastructure and internet access (20.00%), data privacy and security (13.33%), digital literacy (13.33%), reimbursement and liability (10.00%), and clinician and patient's unwillingness (6.67%).

    Conclusions 

    The intrusion of coronavirus has accelerated the transition to telehealth services in healthcare delivery, but it has also provided a unique chance to demonstrate the critical role that telehealth can play in ensuring that people of all races, ethnicities, and communities receive high-quality treatment (justice). Healthcare professionals should emphasize the effectiveness of telehealth services as an alternate healthcare delivery method in promoting healthcare to all populace.

    Citation: Jonathan Kissi, Daniel Kwame Kwansah Quansah, Jonathan Aseye Nutakor, Alex Boadi Dankyi, Yvette Adu-Gyamfi. Telehealth during COVID-19 pandemic era: a systematic review[J]. AIMS Medical Science, 2022, 9(1): 81-97. doi: 10.3934/medsci.2022008

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  • Background 

    Across the globe, the coronavirus (COVID-19) pandemic has altered the delivery of healthcare services as patients must maintain their distance from caregivers, and still receive medical treatment. This has triggered a necessity for exploring means which minimizes the physical gap between patients and healthcare givers while offering health care and ensuring high medical protection at a reduced risk of exposure. Even though telehealth services are no replacement for conventional healthcare, its' usefulness in the coronavirus (COVID-19) pandemic is immense.

    Objective 

    This research reviews the ardent utilization, barriers and recommendations with telehealth services for healthcare delivery during the COVID-19 pandemic.

    Methods 

    An assessment of literature in five large digital databases; PubMed, Science Direct, Sage Pub, ProQuest, and Google Scholar was conducted. Inclusion criteria included studies defining telehealth/telemedicine, utilization, barriers and recommendations during the COVID-19 pandemic from January 2020 to July 2021, written in English and published in peer-reviewed journals. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies. Narrative synthesis was undertaken to summarize and report the findings.

    Results 

    Overall, the study discoveries which are most commonly stated as impediments for telehealth services' full utilization between patients and physicians beyond the scope of typical medical confinement are: infrastructure and internet access (20.00%), data privacy and security (13.33%), digital literacy (13.33%), reimbursement and liability (10.00%), and clinician and patient's unwillingness (6.67%).

    Conclusions 

    The intrusion of coronavirus has accelerated the transition to telehealth services in healthcare delivery, but it has also provided a unique chance to demonstrate the critical role that telehealth can play in ensuring that people of all races, ethnicities, and communities receive high-quality treatment (justice). Healthcare professionals should emphasize the effectiveness of telehealth services as an alternate healthcare delivery method in promoting healthcare to all populace.



    Fractional differential equations rise in many fields, such as biology, physics and engineering. There are many results about the existence of solutions and control problems (see [1,2,3,4,5,6]).

    It is well known that the nonexistence of nonconstant periodic solutions of fractional differential equations was shown in [7,8,11] and the existence of asymptotically periodic solutions was derived in [8,9,10,11]. Thus it gives rise to study the periodic solutions of fractional differential equations with periodic impulses.

    Recently, Fečkan and Wang [12] studied the existence of periodic solutions of fractional ordinary differential equations with impulses periodic condition and obtained many existence and asymptotic stability results for the Caputo's fractional derivative with fixed and varying lower limits. In this paper, we study the Caputo's fractional evolution equations with varying lower limits and we prove the existence of periodic mild solutions to this problem with the case of general periodic impulses as well as small equidistant and shifted impulses. We also study the Caputo's fractional evolution equations with fixed lower limits and small nonlinearities and derive the existence of its periodic mild solutions. The current results extend some results in [12].

    Set ξq(θ)=1qθ11qϖq(θ1q)0, ϖq(θ)=1πn=1(1)n1θnq1Γ(nq+1)n!sin(nπq), θ(0,). Note that ξq(θ) is a probability density function defined on (0,), namely ξq(θ)0, θ(0,) and 0ξq(θ)dθ=1.

    Define T:XX and S:XX given by

    T(t)=0ξq(θ)S(tqθ)dθ,  S(t)=q0θξq(θ)S(tqθ)dθ.

    Lemma 2.1. ([13,Lemmas 3.2,3.3]) The operators T(t) and S(t),t0 have following properties:

    (1) Suppose that supt0S(t)M. For any fixed t0, T() and S() are linear and bounded operators, i.e., for any uX,

    T(t)uMu and S(t)uMΓ(q)u.

    (2) {T(t),t0} and {S(t),t0} are strongly continuous.

    (3) {T(t),t>0} and {S(t),t>0} are compact, if {S(t),t>0} is compact.

    Let N0={0,1,,}. We consider the following impulsive fractional equations

    {cDqtk,tu(t)=Au(t)+f(t,u(t)), q(0,1), t(tk,tk+1), kN0,u(t+k)=u(tk)+Δk(u(tk)), kN,u(0)=u0, (2.1)

    where cDqtk,t denotes the Caputo's fractional time derivative of order q with the lower limit at tk, A:D(A)XX is the generator of a C0-semigroup {S(t),t0} on a Banach space X, f:R×XX satisfies some assumptions. We suppose the following conditions:

    (Ⅰ) f is continuous and T-periodic in t.

    (Ⅱ) There exist constants a>0, bk>0 such that

    {f(t,u)f(t,v)auv, tR, u,vX,uv+Δk(u)Δk(v)bkuv, kN, u,vX.

    (Ⅲ) There exists NN such that T=tN+1,tk+N+1=tk+T and Δk+N+1=Δk for any kN.

    It is well known [3] that (2.1) has a unique solution on R+ if the conditions (Ⅰ) and (Ⅱ) hold. So we can consider the Poincaré mapping

    P(u0)=u(T)+ΔN+1(u(T)).

    By [14,Lemma 2.2] we know that the fixed points of P determine T-periodic mild solutions of (2.1).

    Theorem 2.2. Assume that (I)-(III) hold. Let Ξ:=Nk=0MbkEq(Ma(tk+1tk)q), where Eq is the Mittag-Leffler function (see [3, p.40]), then there holds

    P(u)P(v)Ξuv, u,vX. (2.2)

    If Ξ<1, then (2.1) has a unique T-periodic mild solution, which is also asymptotically stable.

    Proof. By the mild solution of (2.1), we mean that uC((tk,tk+1),X) satisfying

    u(t)=T(ttk)u(t+k)+ttkS(ts)f(s,u(s))ds. (2.3)

    Let u and v be two solutions of (2.3) with u(0)=u0 and v(0)=v0, respectively. By (2.3) and (II), we can derive

    u(t)v(t)T(ttk)(u(t+k)v(t+k))+ttk(ts)q1S(ts)(f(s,u(s)f(s,v(s))dsMu(t+k)v(t+k)+MaΓ(q)ttk(ts)q1f(s,u(s)f(s,v(s))ds. (2.4)

    Applying Gronwall inequality [15, Corollary 2] to (2.4), we derive

    u(t)v(t)Mu(t+k)v(t+k)Eq(Ma(ttk)q), t(tk,tk+1), (2.5)

    which implies

    u(tk+1)v(tk+1)MEq(Ma(tk+1tk)q)u(t+k)v(t+k),k=0,1,,N. (2.6)

    By (2.6) and (Ⅱ), we derive

    P(u0)P(v0)=u(tN+1)v(tN+1)+ΔN+1(u(tN+1))ΔN+1(v(tN+1))bN+1u(tN+1)v(tN+1)(Nk=0MbkEq(Ma(tk+1tk)q))u0v0=Ξu0v0, (2.7)

    which implies that (2.2) is satisfied. Thus P:XX is a contraction if Ξ<1. Using Banach fixed point theorem, we obtain that P has a unique fixed point u0 if Ξ<1. In addition, since

    Pn(u0)Pn(v0)Ξnu0v0, v0X,

    we get that the corresponding periodic mild solution is asymptotically stable.

    We study

    {cDqkhu(t)=Au(t)+f(u(t)), q(0,1), t(kh,(k+1)h), kN0,u(kh+)=u(kh)+ˉΔhq, kN,u(0)=u0, (2.8)

    where h>0, ˉΔX, and f:XX is Lipschitz. We know [3] that under above assumptions, (2.8) has a unique mild solution u(u0,t) on R+, which is continuous in u0X, tR+{kh|kN} and left continuous in t ant impulsive points {kh|kN}. We can consider the Poincaré mapping

    Ph(u0)=u(u0,h+).

    Theorem 2.3. Let w(t) be a solution of following equations

    {w(t)=ˉΔ+1Γ(q+1)f(w(t)), t[0,T],w(0)=u0. (2.9)

    Then there exists a mild solution u(u0,t) of (2.8) on [0,T], satisfying

    u(u0,t)=w(tqq1)+O(hq).

    If w(t) is a stable periodic solution, then there exists a stable invariant curve of Poincaré mapping of (2.8) in a neighborhood of w(t). Note that h is sufficiently small.

    Proof. For any t(kh,(k+1)h),kN0, the mild solution of (2.8) is equivalent to

    u(u0,t)=T(tkh)u(kh+)+tkh(ts)q1S(ts)f(u(u0,s))ds=T(tkh)u(kh+)+tkh0(tkhs)q1S(tkhs)f(u(u(kh+),s))ds. (2.10)

    So

    u((k+1)h+)=T(h)u(kh+)+ˉΔhq+h0(hs)q1S(hs)f(u(u(kh+),s))ds=Ph(u(kh+)), (2.11)

    and

    Ph(u0)=u(u0,h+)=T(h)u0+ˉΔhq+h0(hs)q1S(hs)f(u(u0,s))ds. (2.12)

    Inserting

    u(u0,t)=T(t)u0+hqv(u0,t), t[0,h],

    into (2.10), we obtain

    v(u0,t)=1hqt0(ts)q1S(ts)f(T(t)u0+hqv(u0,t))ds=1hqt0(ts)q1S(ts)f(T(t)u0)ds+1hqt0(ts)q1S(ts)(f(T(t)u0+hqv(u0,t))f(T(t)u0))ds=1hqt0(ts)q1S(ts)f(T(t)u0)ds+O(hq),

    since

    t0(ts)q1S(ts)(f(T(t)u0+hqv(u0,t))f(T(t)u0))dst0(ts)q1S(ts)f(T(t)u0+hqv(u0,t))f(T(t)u0)dsMLlochqtqΓ(q+1)maxt[0,h]{v(u0,t)}h2qMLlocΓ(q+1)maxt[0,h]{v(u0,t)},

    where Lloc is a local Lipschitz constant of f. Thus we get

    u(u0,t)=T(t)u0+t0(ts)q1S(ts)f(T(t)u0)ds+O(h2q), t[0,h], (2.13)

    and (2.12) gives

    Ph(u0)=T(h)u0+ˉΔhq+h0(hs)q1S(hs)f(T(h)u0)ds+O(h2q).

    So (2.11) becomes

    u((k+1)h+)=T(h)u(kh+)+ˉΔhq+(k+1)hkh((k+1)hs)q1S((k+1)hs)f(T(h)u(kh+))ds+O(h2q). (2.14)

    Since T(t) and S(t) are strongly continuous,

    limt0T(t)=I and limt0S(t)=1Γ(q)I. (2.15)

    Thus (2.14) leads to its approximation

    w((k+1)h+)=w(kh+)+ˉΔhq+hqΓ(q+1)f(w(kh+)),

    which is the Euler numerical approximation of

    w(t)=ˉΔ+1Γ(q+1)f(w(t)).

    Note that (2.10) implies

    u(u0,t)T(tkh)u(kh+)=O(hq), t[kh,(k+1)h]. (2.16)

    Applying (2.15), (2.16) and the already known results about Euler approximation method in [16], we obtain the result of Theorem 2.3.

    Corollary 2.4. We can extend (2.8) for periodic impulses of following form

    {cDqkhu(t)=Au(t)+f(u(t)), t(kh,(k+1)h), kN0,u(kh+)=u(kh)+ˉΔkhq, kN,u(0)=u0, (2.17)

    where ˉΔkX satisfy ˉΔk+N+1=ˉΔk for any kN. Then Theorem 2.3 can directly extend to (2.17) with

    {w(t)=N+1k=1ˉΔkN+1+1Γ(q+1)f(w(t)), t[0,T], kN,w(0)=u0 (2.18)

    instead of (2.9).

    Proof. We can consider the Poincaré mapping

    Ph(u0)=u(u0,(N+1)h+),

    with a form of

    Ph=PN+1,hP1,h

    where

    Pk,h(u0)=ˉΔkhq+u(u0,h).

    By (2.13), we can derive

    Pk,h(u0)=ˉΔkhq+u(u0,h)=T(h)u0+ˉΔkhq+h0(hs)q1S(hs)f(T(h)u0)ds+O(h2q).

    Then we get

    Ph(u0)=T(h)u0+N+1k=1ˉΔkhq+(N+1)h0(hs)q1S(hs)f(T(h)u0)ds+O(h2q).

    By (2.15), we obtain that Ph(u0) leads to its approximation

    u0+N+1k=1ˉΔkhq+(N+1)hqΓ(q+1)f(u0). (2.19)

    Moreover, equations

    w(t)=N+1k=1ˉΔkN+1+1Γ(q+1)f(w(t))

    has the Euler numerical approximation

    u0+hq(N+1k=1ˉΔkN+1+1Γ(q+1)f(u0))

    with the step size hq, and its approximation of N+1 iteration is (2.19), the approximation of Ph. Thus Theorem 2.3 can directly extend to (2.17) with (2.18).

    Now we consider following equations with small nonlinearities of the form

    {cDq0u(t)=Au(t)+ϵf(t,u(t)), q(0,1), t(tk,tk+1), kN0,u(t+k)=u(tk)+ϵΔk(u(tk)), kN,u(0)=u0, (3.1)

    where ϵ is a small parameter, cDq0 is the generalized Caputo fractional derivative with lower limit at 0. Then (3.1) has a unique mild solution u(ϵ,t). Give the Poincaré mapping

    P(ϵ,u0)=u(ϵ,T)+ϵΔN+1(u(ϵ,T)).

    Assume that

    (H1) f and Δk are C2-smooth.

    Then P(ϵ,u0) is also C2-smooth. In addition, we have

    u(ϵ,t)=T(t)u0+ϵω(t)+O(ϵ2),

    where ω(t) satisfies

    {cDq0ω(t)=Aω(t)+f(t,T(t)u0), t(tk,tk+1), k=0,1,,N,ω(t+k)=ω(tk)+Δk(T(tk)u0), k=1,2,,N+1,ω(0)=0,

    and

    ω(T)=Nk=1T(Ttk)Δk(T(tk)u0)+T0(Ts)q1S(Ts)f(s,T(s)u0)ds.

    Thus we derive

    {P(ϵ,u0)=u0+M(ϵ,u0)+O(ϵ2)M(ϵ,u0)=(T(T)I)u0+ϵω(T)+ϵΔN+1(T(T)u0). (3.2)

    Theorem 3.1. Suppose that (I), (III) and (H1) hold.

    1). If (T(T)I) has a continuous inverse, i.e. (T(T)I)1 exists and continuous, then (3.1) has a unique T-periodic mild solution located near 0 for any ϵ0 small.

    2). If (T(T)I) is not invertible, we suppose that ker(T(T)I)=[u1,,uk] and X=im(T(T)I)X1 for a closed subspace X1 with dimX1=k. If there is v0[u1,,uk] such that B(0,v0)=0 (see (3.7)) and the k×k-matrix DB(0,v0) is invertible, then (3.1) has a unique T-periodic mild solution located near T(t)v0 for any ϵ0 small.

    3). If rσ(Du0M(ϵ,u0))<0, then the T-periodic mild solution is asymptotically stable. If rσ(Du0M(ϵ,u0))(0,+), then the T-periodic mild solution is unstable.

    Proof. The fixed point u0 of P(ϵ,x0) determines the T-periodic mild solution of (3.1), which is equivalent to

    M(ϵ,u0)+O(ϵ2)=0. (3.3)

    Note that M(0,u0)=(T(T)I)u0. If (T(T)I) has a continuous inverse, then (3.3) can be solved by the implicit function theorem to get its solution u0(ϵ) with u0(0)=0.

    If (T(T)I) is not invertible, then we take a decomposition u0=v+w, v[u1,,uk], take bounded projections Q1:Xim(T(T)I), Q2:XX1, I=Q1+Q2 and decompose (3.3) to

    Q1M(ϵ,v+w)+Q1O(ϵ2)=0, (3.4)

    and

    Q2M(ϵ,v+w)+Q2O(ϵ2)=0. (3.5)

    Now Q1M(0,v+w)=(T(T)I)w, so we can solve by implicit function theorem from (3.4), w=w(ϵ,v) with w(0,v)=0. Inserting this solution into (3.5), we get

    B(ϵ,v)=1ϵ(Q2M(ϵ,v+w)+Q2O(ϵ2))=Q2ω(T)+Q2ΔN+1(T(t)v+w(ϵ,v))+O(ϵ). (3.6)

    So

    B(0,v)=Nk=1Q2T(Ttk)Δk(T(tk)v)+Q2T0(Ts)q1S(Ts)f(s,T(s)v)ds. (3.7)

    Consequently we get, if there is v0[u1,,uk] such that B(0,v0)=0 and the k×k-matrix DB(0,v0) is invertible, then (3.1) has a unique T-periodic mild solution located near T(t)v0 for any ϵ0 small.

    In addition, Du0P(ϵ,u0(ϵ))=I+Du0M(ϵ,u0)+O(ϵ2). Thus we can directly derive the stability and instability results by the arguments in [17].

    In this section, we give an example to demonstrate Theorem 2.2.

    Example 4.1. Consider the following impulsive fractional partial differential equation:

    { cD12tk,tu(t,y)=2y2u(t,y)+sinu(t,y)+cos2πt,  t(tk,tk+1), kN0,  y[0,π], Δk(u(tk,y))=u(t+k,y)u(tk,y)=ξu(tk,y),  kN,  y[0,π], u(t,0)=u(t,π)=0,  t(tk,tk+1),  kN0, u(0,y)=u0(y),  y[0,π], (4.1)

    for ξR, tk=k3. Let X=L2[0,π]. Define the operator A:D(A)XX by Au=d2udy2 with the domain

    D(A)={uXdudy,d2udy2X, u(0)=u(π)=0}.

    Then A is the infinitesimal generator of a C0-semigroup {S(t),t0} on X and S(t)M=1 for any t0. Denote u(,y)=u()(y) and define f:[0,)×XX by

    f(t,u)(y)=sinu(y)+cos2πt.

    Set T=t3=1, tk+3=tk+1, Δk+3=Δk, a=1, bk=|1+ξ|. Obviously, conditions (I)-(III) hold. Note that

    Ξ=2k=0|1+ξ|E12(13)=|1+ξ|3(E12(13))3.

    Letting Ξ<1, we get E12(13)1<ξ<E12(13)1. Now all assumptions of Theorem 2.2 hold. Hence, if E12(13)1<ξ<E12(13)1, (4.1) has a unique 1-periodic mild solution, which is also asymptotically stable.

    This paper deals with the existence and stability of periodic solutions of impulsive fractional evolution equations with the case of varying lower limits and fixed lower limits. Although, Fečkan and Wang [12] prove the existence of periodic solutions of impulsive fractional ordinary differential equations in finite dimensional Euclidean space, we extend some results to impulsive fractional evolution equation on Banach space by involving operator semigroup theory. Our results can be applied to some impulsive fractional partial differential equations and the proposed approach can be extended to study the similar problem for periodic impulsive fractional evolution inclusions.

    The authors are grateful to the referees for their careful reading of the manuscript and valuable comments. This research is supported by the National Natural Science Foundation of China (11661016), Training Object of High Level and Innovative Talents of Guizhou Province ((2016)4006), Major Research Project of Innovative Group in Guizhou Education Department ([2018]012), Foundation of Postgraduate of Guizhou Province (YJSCXJH[2019]031), the Slovak Research and Development Agency under the contract No. APVV-18-0308, and the Slovak Grant Agency VEGA No. 2/0153/16 and No. 1/0078/17.

    All authors declare no conflicts of interest in this paper.


    Acknowledgments



    We wish to render our sincere gratitude to the Management and Staff of Health Information Management, School of Allied Health Sciences, University of Cape Coast for their time and contributions during the period of this research.

    Authors' contributions



    Conceptualization: JK; formal analysis, investigation, and data curation: JK, DKKQ, JAN and YAG; formal data analysis and results interpretation: JK and YAG; writing, original draft preparation: JK; writing, review and editing: JAN and ABD.

    Conflict of interest



    The authors declare no conflict of interest.

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