Cost‐Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face‐to‐Face Dermatology Consultations in the Hospital
ABSTRACT Objective To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost‐utility and cost per quality‐adjusted life years (QALYs) to conventional dermatology consultations (face‐to‐face dermatology...
Gespeichert in:
| Veröffentlicht in: | Public health Nursing 2025-01, Vol.42 (1), p.419-434 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 434 |
|---|---|
| container_issue | 1 |
| container_start_page | 419 |
| container_title | Public health Nursing |
| container_volume | 42 |
| creator | Lopez‐Villegas, Antonio Bautista‐Mesa, Rafael Jesus Lopez‐Liria, Remedios Perez‐Heredia, Mercedes Hernandez‐Montoya, Carlos Javier Gutierrez‐Maldonado, Maria Gador Leal‐Costa, Cesar Peiro, Salvador |
| description | ABSTRACT
Objective
To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost‐utility and cost per quality‐adjusted life years (QALYs) to conventional dermatology consultations (face‐to‐face dermatology [F‐F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients.
Methods
This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F‐F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol‐5D‐5L (EQ5D‐5L) questionnaire responses.
Results
From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients’ perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F‐F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F‐F/D group (p = 0.004).
Conclusions
This study shows that TD units in PC represent a significant cost‐effective alternative to conventional hospital follow‐up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients. |
| doi_str_mv | 10.1111/phn.13438 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3116676836</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3151783450</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2438-f38b9e4996b86da07c183abb763eb4f4e929daa63691d61df96316c963e41da63</originalsourceid><addsrcrecordid>eNp1kc1O3DAURi3UqgzQBS9QWeoGFgE7dpx4icLPVEItC4Zt5CQ3xcgTD7YjlB1rVjwjT4JDaFUh1YvPV9bRkXw_hPYpOaLxHG9u-yPKOCu20IJmaZZQzsUntCA5yxOaErmNdry_I4SwLBVf0DaTnHAqswV6Kq0PL4_Pq6CNDiM-6ZUZvfbYdvgaDLTg1ipYY3-PeNXr4LHu8ZXTa-VGXCoHuIQ-gPP4Jsbg8blqIPqCjTHN-PQfQ2l7P5iggo7DZAq3gJfWb3RQZg997pTx8PX93kWr87Prcplc_rr4UZ5cJk0av5h0rKglcClFXYhWkbyhBVN1nQsGNe84yFS2SgkmJG0FbTspGBVNTOC0je-76GD2bpy9H8CHaq19A8aoHuzgK0apELko2IR-_4De2cHFFU1URvOC8YxE6nCmGme9d9BVm3lBFSXVVFAVC6reCorst3fjUK-h_Uv-aSQCxzPwoA2M_zdVV8ufs_IVmsueTg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3151783450</pqid></control><display><type>article</type><title>Cost‐Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face‐to‐Face Dermatology Consultations in the Hospital</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Lopez‐Villegas, Antonio ; Bautista‐Mesa, Rafael Jesus ; Lopez‐Liria, Remedios ; Perez‐Heredia, Mercedes ; Hernandez‐Montoya, Carlos Javier ; Gutierrez‐Maldonado, Maria Gador ; Leal‐Costa, Cesar ; Peiro, Salvador</creator><creatorcontrib>Lopez‐Villegas, Antonio ; Bautista‐Mesa, Rafael Jesus ; Lopez‐Liria, Remedios ; Perez‐Heredia, Mercedes ; Hernandez‐Montoya, Carlos Javier ; Gutierrez‐Maldonado, Maria Gador ; Leal‐Costa, Cesar ; Peiro, Salvador</creatorcontrib><description>ABSTRACT
Objective
To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost‐utility and cost per quality‐adjusted life years (QALYs) to conventional dermatology consultations (face‐to‐face dermatology [F‐F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients.
Methods
This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F‐F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol‐5D‐5L (EQ5D‐5L) questionnaire responses.
Results
From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients’ perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F‐F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F‐F/D group (p = 0.004).
Conclusions
This study shows that TD units in PC represent a significant cost‐effective alternative to conventional hospital follow‐up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients.</description><identifier>ISSN: 0737-1209</identifier><identifier>ISSN: 1525-1446</identifier><identifier>EISSN: 1525-1446</identifier><identifier>DOI: 10.1111/phn.13438</identifier><identifier>PMID: 39404195</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Artificial intelligence ; asynchronous ; Cost-Benefit Analysis ; Costs ; cost‐utility analysis ; Dermatology ; Dermatology - economics ; Dermatology - methods ; Female ; Health care ; Hospitals ; Humans ; Male ; Medical personnel ; Middle Aged ; Nurses ; Patients ; perceived quality of life ; Primary care ; Primary Health Care - economics ; Public health ; Quality of life ; Quality-Adjusted Life Years ; Referral and Consultation - economics ; Remote Consultation - economics ; Skin Diseases - diagnosis ; Skin Diseases - economics ; Surveys and Questionnaires ; teledermatology ; telemedicine ; Telemedicine - economics</subject><ispartof>Public health Nursing, 2025-01, Vol.42 (1), p.419-434</ispartof><rights>2024 Wiley Periodicals LLC.</rights><rights>2025 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2438-f38b9e4996b86da07c183abb763eb4f4e929daa63691d61df96316c963e41da63</cites><orcidid>0000-0002-7711-3877</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fphn.13438$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fphn.13438$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39404195$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lopez‐Villegas, Antonio</creatorcontrib><creatorcontrib>Bautista‐Mesa, Rafael Jesus</creatorcontrib><creatorcontrib>Lopez‐Liria, Remedios</creatorcontrib><creatorcontrib>Perez‐Heredia, Mercedes</creatorcontrib><creatorcontrib>Hernandez‐Montoya, Carlos Javier</creatorcontrib><creatorcontrib>Gutierrez‐Maldonado, Maria Gador</creatorcontrib><creatorcontrib>Leal‐Costa, Cesar</creatorcontrib><creatorcontrib>Peiro, Salvador</creatorcontrib><title>Cost‐Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face‐to‐Face Dermatology Consultations in the Hospital</title><title>Public health Nursing</title><addtitle>Public Health Nurs</addtitle><description>ABSTRACT
Objective
To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost‐utility and cost per quality‐adjusted life years (QALYs) to conventional dermatology consultations (face‐to‐face dermatology [F‐F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients.
Methods
This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F‐F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol‐5D‐5L (EQ5D‐5L) questionnaire responses.
Results
From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients’ perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F‐F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F‐F/D group (p = 0.004).
Conclusions
This study shows that TD units in PC represent a significant cost‐effective alternative to conventional hospital follow‐up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Artificial intelligence</subject><subject>asynchronous</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>cost‐utility analysis</subject><subject>Dermatology</subject><subject>Dermatology - economics</subject><subject>Dermatology - methods</subject><subject>Female</subject><subject>Health care</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Middle Aged</subject><subject>Nurses</subject><subject>Patients</subject><subject>perceived quality of life</subject><subject>Primary care</subject><subject>Primary Health Care - economics</subject><subject>Public health</subject><subject>Quality of life</subject><subject>Quality-Adjusted Life Years</subject><subject>Referral and Consultation - economics</subject><subject>Remote Consultation - economics</subject><subject>Skin Diseases - diagnosis</subject><subject>Skin Diseases - economics</subject><subject>Surveys and Questionnaires</subject><subject>teledermatology</subject><subject>telemedicine</subject><subject>Telemedicine - economics</subject><issn>0737-1209</issn><issn>1525-1446</issn><issn>1525-1446</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1O3DAURi3UqgzQBS9QWeoGFgE7dpx4icLPVEItC4Zt5CQ3xcgTD7YjlB1rVjwjT4JDaFUh1YvPV9bRkXw_hPYpOaLxHG9u-yPKOCu20IJmaZZQzsUntCA5yxOaErmNdry_I4SwLBVf0DaTnHAqswV6Kq0PL4_Pq6CNDiM-6ZUZvfbYdvgaDLTg1ipYY3-PeNXr4LHu8ZXTa-VGXCoHuIQ-gPP4Jsbg8blqIPqCjTHN-PQfQ2l7P5iggo7DZAq3gJfWb3RQZg997pTx8PX93kWr87Prcplc_rr4UZ5cJk0av5h0rKglcClFXYhWkbyhBVN1nQsGNe84yFS2SgkmJG0FbTspGBVNTOC0je-76GD2bpy9H8CHaq19A8aoHuzgK0apELko2IR-_4De2cHFFU1URvOC8YxE6nCmGme9d9BVm3lBFSXVVFAVC6reCorst3fjUK-h_Uv-aSQCxzPwoA2M_zdVV8ufs_IVmsueTg</recordid><startdate>202501</startdate><enddate>202501</enddate><creator>Lopez‐Villegas, Antonio</creator><creator>Bautista‐Mesa, Rafael Jesus</creator><creator>Lopez‐Liria, Remedios</creator><creator>Perez‐Heredia, Mercedes</creator><creator>Hernandez‐Montoya, Carlos Javier</creator><creator>Gutierrez‐Maldonado, Maria Gador</creator><creator>Leal‐Costa, Cesar</creator><creator>Peiro, Salvador</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7TS</scope><scope>ASE</scope><scope>C1K</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7711-3877</orcidid></search><sort><creationdate>202501</creationdate><title>Cost‐Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face‐to‐Face Dermatology Consultations in the Hospital</title><author>Lopez‐Villegas, Antonio ; Bautista‐Mesa, Rafael Jesus ; Lopez‐Liria, Remedios ; Perez‐Heredia, Mercedes ; Hernandez‐Montoya, Carlos Javier ; Gutierrez‐Maldonado, Maria Gador ; Leal‐Costa, Cesar ; Peiro, Salvador</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2438-f38b9e4996b86da07c183abb763eb4f4e929daa63691d61df96316c963e41da63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Artificial intelligence</topic><topic>asynchronous</topic><topic>Cost-Benefit Analysis</topic><topic>Costs</topic><topic>cost‐utility analysis</topic><topic>Dermatology</topic><topic>Dermatology - economics</topic><topic>Dermatology - methods</topic><topic>Female</topic><topic>Health care</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Middle Aged</topic><topic>Nurses</topic><topic>Patients</topic><topic>perceived quality of life</topic><topic>Primary care</topic><topic>Primary Health Care - economics</topic><topic>Public health</topic><topic>Quality of life</topic><topic>Quality-Adjusted Life Years</topic><topic>Referral and Consultation - economics</topic><topic>Remote Consultation - economics</topic><topic>Skin Diseases - diagnosis</topic><topic>Skin Diseases - economics</topic><topic>Surveys and Questionnaires</topic><topic>teledermatology</topic><topic>telemedicine</topic><topic>Telemedicine - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lopez‐Villegas, Antonio</creatorcontrib><creatorcontrib>Bautista‐Mesa, Rafael Jesus</creatorcontrib><creatorcontrib>Lopez‐Liria, Remedios</creatorcontrib><creatorcontrib>Perez‐Heredia, Mercedes</creatorcontrib><creatorcontrib>Hernandez‐Montoya, Carlos Javier</creatorcontrib><creatorcontrib>Gutierrez‐Maldonado, Maria Gador</creatorcontrib><creatorcontrib>Leal‐Costa, Cesar</creatorcontrib><creatorcontrib>Peiro, Salvador</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Physical Education Index</collection><collection>British Nursing Index</collection><collection>Environmental Sciences and Pollution Management</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Public health Nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lopez‐Villegas, Antonio</au><au>Bautista‐Mesa, Rafael Jesus</au><au>Lopez‐Liria, Remedios</au><au>Perez‐Heredia, Mercedes</au><au>Hernandez‐Montoya, Carlos Javier</au><au>Gutierrez‐Maldonado, Maria Gador</au><au>Leal‐Costa, Cesar</au><au>Peiro, Salvador</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost‐Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face‐to‐Face Dermatology Consultations in the Hospital</atitle><jtitle>Public health Nursing</jtitle><addtitle>Public Health Nurs</addtitle><date>2025-01</date><risdate>2025</risdate><volume>42</volume><issue>1</issue><spage>419</spage><epage>434</epage><pages>419-434</pages><issn>0737-1209</issn><issn>1525-1446</issn><eissn>1525-1446</eissn><abstract>ABSTRACT
Objective
To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost‐utility and cost per quality‐adjusted life years (QALYs) to conventional dermatology consultations (face‐to‐face dermatology [F‐F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients.
Methods
This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F‐F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol‐5D‐5L (EQ5D‐5L) questionnaire responses.
Results
From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients’ perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F‐F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F‐F/D group (p = 0.004).
Conclusions
This study shows that TD units in PC represent a significant cost‐effective alternative to conventional hospital follow‐up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>39404195</pmid><doi>10.1111/phn.13438</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-7711-3877</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0737-1209 |
| ispartof | Public health Nursing, 2025-01, Vol.42 (1), p.419-434 |
| issn | 0737-1209 1525-1446 1525-1446 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3116676836 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Artificial intelligence asynchronous Cost-Benefit Analysis Costs cost‐utility analysis Dermatology Dermatology - economics Dermatology - methods Female Health care Hospitals Humans Male Medical personnel Middle Aged Nurses Patients perceived quality of life Primary care Primary Health Care - economics Public health Quality of life Quality-Adjusted Life Years Referral and Consultation - economics Remote Consultation - economics Skin Diseases - diagnosis Skin Diseases - economics Surveys and Questionnaires teledermatology telemedicine Telemedicine - economics |
| title | Cost‐Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face‐to‐Face Dermatology Consultations in the Hospital |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T20%3A47%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cost%E2%80%90Utility%20Analysis%20of%20Teledermatology%20Units%20in%20Primary%20Care%20Centers%20Versus%20Face%E2%80%90to%E2%80%90Face%20Dermatology%20Consultations%20in%20the%20Hospital&rft.jtitle=Public%20health%20Nursing&rft.au=Lopez%E2%80%90Villegas,%20Antonio&rft.date=2025-01&rft.volume=42&rft.issue=1&rft.spage=419&rft.epage=434&rft.pages=419-434&rft.issn=0737-1209&rft.eissn=1525-1446&rft_id=info:doi/10.1111/phn.13438&rft_dat=%3Cproquest_cross%3E3151783450%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3151783450&rft_id=info:pmid/39404195&rfr_iscdi=true |