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Gabet A, Grave C, Tuppin P, Lesuffleur T, Guenancia C, Nguyen-Thanh V, Guignard R, Blacher J, Olié V. Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope? Front Cardiovasc Med 2022; 9:856689. [PMID: 35548431 PMCID: PMC9081923 DOI: 10.3389/fcvm.2022.856689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population. Methods For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017–2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists. Results In 2020, IRR significantly decreased for initiations of antihypertensives (−11.1%[CI95%, −11.4%;−10.8%]), lipid-lowering drugs (−5.2%[CI95%, −5.5%;−4.8%]), oral anticoagulants in atrial fibrillation (−8.6%[CI95%, −9.1%;−8.0%]), and smoking cessation medications (−50.9%[CI95%, −51.1%;−50.7%]) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women. Conclusion The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.
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Affiliation(s)
- Amélie Gabet
- Santé Publique France, Paris, France
- *Correspondence: Amélie Gabet,
| | | | | | | | | | | | | | - Jacques Blacher
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, AP-HP, Université de Paris, Paris, France
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152
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Nilsen P, Fernemark H, Seing I, Schildmeijer K, Skagerström J. Seven lessons from the coronavirus pandemic for primary health care: A qualitative study of registered and assistant nurses in Sweden. Scand J Caring Sci 2022; 36:1197-1205. [PMID: 35466416 PMCID: PMC9115448 DOI: 10.1111/scs.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
Aim The aim of this study was to explore lessons from the pandemic by registered and assistant nurses in Swedish primary health care (PHC) of potential relevance for the future operation of PHC. Methods Twenty‐one semi‐structured interviews were conducted with registered and assistant nurses. We used a purposeful sampling strategy to achieve a diverse sample with regard to size and location of PHC centres. Data were analysed using qualitative content analysis. Results Analysis yielded two categories: lessons from the pandemic pertaining to PHC personnel and patient behaviours (adaptability of the personnel; importance of hygiene and maintaining physical distance; and importance of being attentive to illness symptoms) and lessons from the pandemic related to primary healthcare work routines (effectiveness of digital job meetings; advantages of digital patient consultations; importance of keeping infectious patients separate from other patients; and the need to allow only pre‐booked patient appointments). Conclusions The seven sub‐categories represent seven lessons from the pandemic. The lessons generated both instrumental knowledge, which the nurses could apply in work‐related decisions, and conceptual knowledge which yielded improved understanding of problems and potential solutions for PHC.
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Affiliation(s)
- Per Nilsen
- Division of Health and Society Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Hanna Fernemark
- Division of Health and Society Department of Health, Medicine and Caring Sciences Primary Health Care Centre, Lambohov Linköping University Linköping Sweden
| | - Ida Seing
- Department of Behavioral Science and Learning Linköping University Linköping Sweden
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences Faculty of Health and Life Sciences Linnaeus University Kalmar Sweden
| | - Janna Skagerström
- Research and Development Unit in Region Östergötland Linköping Sweden
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153
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Govier DJ, Cohen-Cline H, Marsi K, Roth SE. Differences in access to virtual and in-person primary care by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. BMC Health Serv Res 2022; 22:511. [PMID: 35428257 PMCID: PMC9012053 DOI: 10.1186/s12913-022-07858-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
Background Research exploring telehealth expansion during the COVID-19 pandemic has demonstrated that groups disproportionately impacted by COVID-19 also experience worse access to telehealth. However, this research has been cross-sectional or short in duration; geographically limited; has not accounted for pre-existing access disparities; and has not examined COVID-19 patients. We examined virtual primary care use by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. We also assessed use of in-person primary care to understand whether disparities in virtual access may have been offset by improved in-person access. Methods Using a cohort design, electronic health records, and Centers for Disease Control and Prevention Social Vulnerability Index, we compared changes in virtual and in-person primary care use by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our study population included 11,326 adult patients diagnosed with COVID-19 between March and July 2020. We estimated logistic regression models to examine likelihood of primary care use. In all regression models we computed robust standard errors; in adjusted models we controlled for demographic and health characteristics of patients. Results In a patient population of primarily Hispanic/Latino and non-Hispanic White individuals, and in which over half lived in socially vulnerable areas, likelihood of virtual primary care use increased from the year before to the year after COVID-19 diagnosis (3.6 to 10.3%); while in-person use remained stable (21.0 to 20.7%). In unadjusted and adjusted regression models, compared with White patients, Hispanic/Latino and other race/ethnicity patients were significantly less likely to use virtual care before and after COVID-19 diagnosis; Hispanic/Latino, Native Hawaiian/Pacific Islander, and other race/ethnicity patients, and patients living in socially vulnerable areas were also significantly less likely to use in-person care during these time periods. Conclusions Newly expanded virtual primary care has not equitably benefited individuals from racialized groups diagnosed with COVID-19, and virtual access disparities have not been offset by improved in-person access. Health systems should employ evidence-based strategies to equitably provide care, including representative provider networks; targeted, empowering outreach; co-developed culturally and linguistically appropriate tools and technologies; and provision of enabling resources and services.
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154
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Mercadante AR, Chu V, Chen AM, Wong JC, Khare MM, Law AV. COVID
‐19 Behavioral Questionnaire (
CoBQ
): Comparing the pandemic’s impact on health behavior in three
US
states. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:590-598. [PMID: 35572211 PMCID: PMC9087522 DOI: 10.1002/jac5.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
Background The COVID‐19 pandemic impacted daily routines for a majority of the population, with implications for their health behaviors. Racial and ethnic minorities have been disproportionately impacted by COVID‐19. The novel COVID‐19 Behavioral Questionnaire (CoBQ) was developed in Fall 2020 to provide a means to measure the impact of the COVID‐19 pandemic on the United States population. The study utilized behavioral domains to determine which demographic groups reported that they were made the most vulnerable during Fall‐Winter 2020–2021 of the pandemic. Objectives The study aimed to further validate and test the CoBQ in varied US regions and compare the scores obtained from three states, California, Ohio, and Illinois. Methods A prospective, multi‐site survey‐based study was designed to further validate and test the 17‐item CoBQ in varied populations. Respondents included patients on routine visits at each pharmacy or clinical site who agreed to complete the survey online via Qualtrics. Data analyses included descriptive statistics, psychometric testing, and comparison of groups using Analysis of Variance. Results Completed surveys (n = 507) between October 2021 and March 2021 were analyzed. Respondents were mostly female, white, and had some college education. The CoBQ showed improved reliability compared with previous testing and strong construct validity through factor analysis. Overall scores were similar between three states. The most impacted groups included those who reported within the 18–49 age group, a yearly household income <$50 000, or education up to high school. Conclusions The CoBQ is the first validated tool to measure the negative impact of the COVID‐19 pandemic on health behaviors. Results could serve as a baseline to address the most vulnerable patient groups and support identified behavioral needs during a similar pandemic situation.
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Affiliation(s)
| | - Vivian Chu
- College of Pharmacy, Western University of Health Sciences, Pomona California
| | | | - Jason C. Wong
- College of Pharmacy, Western University of Health Sciences, Pomona California
| | | | - Anandi V. Law
- Department of Pharmacy Practice and Administration Associate Dean for Assessment Director ACCP‐peer reviewed Fellowship in Health Outcomes College of Pharmacy Western University of Health Sciences 309 E. Second Street Pomona CA
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155
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Smartphone-Enabled versus Conventional Otoscopy in Detecting Middle Ear Disease: A Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12040972. [PMID: 35454020 PMCID: PMC9029949 DOI: 10.3390/diagnostics12040972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 01/27/2023] Open
Abstract
Traditional otoscopy has some limitations, including poor visualization and inadequate time for evaluation in suboptimal environments. Smartphone-enabled otoscopy may improve examination quality and serve as a potential diagnostic tool for middle ear diseases using a telemedicine approach. The main objectives are to compare the correctness of smartphone-enabled otoscopy and traditional otoscopy and to evaluate the diagnostic confidence of the examiner via meta-analysis. From inception through 20 January 2022, the Cochrane Library, PubMed, EMBASE, Web of Science, and Scopus databases were searched. Studies comparing smartphone-enabled otoscopy with traditional otoscopy regarding the outcome of interest were eligible. The relative risk (RR) for the rate of correctness in diagnosing ear conditions and the standardized mean difference (SMD) in diagnostic confidence were extracted. Sensitivity analysis and trial sequential analyses (TSAs) were conducted to further examine the pooled results. Study quality was evaluated by using the revised Cochrane risk of bias tool 2. Consequently, a total of 1840 examinees were divided into the smartphone-enabled otoscopy group and the traditional otoscopy group. Overall, the pooled result showed that smartphone-enabled otoscopy was associated with higher correctness than traditional otoscopy (RR, 1.26; 95% CI, 1.06 to 1.51; p = 0.01; I2 = 70.0%). Consistently significant associations were also observed in the analysis after excluding the simulation study (RR, 1.10; 95% CI, 1.00 to 1.21; p = 0.04; I2 = 0%) and normal ear conditions (RR, 1.18; 95% CI, 1.01 to 1.40; p = 0.04; I2 = 65.0%). For the confidence of examiners using both otoscopy methods, the pooled result was nonsignificant between the smartphone-enabled otoscopy and traditional otoscopy groups (SMD, 0.08; 95% CI, -0.24 to 0.40; p = 0.61; I2 = 16.3%). In conclusion, smartphone-enabled otoscopy was associated with a higher rate of correctness in the detection of middle ear diseases, and in patients with otologic complaints, the use of smartphone-enabled otoscopy may be considered. More large-scale studies should be performed to consolidate the results.
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156
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Sabeti S, Ochtli CR, Tay-Lasso E, Whelton M, Burton K, Bernal NO, Joe VC, Chin TL. The Effects of the COVID-19 Pandemic on Burn Clinic. J Burn Care Res 2022; 43:766-771. [PMID: 35488371 PMCID: PMC9047216 DOI: 10.1093/jbcr/irac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The COVID-19 pandemic has led to anxiety and fears for the general public. It is unclear how the behavior of people with acute burns and the services available to them has changed during the pandemic. The aim of our observational study was to evaluate our clinic’s experience with patients presenting with burns during the first ten months of the COVID-19 pandemic and determine if delays in presentation and healthcare delivery exist within our burn population. Patients referred to our clinic from March 1, 2020 to Dec 15, 2020 were reviewed for time of presentation after injury. We defined a true delay in presentation of >5 days from date of injury to date of referral for patients who were not inpatients at our facility or received initial care elsewhere prior to referral. Of the 246 patients who were referred to our clinic, during this time period, 199 patients (80.89%) attended their appointments. Our in-person clinic volume from referrals increased in July 2020 with a sharp decrease in August 2020. Our total clinic volume decreased in 2020 from 2019 by about 14%. Referrals to our clinic decreased in 2020 from 2019 by about 34%. Video telehealth visits did not account for the decrease in visits. There was low incidence of delays in presentation to our clinic during the pandemic. Additional investigation is necessary to see if the incidence of burn injury decreased. Despite the pandemic, our clinic remained ready and open to serve the burn population.
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Affiliation(s)
- Sara Sabeti
- Department of Surgery, University of California at Irvine, USA
| | - Ché R Ochtli
- Department of Surgery, University of California at Irvine, USA
| | - Erika Tay-Lasso
- Department of Surgery, University of California at Irvine, USA
| | - Melissa Whelton
- Department of Surgery, University of California at Irvine, USA
| | - Kimberly Burton
- Department of Surgery, University of California at Irvine, USA
| | - Nicole O Bernal
- Department of Surgery, University of California at Irvine, USA
| | - Victor C Joe
- Department of Surgery, University of California at Irvine, USA
| | - Theresa L Chin
- Department of Surgery, University of California at Irvine, USA
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157
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Saunders NR, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Hepburn CM, Moran K, Gardner W, Cappelli M, Sundar P, Toulany A. Utilization of Physician-Based Mental Health Care Services Among Children and Adolescents Before and During the COVID-19 Pandemic in Ontario, Canada. JAMA Pediatr 2022; 176:e216298. [PMID: 35129604 PMCID: PMC8822447 DOI: 10.1001/jamapediatrics.2021.6298] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Public health measures to reduce the spread of COVID-19 have heightened distress among children and adolescents and contributed to a shift in delivery of mental health care services. OBJECTIVES To measure and compare physician-based outpatient mental health care utilization before and during the COVID-19 pandemic and quantify the extent of uptake of virtual care delivery. DESIGN, SETTING, AND PARTICIPANTS Population-based repeated cross-sectional study using linked health and administrative databases in Ontario, Canada. All individuals aged 3 to 17 years residing in Ontario from January 1, 2017, to February 28, 2021. EXPOSURES Pre-COVID-19 period from January 1, 2017, to February 29, 2020, and post-COVID-19 onset from March 1, 2020, to February 28, 2021. MAIN OUTCOMES AND MEASURES Physician-based outpatient weekly visit rates per 1000 population for mental health diagnoses overall and stratified by age group, sex, and mental health diagnostic grouping and proportion of virtual visits. Poisson generalized estimating equations were used to model 3-year pre-COVID-19 trends and forecast expected trends post-COVID-19 onset and estimate the change in visit rates before and after the onset of COVID-19. The weekly proportions of virtual visits were calculated. RESULTS In a population of almost 2.5 million children and adolescents (48.7% female; mean [SD] age, 10.1 [4.3] years), the weekly rate of mental health outpatient visits was 6.9 per 1000 population. Following the pandemic onset, visit rates declined rapidly to below expected (adjusted relative rate [aRR], 0.81; 95% CI, 0.79-0.82) in April 2020 followed by a growth to above expected (aRR, 1.07; 95% CI, 1.04-1.09) by July 2020 and sustained at 10% to 15% above expected as of February 2021. Adolescent female individuals had the greatest increase in visit rates relative to expected by the end of the study (aRR, 1.26; 95% CI, 1.25-1.28). Virtual care accounted for 5.0 visits per 1000 population (72.5%) of mental health visits over the study period, with a peak of 5.3 visits per 1000 population (90.1%) (April 2020) and leveling off to approximately 70% in the latter months. CONCLUSIONS AND RELEVANCE Physician-based outpatient mental health care in Ontario increased during the pandemic, accompanied by a large, rapid shift to virtual care. There was a disproportionate increase in use of mental health care services among adolescent female individuals. System-level planning to address the increasing capacity needs and to monitor quality of care with such large shifts is warranted.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Lisa Fiksenbaum
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | | | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Moran
- Children’s Mental Health Ontario, Toronto, Ontario, Canada
| | - William Gardner
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mario Cappelli
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario, Canada
| | - Purnima Sundar
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario, Canada
| | - Alene Toulany
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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158
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Le VT, Fulton-Kehoe D, Sears JM, Nkyekyer EW, Ehde DM, Young M, Franklin GM. Trends and Disparities in the Use of Telehealth Among Injured Workers During the COVID-19 Pandemic. J Occup Environ Med 2022; 64:e249-e256. [PMID: 35195110 PMCID: PMC9038672 DOI: 10.1097/jom.0000000000002520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe telehealth trends within a population-based workers' compensation system during the COVID-19 pandemic, and to assess telehealth utilization by sociodemographic characteristics. METHODS This cross-sectional study used Washington State workers' compensation claims and medical billing data from January 2019 to October 2020. RESULTS Telehealth use averaged 1.2% of medical bills pre-pandemic, peaked in April 2020 at 8.8%, and leveled off to around 3.6% from July to October 2020. Telehealth utilization differed significantly by age, sex, number of dependents, injury, industry, and receipt of interpreter services. Workers residing in counties with higher population, lower poverty rates, and greater Internet access had higher telehealth usage. CONCLUSIONS There were dramatic shifts in telehealth; usage differed by sociodemographic characteristics. Further studies evaluating disparities in tele-health access among injured workers are needed.
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Affiliation(s)
- Vi T Le
- Department of Epidemiology, University of Washington, Seattle, Washington (Le), Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington (Fulton-Kehoe, Sears, Franklin), Department of Health Systems and Population Health, University of Washington, Seattle, Washington (Sears), Harborview Injury Prevention and Research Center, Seattle, Washington (Sears), Institute for Work and Health, Toronto, Ontario, Canada (Sears), Department of Medicine, University of Washington School of Medicine, Seattle, Washington (Nkyekyer), Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (Ehde), Washington State Department of Labor and Industries, Tumwater, Washington (Young, Franklin), Department of Neurology, University of Washington, Seattle, Washington (Franklin)
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159
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Methi F, Hernæs KH, Skyrud KD, Magnusson K. Pandemic trends in health care use: From the hospital bed to self-care with COVID-19. PLoS One 2022; 17:e0265812. [PMID: 35320323 PMCID: PMC8942224 DOI: 10.1371/journal.pone.0265812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
AIM To explore whether the acute 30-day burden of COVID-19 on health care use has changed from February 2020 to February 2022. METHODS In all Norwegians (N = 493 520) who tested positive for SARS-CoV-2 in four pandemic waves (February 26th, 2020 -February 16th, 2021 (1st wave dominated by the Wuhan strain), February 17th-July 10th, 2021 (2nd wave dominated by the Alpha variant), July 11th-December 27th, 2021 (3rd wave dominated by the Delta variant), and December 28th, 2021 -January 14th, 2022 (4th wave dominated by the Omicron variant)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used outpatient care (visiting general practitioners or emergency ward for COVID-19), and 3) used inpatient care (hospitalized ≥24 hours with COVID-19). RESULTS We find a remarkable decline in the use of health care services among COVID-19 patients for all age/sex groups throughout the pandemic. From 83% [95%CI = 83%-84%] visiting outpatient care in the first wave, to 80% [81%-81%], 69% [69%-69%], and 59% [59%-59%] in the second, third, and fourth wave. Similarly, from 4.9% [95%CI = 4.7%-5.0%] visiting inpatient care in the first wave, to 3.6% [3.4%-3.7%], 1.4% [1.3%-1.4%], and 0.5% [0.4%-0.5%]. Of persons testing positive for SARS-CoV-2, 41% [41%-41%] relied on self-care in the 30 days after testing positive in the fourth wave, compared to 16% [15%-16%] in the first wave. CONCLUSION From 2020 to 2022, the use of COVID-19 related outpatient care services decreased with 29%, whereas the use of COVID-19 related inpatient care services decreased with 80%.
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Affiliation(s)
- Fredrik Methi
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Kjersti Helene Hernæs
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Karin Magnusson
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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160
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The Ecology of Medical Care During the COVID-19 Pandemic in Japan: a Nationwide Survey. J Gen Intern Med 2022; 37:1211-1217. [PMID: 35132558 PMCID: PMC8821790 DOI: 10.1007/s11606-022-07422-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on health care utilization. However, the overall picture of shifts in health care utilization remains unclear. OBJECTIVE We assessed the ecology of medical care during the COVID-19 pandemic in Japan and compared it with the results pre-pandemic. We also investigated the associations of sociodemographic and clinical factors with health care utilization during the COVID-19 pandemic. DESIGN AND METHODS We conducted a nationwide cross-sectional survey of a representative sample of the general Japanese adult population in May 2021. The main outcomes were health care utilization for health-related events in the last month. We assessed sociodemographic and clinical factors, including age, sex, years of education, annual household income, social isolation, and the number of chronic conditions. KEY RESULTS Data were analyzed from 1747 respondents. Over-the-counter drug use, physician's office visits, and hospital outpatient clinic visits decreased drastically during the COVID-19 pandemic compared with pre-pandemic levels. The decrease in the use of medical facilities was especially pronounced among the elderly. Sociodemographic and clinical factors were differently associated with health care utilization during the COVID-19 pandemic. Social isolation and years of education were positively associated with over-the-counter drug use, while female sex was associated with increased over-the-counter drug use and physician's office visits. In addition, the number of chronic conditions was associated with increased hospital visits. CONCLUSIONS During the COVID-19 pandemic, the use of medical facilities for health-related events decreased drastically, especially among the elderly. A pharmacy is an important source of health care in a population with social isolation. These findings may be useful to researchers and policymakers in rethinking health care systems during and after the pandemic.
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161
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Hatef E, Lans D, Bandeian S, Lasser EC, Goldsack J, Weiner JP. Outcomes of In-Person and Telehealth Ambulatory Encounters During COVID-19 Within a Large Commercially Insured Cohort. JAMA Netw Open 2022; 5:e228954. [PMID: 35471570 PMCID: PMC9044109 DOI: 10.1001/jamanetworkopen.2022.8954] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Since the start of the COVID-19 pandemic, few studies have assessed the association of telehealth with outcomes of care, including patterns of health care use after the initial encounter. OBJECTIVE To assess the association of telehealth and in-person visits with outcomes of care during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed continuously enrolled members in private health plans of the Blue Cross and Blue Shield Association from July 1, 2019, to December 31, 2020. MAIN OUTCOMES AND MEASURES Main outcomes were ambulatory encounters per enrollee stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. Outcomes of care were assessed 14 days after the initial encounters and included follow-up encounters of any kind, emergency department encounters, and hospitalizations after initial telehealth or in-person encounters. RESULTS In this cohort study of 40 739 915 individuals (mean [SD] age, 35.37 [18.77] years; 20 480 768 [50.3%] female), ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020; however, as a proportion of all ambulatory encounters, telehealth encounters increased substantially from 0.6% (n = 236 220) to 14.1% (n = 5 743 718). For members with an initial telehealth encounter for a new acute condition, the adjusted odds ratio was 1.44 (95% CI, 1.42-1.46) for all follow-ups combined and 1.11 (95% CI, 1.06-1.16) for an emergency department encounter. For members with an initial telehealth encounter for a new chronic condition, the adjusted odds ratios were 0.94 (95% CI, 0.92-0.95) for all follow-ups combined and 0.94 (95% CI, 0.90-0.99) for in-patient admissions. CONCLUSIONS AND RELEVANCE In this cohort study of 40.7 million commercially insured adults, telehealth accounted for a large share of ambulatory encounters at the peak of the pandemic and remained prevalent after infection rates subsided. Telehealth encounters for chronic conditions had similar rates of follow-up to in-person encounters for these conditions, whereas telehealth encounters for acute conditions seemed to be more likely than in-person encounters to require follow-up. These findings suggest a direction for future work and are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the COVID-19 pandemic and afterward.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel Lans
- Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association, Chicago, Illinois
| | - Stephen Bandeian
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elyse C. Lasser
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jonathan P. Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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162
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Baughman D, Ptasinski A, Baughman K, Buckwalter N, Jabbarpour Y, Waheed A. Comparable Quality Performance of Acute Low-Back Pain Care in Telemedicine and Office-Based Cohorts. Telemed J E Health 2022; 28:1579-1586. [PMID: 35349350 DOI: 10.1089/tmj.2021.0535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Back pain is among the most common presentations in primary care offices. National organizations have standardized the appropriate use of imaging for acute low-back pain (LBP). The objective of this study was to evaluate the use of imaging in LBP between telemedicine and in-person clinical encounters. Methods: This retrospective cohort compared secondary data from 20,624 telemedicine and office encounters in a large nonprofit health system from July 1, 2019, to June 30, 2021. The proportion of patients aged 18-50 years who did not receive imaging for acute LBP (X-ray, computed tomography, or magnetic resonance imaging) within 28 days of the provider encounter was measured according to Healthcare Effectiveness Data and Information Set specifications. Performance was compared across race, ethnicity, age, body mass index, overall risk score, and insurance type. Chi-squared tests determined significant differences between cohorts (p < 0.05). Results: Patients seen via telemedicine had significantly lower rates of imaging within 28 days of their physician encounter (office: 16.32%, telemedicine: 11.20%; difference: 5.12%; p < 0.01). This was consistent across racial, ethnic, and risk score subgroups. Discussion: For practices and health systems, telemedicine might be a higher value approach for initial evaluation of acute LBP in primary care. For policy makers, telemedicine can save on health care costs without negatively impacting quality performance measures. Conclusions: Telemedicine is unlikely to compromise quality of acute LBP care, supporting this virtual space as an alternative care venue. The most beneficial use of telemedicine might be triaging initial encounters of acute LBP in primary care. Stronger evidence could support its long-term potential for driving value through cost savings.
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Affiliation(s)
- Derek Baughman
- WellSpan Good Samaritan Hospital Family Medicine Residency Program, Lebanon, Pennsylvania, USA
- The Robert Graham Center for Policy Studies in Family and Primary Care, Washington, District of Columbia, USA
| | - Anna Ptasinski
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Nicholas Buckwalter
- WellSpan Good Samaritan Hospital Family Medicine Residency Program, Lebanon, Pennsylvania, USA
| | - Yalda Jabbarpour
- The Robert Graham Center for Policy Studies in Family and Primary Care, Washington, District of Columbia, USA
| | - Abdul Waheed
- WellSpan Good Samaritan Hospital Family Medicine Residency Program, Lebanon, Pennsylvania, USA
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163
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Yan X, Stults CD, Deng S, Liang SY, Dillon E, Mudiganti S, Oscarson B, Jones JB, Frosch DL. Do Patients Continue to Use Video Visits? Factors Related to Continued Video Visit Use. Popul Health Manag 2022; 25:462-471. [PMID: 35353619 DOI: 10.1089/pop.2021.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many studies have assessed the factors associated with overall video visit use during the COVID-19 pandemic, but little is known about who is most likely to continue to use video visits and why. The authors combined a survey with electronic health record data to identify factors affecting the continued use of video visit. In August 2020, a stratified random sample of 20,000 active patients from a large health care system were invited to complete an email survey on health care seeking preferences during the COVID. Weighted logistic regression models were applied, adjusting for sampling frame and response bias, to identify factors associated with video visit experience, and separately for preference of continued use of video visits. Actual video visit utilization was also estimated within 12 months after the survey. Three thousand three hundred fifty-one (17.2%) patients completed the survey. Of these, 1208 (36%) reported having at least 1 video visit in the past, lowest for African American (33%) and highest for Hispanic (41%). Of these, 38% would prefer a video visit in the future. The strongest predictors of future video visit use were comfort using video interactions (odds ratio [OR] = 5.30, 95% confidence interval [95% CI]: 3.57-7.85) and satisfaction with the overall quality (OR = 3.94, 95% CI: 2.66-5.86). Interestingly, despite a significantly higher satisfaction for Hispanic (40%-55%) and African American (40%-50%) compared with Asian (29%-39%), Hispanic (OR = 0.46, 95% CI: 0.12-0.88) and African American (OR = 0.54, 95% CI: 0.16-0.90) were less likely to prefer a future video visit. Disparity exists in the use of video visit. The association between patient satisfaction and continued video visit varies by race/ethnicity, which may change the future long-term video visit use among race/ethnicity groups.
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Affiliation(s)
- Xiaowei Yan
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Cheryl D Stults
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Sien Deng
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Su-Ying Liang
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Ellis Dillon
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Satish Mudiganti
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Brandon Oscarson
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - James B Jones
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Dominick L Frosch
- Health Science Diligence Advisors, LLC, Redwood City, California, USA
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164
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Aoki T, Fujinuma Y, Matsushima M. Usual source of primary care and preventive care measures in the COVID-19 pandemic: a nationwide cross-sectional study in Japan. BMJ Open 2022; 12:e057418. [PMID: 35297779 PMCID: PMC8968108 DOI: 10.1136/bmjopen-2021-057418] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To assess multiple preventive care measures and to examine their associations with having a usual source of primary care and primary care performance during the COVID-19 pandemic in Japan. DESIGN Nationwide cross-sectional study. SETTING Japanese general adult population. PARTICIPANTS 1757 adult residents. PRIMARY OUTCOME MEASURES Fourteen preventive care measures aggregated the overall screening, immunisation and counselling composites. RESULTS Depression screening, zoster vaccination and tetanus vaccination had low implementation rates even among participants with a usual source of primary care. After adjustment for possible confounders, having a usual source of primary care was positively associated with all preventive care composites. Primary care performance assessed by the Japanese version of Primary Care Assessment Tool Short Form was also dose dependently associated with an increase in all composites. Results of the sensitivity analyses using a different calculation of preventive care composite were similar to those of the primary analyses. CONCLUSIONS Receipt of primary care, particularly high-quality primary care, contributed to increased preventive care utilisation even during the COVID-19 pandemic. However, the rate of mental health screening in primary care was at a very low level. Therefore, addressing mental health issues should be a major challenge for primary care providers during and after the pandemic.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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165
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Muse ED, Chen SF, Liu S, Fernandez B, Schrader B, Molparia B, León AN, Lee R, Pubbi N, Mejia N, Ren C, El-Kalliny A, Montes de Oca EP, Aguilar H, Ghoshal A, Dias R, Evans D, Chen KY, Zhang Y, Wineinger NE, Spencer EG, Topol EJ, Torkamani A. Impact of polygenic risk communication: an observational mobile application-based coronary artery disease study. NPJ Digit Med 2022; 5:30. [PMID: 35277577 PMCID: PMC8917120 DOI: 10.1038/s41746-022-00578-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
We developed a smartphone application, MyGeneRank, to conduct a prospective observational cohort study (NCT03277365) involving the automated generation, communication, and electronic capture of response to a polygenic risk score (PRS) for coronary artery disease (CAD). Adults with a smartphone and an existing 23andMe genetic profiling self-referred to the study. We evaluated self-reported actions taken in response to personal CAD PRS information, with special interest in the initiation of lipid-lowering therapy. 19% (721/3,800) of participants provided complete responses for baseline and follow-up use of lipid-lowering therapy. 20% (n = 19/95) of high CAD PRS vs 7.9% (n = 8/101) of low CAD PRS participants initiated lipid-lowering therapy at follow-up (p-value = 0.002). Both the initiation of statin and non-statin lipid-lowering therapy was associated with degree of CAD PRS: 15.2% (n = 14/92) vs 6.0% (n = 6/100) for statins (p-value = 0.018) and 6.8% (n = 8/118) vs 1.6% (n = 2/123) for non-statins (p-value = 0.022) in high vs low CAD PRS, respectively. High CAD PRS was also associated with earlier initiation of lipid lowering therapy (average age of 52 vs 65 years in high vs low CAD PRS respectively, p-value = 0.007). Overall, degree of CAD PRS was associated with use of any lipid-lowering therapy at follow-up: 42.4% (n = 56/132) vs 28.5% (n = 37/130) (p-value = 0.009). We find that digital communication of personal CAD PRS information is associated with increased and earlier lipid-lowering initiation in individuals of high CAD PRS. Loss to follow-up is the primary limitation of this study. Alternative communication routes, and long-term studies with EHR-based outcomes are needed to understand the generalizability and durability of this finding.
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Affiliation(s)
- Evan D Muse
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Scripps Clinic, La Jolla, CA, 92037, USA
| | - Shang-Fu Chen
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Shuchen Liu
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Brianna Fernandez
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Brian Schrader
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Bhuvan Molparia
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - André Nicolás León
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Scripps Clinic, La Jolla, CA, 92037, USA
| | - Raymond Lee
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Neha Pubbi
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Nolan Mejia
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | | | | | - Ernesto Prado Montes de Oca
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Personalized Medicine National Laboratory, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco A.C, Guadalajara, Jalisco, 44270, México
| | - Hector Aguilar
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Arjun Ghoshal
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Raquel Dias
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Doug Evans
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Kai-Yu Chen
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Yunyue Zhang
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Nathan E Wineinger
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Emily G Spencer
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.,Scripps Clinic, La Jolla, CA, 92037, USA
| | - Ali Torkamani
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA. .,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA.
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166
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Li K, Yu T, Seabury SA, Dor A. Trends and Disparities in the Utilization of Influenza Vaccines Among Commercially Insured US Adults During the COVID-19 Pandemic. Vaccine 2022; 40:2696-2704. [PMID: 35370018 PMCID: PMC8960160 DOI: 10.1016/j.vaccine.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Objectives Little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected influenza vaccine utilization and disparities. We sought to estimate changes in the likelihood of receiving an influenza vaccine across different demographic subgroups during the COVID-19 pandemic. Methods In this cohort study, we analyzed influenza vaccine uptake from 2019 to 2020 using Optum commercial insurance claims data. Eligible individuals were aged 18 or above in 2018 and continuously enrolled from 08/01/2018 through 12/31/2020. Multivariable logistic regressions were fitted for the individual-level influenza vaccine uptake. Adjusting for demographic factors and medical histories, we estimated probabilities of receiving influenza vaccines before and after the COVID-19 pandemic across demographic subgroups. Results From August to December 2019, unadjusted influenza vaccination rate was 42.3%, while in the same period of 2020, the vaccination rate increased to 45.9%. Females had a higher vaccination rate in 2019 (OR: 1.16, 95% CI 1.15–1.16), but the increase was larger for males. Blacks and Hispanics had lower vaccination rates relative to whites in both flu seasons. Hispanics showed a greater increase in vaccination rate, increasing by 7.8 percentage points (p < .001) compared to 4.4 (p < .001) for whites. The vaccination rate for Blacks increased by 5.2 percentage points (p < .001). All income groups experienced vaccination improvements, but poorer individuals had lower vaccination rates in both seasons. The most profound disparities occurred when educational cohort were considered. The vaccination rate increased among college-educated enrollees by 8.8 percentage points (p < .001) during the pandemic compared to an increase of 2.8 percentage points (p < .001) for enrollees with less than a 12th grade education. Past influenza infections or vaccination increased the likelihood of vaccination (p < .001). Conclusions The COVID-19 pandemic was associated with increased influenza vaccine utilization. Disparities persisted but narrowed with respect to gender and race but worsened with respect to income and educational attainment.
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167
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Ali-Mohamad N, Cau MF, Baylis JR, Semple H, Kastrup CJ, Beckett A. Videoconferencing for Large Animal Trauma Experiments During COVID-19: A Cross-Continent Experience. Mil Med 2022; 188:usac032. [PMID: 35231116 PMCID: PMC9383491 DOI: 10.1093/milmed/usac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/31/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION COVID-19 shutdowns in many research facilities across North America impacted preclinical trauma-related research and development. Shutdown limited the speed and resources available for large animal experiments necessary for advancing medical devices and technologies. However, the pandemic led to the rapid adoption and expansion of videoconferencing in social circles, workplaces, and primary care health settings. Here, we describe the use of simple videoconferencing equipment to plan and carry out 3 total weeks of large animal experiments with a large, cross-continent, interdisciplinary team testing a novel technology in swine models of noncompressible intraabdominal hemorrhage and junctional hemorrhage. MATERIALS AND METHODS Animal experiments using swine were scheduled over 3 weeks in February and March 2021 to take place in Toronto, Canada. All relevant animal protocols and COVID-19 site-specific risk assessments were completed and approved by the responsible institutional committees. Experiments were conducted by connecting 12 total research personnel from 3 sites by a simple video conferencing setup which included low-cost, high-definition webcams and standard smartphones streaming to Zoom. RESULTS Video conferencing allowed for 3 weeks of trauma experiments to take place at the height of Toronto's third peak of COVID-19 cases. Up to 3 experiments were completed for models requiring 6 hours of monitoring, and up to 5 experiments were completed for models requiring 3 hours of monitoring. The large amount of digital data collected during these experiments was rapidly shared with our network of collaborators, who analyzed results and interpreted findings in real time. CONCLUSIONS The system described in this paper has the potential to reduce costs of trauma animal model development and allow for rapid testing and implementation of life-saving devices in settings with limited onsite personnel as experienced during the COVID-19 pandemic.
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Affiliation(s)
- Nabil Ali-Mohamad
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Massimo F Cau
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - James R Baylis
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Hugh Semple
- Defence Research and Development Canada-Suffield Research Centre, Ralston, AB T1A 8K6, Canada
- Canadian Forces Health Services, Ottawa, ON K1A 0S2, Canada
| | - Christian J Kastrup
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Blood Research Institute, Versiti, Milwaukee, WI 53226, USA
- Departments of Surgery, Biochemistry, Biomedical Engineering, and Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Andrew Beckett
- Royal Canadian Medical Service, ON K1A 0K2, Canada
- St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
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168
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Li KY, Ng S, Zhu Z, McCullough JS, Kocher KE, Ellimoottil C. Association Between Primary Care Practice Telehealth Use and Acute Care Visits for Ambulatory Care-Sensitive Conditions During COVID-19. JAMA Netw Open 2022; 5:e225484. [PMID: 35357448 PMCID: PMC8972029 DOI: 10.1001/jamanetworkopen.2022.5484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE During the COVID-19 pandemic, many primary care practices adopted telehealth in place of in-person care to preserve access to care for patients with acute and chronic conditions. The extent to which this change was associated with their rates of acute care visits (ie, emergency department visits and hospitalizations) for these conditions is unknown. OBJECTIVE To examine whether a primary care practice's level of telehealth use is associated with a change in their rate of acute care visits for ambulatory care-sensitive conditions (ACSC visits). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis used a difference-in-differences study design to analyze insurance claims data from 4038 Michigan primary care practices from January 1, 2019, to September 30, 2020. EXPOSURES Low, medium, or high tertile of practice-level telehealth use based on the rate of telehealth visits from March 1 to August 31, 2020, compared with prepandemic visit volumes. MAIN OUTCOMES AND MEASURES Risk-adjusted ACSC visit rates before (June to September 2019) and after (June to September 2020) the start of the COVID-19 pandemic, reported as an annualized average marginal effect. The study examined overall, acute, and chronic ACSC visits separately and controlled for practice size, in-person visit volume, zip code-level attributes, and patient characteristics. RESULTS A total of nearly 1.5 million beneficiaries (53% female; mean [SD] age, 40 [22] years) were attributed to 4038 primary care practices. Compared with 2019 visit volumes, median telehealth use was 0.4% for the low telehealth tertile, 14.7% for the medium telehealth tertile, and 39.0% for the high telehealth tertile. The number of ACSC visits decreased in all tertiles, with adjusted rates changing from 24.3 to 14.9 per 1000 patients per year (low), 23.9 to 15.3 per 1000 patients per year (medium), and 27.5 to 20.2 per 1000 patients per year (high). In difference-in-differences analysis, high telehealth use was associated with a higher ACSC visit rate (2.10 more visits per 1000 patients per year; 95% CI, 0.22-3.97) compared with low telehealth practices; practices in the middle tertile did not differ significantly from the low tertile. No difference was found in ACSC visits across tertiles when acute and chronic ACSC visits were examined separately. CONCLUSIONS AND RELEVANCE In this cohort study that used a difference-in-differences analysis, the association between practice-level telehealth use and ACSC visits was mixed. High telehealth use was associated with a slightly higher overall ACSC visit rate than low telehealth practices. The association of telehealth with downstream care use should be closely monitored going forward.
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Affiliation(s)
- Kathleen Y. Li
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophia Ng
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Ziwei Zhu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Keith E. Kocher
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Urology, University of Michigan, Ann Arbor
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2480] [Impact Index Per Article: 1240.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Schaffler-Schaden D, Mergenthal K, Avian A, Huter S, Spary-Kainz U, Bachler H, Flamm M, Siebenhofer A. COVI-Prim Longitudinal Survey: Experiences of Primary Care Physicians During the Early Phase of the COVID-19 Pandemic. Front Med (Lausanne) 2022; 9:761283. [PMID: 35265636 PMCID: PMC8898947 DOI: 10.3389/fmed.2022.761283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background General practitioners (GPs) are the mainstay of primary care and play a critical role in pandemics. During the first wave of the COVID-19 pandemic, this international study aimed to explore changes in the workload of general practitioners, as well as their interactions with patients and colleagues, and their self-confidence and concerns. Methods An online survey was conducted among GPs in Austria and Germany. Participants were asked to answer a basic questionnaire and participate in a subsequent longitudinal survey containing closed and open-ended items. All data were pseudonymized. Results Overall, 723 general practitioners from Austria and Germany took part in the longitudinal survey over a period of 12 weeks (April 3–July 2, 2020). The majority of GPs had less direct contact with patients at the beginning of the survey (96 vs. 49% at the end of the study period). At first, doctors were mainly concerned with pandemic-related issues and had to care for the patients of GP colleagues that were in quarantine, which meant they had less time for routine work such as screenings and treating chronic diseases. Over the survey period, GPs' self-confidence increased and their concerns about income loss decreased. Conclusions Following a difficult initial phase when protective equipment and information were lacking, physicians in primary care adapted quickly to new situations. Experience with telemedicine should help them face future challenges and may help prevent a decline in the delivery of routine health care and care for chronically ill patients. Registration Trial registration at the German Clinical Trials Register: DRKS00021231.
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Affiliation(s)
- Dagmar Schaffler-Schaden
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Karola Mergenthal
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
- *Correspondence: Alexander Avian
| | - Sebastian Huter
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ulrike Spary-Kainz
- Institute of General Practice and Evidence Based Health Services Research, Medical University Graz, Graz, Austria
| | - Herbert Bachler
- Institute of General Practice, Medical University Innsbruck, Innsbruck, Austria
| | - Maria Flamm
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andrea Siebenhofer
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
- Institute of General Practice and Evidence Based Health Services Research, Medical University Graz, Graz, Austria
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171
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Pendrith C, Nayyar D, Chu C, O'Brien T, Lyons OD, Agarwal P, Martin D, Bhatia RS, Mukerji G. Outpatient visit trends for internal medicine ambulatory care sensitive conditions after the COVID-19 pandemic: a time-series analysis. BMC Health Serv Res 2022; 22:198. [PMID: 35164751 PMCID: PMC8845247 DOI: 10.1186/s12913-022-07566-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/31/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to a dramatic shift in the delivery of outpatient medicine with reduced in-person visits and a transition to predominantly virtual visits. We sought to understand trends in visit patterns for ambulatory care sensitive conditions (ACSCs) commonly seen in internal medicine clinics. METHODS We included adult outpatients seen for an ACSC between March 15th, 2017 and March 14th, 2021 at a single-centre in Ontario, Canada. Monthly visits were assessed by visit type (new consultation, follow-up), diagnosis, and clinic. Time series analyses compared visit volumes pre- and post-pandemic. Proportion of virtual visits were compared before and during the pandemic. Patient and visit factors were compared between in-person and virtual visits. RESULTS 8274 patients with 34,021 visits were included. Monthly visits increased by 15% during the pandemic (p < 0.0001). New consultations decreased by 10% (p = 0.0053) but follow-up visits increased by 21% (p < 0.0001). Monthly heart failure visits increased by 43% (p < 0.0001) whereas atrial fibrillation visits decreased. Pre- pandemic, < 1% of visits were virtual compared to 82% during the pandemic (p < 0.0001). Less than half of heart failure visits were virtual whereas > 95% of diabetes visits were virtual. CONCLUSIONS We found a significant increase in overall visits to internal medicine clinics driven by increased volumes of follow-up visits, which more than offset decreased new consultations. There was variability in visit trends and uptake of virtual care by visit diagnosis, which may indicate challenges with delivery of virtual care for certain conditions.
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Affiliation(s)
- Ciara Pendrith
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
| | - Dhruv Nayyar
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cherry Chu
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
| | - Tara O'Brien
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Owen D Lyons
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Martin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Geetha Mukerji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Women's College Hospital, Toronto, ON, Canada.
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Paelet L, Raskin J, ZuWallack R. Potential downside issues with telemedicine for individuals with chronic respiratory diseases. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Telemedicine refers to the use of communications technologies to provide or enhance medical care through mitigating the negative effects of patient-caregiver distance on medical evaluation and treatment. The general concept, telemedicine, can refer to a number of interventions, such as telemonitoring, tele-consultations, tele-education, tele-communication, and tele-rehabilitation. While telemedicine has seen steady growth its trajectory has increased during the COVID-19 pandemic. As a tool in health care delivery, telemedicine is often met with patient satisfaction often resulting from ease of use and accessibility. Additionally, outcomes may improve, although the medical literature is not consistent in this regard. However, enthusiasm over its beneficial effects should be tempered by negative aspects, including the decrease in direct patient-clinician interaction (such as loss of information from the physical examination) and potentially serious privacy risks. Finding a happy median between positive and negative features of telemedicine remains a work in progress.
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173
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Pujolar G, Oliver-Anglès A, Vargas I, Vázquez ML. Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1749. [PMID: 35162772 PMCID: PMC8834942 DOI: 10.3390/ijerph19031749] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services' use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services' use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic's impact on equity of access.
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Affiliation(s)
- Georgina Pujolar
- Health Policy Research Unit (SEPPS), Consorci de Salut i Social de Catalunya, 08022 Barcelona, Spain; (A.O.-A.); (I.V.); (M.-L.V.)
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Aliberti GM, Bhatia R, Desrochers LB, Gilliam EA, Schonberg MA. Perspectives of Primary Care Clinicians in Massachusetts on use of Telemedicine with Adults aged 65 and Older during the COVID-19 Pandemic. Prev Med Rep 2022; 26:101729. [PMID: 35155085 PMCID: PMC8824169 DOI: 10.1016/j.pmedr.2022.101729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 02/06/2023] Open
Abstract
PCPs have disparate attitudes towards telemedicine primary care for adults >65. Multilevel interventions are needed to optimize telemedicine care for older adults. PCPs find telemedicine most effective for chronic disease management. PCPs appreciate telemedicine’s convenience but worry about the lack of touch.
To learn how to improve telemedicine for adults >65, we asked primary care clinicians (“PCPs”) affiliated with one large Boston-area health system their views on using telemedicine (which included phone-only or video visits) with adults >65 during the COVID-19 pandemic. In open-ended questions, we asked PCPs to describe any challenges or useful experiences with telemedicine and suggestions for improving telemedicine as part of a larger web-based survey conducted between September 2020 and February 2021. Overall, 163/383 (42%) PCPs responded to the survey. Of these, 114 (70%) completed at least one open-ended question, 85% were non-Hispanic white, 59% were female, 75% were community-based, and 75% were in practice >20 years. We identified three major themes in participants’ comments including the need to optimize telemedicine; integrate telemedicine within primary care; and that PCPs had disparate attitudes towards telemedicine for older adults. To optimize telemedicine, PCPs recommended more effective digital platforms, increased utilization of home medical equipment (e.g., blood pressure cuffs), and better coordination with caregivers. For integration, PCPs recommended targeting telemedicine for certain types of visits (e.g., chronic disease management), enabling video access, and reducing administrative burdens on PCPs. As for PCP attitudes, some felt telemedicine enhanced the doctor-patient relationship, improved the patient experience, and improved show rates. Others felt that telemedicine visits were incomplete without a physical exam, were less rewarding, and could be frustrating. Overall, PCPs saw a role for telemedicine in older adults’ care but felt that more support is needed for these visits than currently offered.
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Affiliation(s)
| | | | | | | | - Mara A. Schonberg
- Corresponding author at: 1309 Beacon Street, 2 Fl, Brookline, MA 02446.
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175
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Dutcher L, Li Y, Lee G, Grundmeier R, Hamilton KW, Gerber JS. COVID-19 and Antibiotic Prescribing in Pediatric Primary Care. Pediatrics 2022; 149:184457. [PMID: 35102416 PMCID: PMC9825803 DOI: 10.1542/peds.2021-053079] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODS We conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTS There were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of -25.2 prescriptions per 1000 patients; 95% CI: -32.9 to -17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONS Reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.
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Affiliation(s)
- Lauren Dutcher
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yun Li
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Giyoung Lee
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert Grundmeier
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keith W. Hamilton
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jeffrey S. Gerber
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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176
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Stulock R, Montgomery J, Parker M, Singrey A, Zeleznikar E. Pharmacist involvement in a comprehensive remote monitoring and telemanagement program. Am J Health Syst Pharm 2022; 79:888-895. [PMID: 35084451 PMCID: PMC9383369 DOI: 10.1093/ajhp/zxac025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe the role of the pharmacist in and initial outcomes of a remote monitoring and telemanagement program implemented to proactively provide outreach to high-risk patients during the coronavirus disease 2019 (COVID-19) pandemic. Summary A remote monitoring and telemanagement program was developed at a large, nonprofit, multicenter, academic health system as an innovative way to manage patients at risk for decompensation of their chronic diseases in the midst of the COVID-19 pandemic. The program mobilized an interprofessional workforce including nurses, medical assistants, social workers, virtualists, patient schedulers, and ambulatory care pharmacists. Patient outreach included a combination of telephone calls and digital outreach. The goal was to monitor patients’ health status remotely and assess for early signs of decompensation. Pharmacists conducted telephone outreach to answer patients’ medication questions and address signs and symptoms of worsening chronic conditions. Pharmacists were able to utilize an existing collaborative practice agreement (CPA) to adjust medication therapy and order laboratory tests as needed for safety and efficacy monitoring. Since the program’s inception in April 2020 through January 2021, pharmacists have addressed over 1,600 medication questions or instances of worsening clinical signs and symptoms. Conclusion A comprehensive remote monitoring and telemanagement program utilized a multidisciplinary team to monitor high-risk patients during the COVID-19 pandemic. Pharmacists contributed to chronic disease management via the use of a comprehensive CPA, allowing medications to be started, stopped, or adjusted on the basis of patients’ needs, to improve population health management and reduce workload for primary care providers who were addressing new and emerging issues during the pandemic.
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Affiliation(s)
- Rachel Stulock
- Cleveland Clinic Department of Pharmacy, Cleveland, OH, USA
| | | | - Marcie Parker
- Cleveland Clinic Department of Pharmacy, Cleveland, OH, USA
| | - Amanda Singrey
- Cleveland Clinic Department of Pharmacy, Cleveland, OH, USA
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177
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Heinert SW, Riggs R, Prendergast H. Emergency Department Management of Hypertension in the Context of COVID-19. Curr Hypertens Rep 2022; 24:37-43. [PMID: 35076879 PMCID: PMC8787746 DOI: 10.1007/s11906-022-01169-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review This review describes the relationship between COVID-19 and hypertension (HTN), and considerations for emergency medicine providers in the management of hypertensive patients during the COVID-19 pandemic. Recent Findings Hypertensive patients with COVID-19 have a higher risk of severe disease/complications, hospitalizations, intensive care unit (ICU) admissions, and mortality than non-hypertensive patients. Studies have also shown the importance of consideration of various demographic factors (such as older age) and socioeconomic factors that may confound these relationships. Despite concerns at the start of the pandemic that RAAS inhibiting antihypertension medications may contribute to worsened outcomes in COVID-19 patients, subsequent research has shown that use of ACEi/ARBs is associated with neutral or even improved COVID-19 outcomes. Socioeconomic factors must also be considered including patients’ potential delay of health care due to fear of contracting COVID-19, loss of health insurance, and barriers to accessing primary care appointments for post-ED follow-up care. Summary While there is mixed evidence on biological considerations for HTN care during the COVID-19 pandemic, the pandemic has undoubtedly been a major stressor and barrier to effective chronic disease management. Emergency medicine and other providers should consider this when evaluating acute care patients with a history of HTN or newly elevated blood pressure.
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Affiliation(s)
- Sara W Heinert
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Renee Riggs
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Heather Prendergast
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
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178
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Bronskill SE, Maclagan LC, Maxwell CJ, Iaboni A, Jaakkimainen RL, Marras C, Wang X, Guan J, Harris DA, Emdin A, Jones A, Sourial N, Godard-Sebillotte C, Vedel I, Austin PC, Swartz RH. Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic. JAMA HEALTH FORUM 2022; 3:e214599. [PMID: 35977228 PMCID: PMC8903126 DOI: 10.1001/jamahealthforum.2021.4599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/07/2021] [Indexed: 12/15/2022] Open
Abstract
Question Was the COVID-19 pandemic associated with changes in health service use and mortality among community-dwelling persons with dementia and Parkinson disease compared with older adults? Findings In this population-based repeated cross-sectional analysis, large declines in hospital use and nursing home admission were experienced across all cohorts. After the first wave, most services returned to historical levels, with physician visits elevated and mostly virtual, nursing home admissions reduced, and excess all-cause mortality. Meaning The pandemic was associated with meaningful health service disruptions for persons with dementia and Parkinson disease, highlighting that continued support for virtual care is needed to ensure optimal health outcomes. Importance Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services. Objective To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Design, Setting, and Participants Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada. Exposures COVID-19 pandemic as of March 1, 2020. Main Outcomes and Measures Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels. Results Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts. Conclusions and Relevance In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.
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Affiliation(s)
- Susan E. Bronskill
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Colleen J. Maxwell
- ICES, Toronto, Ontario, Canada
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - R. Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connie Marras
- ICES, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | - Daniel A. Harris
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abby Emdin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Jones
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard H. Swartz
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
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Douillet D, Dupont C, Leloup N, Ménager G, Delori M, Soulie C, Morin F, Moumneh T, Savary D, Roy PM, Armand A. Prevalence and characterization of forgoing care: comparison of two prospective multicentre cohorts between pre-COVID-19 era and a lockdown period. Arch Public Health 2022; 80:32. [PMID: 35042548 PMCID: PMC8766360 DOI: 10.1186/s13690-022-00797-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about patients who forego healthcare, although it is an important provider of unfavorable health-related outcomes. Forgoing healthcare characterizes situations in which people do not initiate or interrupt a care process, even though they perceive the need for it, whether or not this need is medically proven. The aims of this study were to assess the prevalence and the determinants of patients who forego healthcare. The second aim was to compare the characteristics of patients who gave up healthcare during the French lockdown due to COVID-19. METHODS We conducted two multicenter cross-sectional studies in 2017 and 2020 carried out in French patients presenting to the emergency departments. Patients who gave their consent to participate were interviewed with a standardized questionnaire. It consisted of two parts: epidemiological characteristics and health care refusal. A third part concerning the renunciation of care during the COVID-19 period was added to the second study period. RESULTS A total of 1878 patients had completed the questionnaire during the interview with the physicians, 900 during the first period in 2017 (47.9%) and 978 (52.1%) during the second period. A total of 401/1878 patients reported not seeking care in the last 12 months (21.4% [95%CI: 19.5-23.3%]). In 2020, patients forewent care more during the confinement period than outside with different characteristics of the foregoing care populations. CONCLUSION Forgoing care is common in a universal health care system such as France's and increased during the pandemic. Key public health messages targeted at the reasons for not seeking care must now be disseminated in order to combat this.
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Affiliation(s)
- Delphine Douillet
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France. .,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France.
| | - Clémence Dupont
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | - Noémie Leloup
- Emergency Department, Le Mans Hospital, Le Mans, France
| | | | - Maud Delori
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | | | - François Morin
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | - Thomas Moumneh
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,EHESP, Irset, Inserm, UMR S1085, CAPTV CDC, University of Rennes, Rennes, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
| | - Aurore Armand
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,République des Savoirs- Lettres, Sciences, Philosophie - USR3608- ED540- ENS-PSL, Paris, France
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Santillan DA, Brandt DS, Sinkey R, Scheib S, Peterson S, LeDuke R, Dimperio L, Cherek C, Varsho A, Granza M, Logan K, Hunter SK, Knosp BM, Davis HA, Spring JC, Piehl D, Makkapati R, Doering T, Harris S, Day L, Eder M, Winokur P, Santillan MK. Barriers and solutions to developing and maintaining research networks during a pandemic: An example from the iELEVATE perinatal network. J Clin Transl Sci 2022; 6:e56. [PMID: 35720965 PMCID: PMC9161042 DOI: 10.1017/cts.2022.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction To improve maternal health outcomes, increased diversity is needed among pregnant people in research studies and community surveillance. To expand the pool, we sought to develop a network encompassing academic and community obstetrics clinics. Typical challenges in developing a network include site identification, contracting, onboarding sites, staff engagement, participant recruitment, funding, and institutional review board approvals. While not insurmountable, these challenges became magnified as we built a research network during a global pandemic. Our objective is to describe the framework utilized to resolve pandemic-related issues. Methods We developed a framework for site-specific adaptation of the generalized study protocol. Twice monthly video meetings were held between the lead academic sites to identify local challenges and to generate ideas for solutions. We identified site and participant recruitment challenges and then implemented solutions tailored to the local workflow. These solutions included the use of an electronic consent and videoconferences with local clinic leadership and staff. The processes for network development and maintenance changed to address issues related to the COVID-19 pandemic. However, aspects of the sample processing/storage and data collection elements were held constant between sites. Results Adapting our consenting approach enabled maintaining study enrollment during the pandemic. The pandemic amplified issues related to contracting, onboarding, and IRB approval. Maintaining continuity in sample management and clinical data collection allowed for pooling of information between sites. Conclusions Adaptability is key to maintaining network sites. Rapidly changing guidelines for beginning and continuing research during the pandemic required frequent intra- and inter-institutional communication to navigate.
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Affiliation(s)
- Donna A. Santillan
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Debra S. Brandt
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Rachel Sinkey
- Department of Obstetrics & Gynecology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Susan Peterson
- West Des Moines OB/GYN Associates, West Des Moines, IA, USA
| | - Rachel LeDuke
- Department of Obstetrics & Gynecology, UAB Medicine, Birmingham, AL, USA
| | - Lisa Dimperio
- Department of Obstetrics & Gynecology, UAB Medicine, Birmingham, AL, USA
| | - Cindy Cherek
- Marshfield Clinic Health System, Marshfield, WI, USA
| | - Angela Varsho
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Melissa Granza
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Kim Logan
- OB-Gyn Associates, PC., Cedar Rapids, IA, USA
| | - Stephen K. Hunter
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Boyd M. Knosp
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Heather A. Davis
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Joseph C. Spring
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Debra Piehl
- OB-Gyn Associates, PC., Cedar Rapids, IA, USA
| | - Rani Makkapati
- West Des Moines OB/GYN Associates, West Des Moines, IA, USA
| | | | - Stacy Harris
- Department of Obstetrics & Gynecology, UAB Medicine, Birmingham, AL, USA
| | - Lyndsey Day
- The Group, Obstetrics and Gynecology Specialists, Davenport, IA, USA
| | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Winokur
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Mark K. Santillan
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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181
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Van Poel E, Vanden Bussche P, Klemenc-Ketis Z, Willems S. How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC PRIMARY CARE 2022; 23:11. [PMID: 35172744 PMCID: PMC8760114 DOI: 10.1186/s12875-021-01587-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND General practitioners (GPs) play a crucial role in the fight against the COVID-19 pandemic as the first point of contact for possibly infected patients and are responsible for short and long-term follow-up care of the majority of COVID-19 patients. Nonetheless, they experience many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices in 38 countries are organized during the COVID-19 pandemic to guarantee safe, effective, patient-centered, and equitable care. Also, the shift in roles and tasks and the wellbeing of staff members is researched. Finally, PRICOV-19 aims to study the association with practice- and health care system characteristics. It is expected that both characteristics of the GP practice and health care system features are associated with how GP practices can cope with these challenges. This paper describes the protocol of the study. METHODS Using a cross-sectional design, data are collected through an online questionnaire sent to GP practices in 37 European countries and Israel. The questionnaire is developed in multiple phases, including a pilot study in Belgium. The final version includes 53 items divided into six sections: patient flow (including appointments, triage, and management for routine care); infection prevention; information processing; communication; collaboration and self-care; and practice and participant characteristics. In the countries where data collection is already finished, between 13 and 636 GP practices per country participated in the study. Questionnaire data are linked with OECD and HSMR data regarding national policy responses to the pandemic and analyzed using multilevel models considering the system- and practice-level. DISCUSSION To the best of our knowledge, the PRICOV-19 study is the largest and most comprehensive study that examines how GP practices function during the COVID-19 pandemic. Its results can significantly contribute to better preparedness of primary health care systems across Europe for future major outbreaks of infectious diseases.
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Affiliation(s)
- E Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - P Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Z Klemenc-Ketis
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - S Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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182
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Chen N, Liu P. Assessing Elderly User Preference for Telehealth Solutions in China: Exploratory Quantitative Study. JMIR Mhealth Uhealth 2022; 10:e27272. [PMID: 35019852 PMCID: PMC8792775 DOI: 10.2196/27272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/16/2021] [Accepted: 10/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background In the next 15 to 20 years, the Chinese population will reach a plateau and start to decline. With the changing family structure and rushed urbanization policies, there will be greater demand for high-quality medical resources at urban centers and home-based elderly care driven by telehealth solutions. This paper describes an exploratory study regarding elderly users’ preference for telehealth solutions in the next 5 to 10 years in 4 cities, Shenzhen, Hangzhou, Wuhan, and Yichang. Objective The goal is to analyze why users choose telehealth solutions over traditional health solutions based on a questionnaire study involving 4 age groups (50-60, 61-70, 71-80, and 80+) in 4 cities (Shenzhen, Hangzhou, Wuhan, and Yichang) in the next 10 to 20 years. The legal retirement age for female workers in China is 50 to 55 years and 60 years for male workers. To simulate reality in terms of elderly care in China, the authors use the Chinese definition of elderly for employees, defined as being 50 to 60 years old rather than 65 years, as defined by the World Health Organization. Methods The questionnaires were collected from Shenzhen, Hangzhou, Wuhan, and Yichang randomly with 390 valid data samples. The questionnaire consists of 31 questions distributed offline on tablet devices by local investigators. Subsequently, Stata 16.0 and SPSS 24.0 were used to analyze the data. O-logit ordered regression and principal component analysis (PCA) were the main theoretical models used. The study is currently in the exploratory stage and therefore does not seek generalization of the results. Results Approximately 71.09% (280/390) of the respondents reported having at least 1 type of chronic disease. We started with PCA and categorized all Likert scale variables into 3 factors. The influence of demographic variables on Factors 1, 2, and 3 was verified using analysis of variance (ANOVA) and t tests. The ordered logit regression results suggest that health-related motivations are positively related to the willingness to use telehealth solutions, and trust on data collected from telehealth solutions is negatively correlated with the willingness to use telehealth solutions. Conclusions The findings suggest that there is a need to address the gap in community health care and ensure health care continuity between different levels of health care institutions in China by providing telehealth solutions. Meanwhile, telehealth solution providers must focus on improving users’ health awareness and lower health risk for chronic diseases by addressing lifestyle changes such as regular exercise and social activity. The interoperability between the electronic health record system and telehealth solutions remains a hurdle for telehealth solutions to add value in health care. The hurdle is that doctors neither adjust health care plans nor diagnose based on data collected by telehealth solutions.
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Affiliation(s)
- Nuoya Chen
- Faculty of Global Studies, Justice and Rights, University of Macerata, Macerata, Italy
| | - Pengqi Liu
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
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183
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Rossano A, Crijns T, Ring D, Reichenberg J. Clinician Preferences for Current and Planned Future Use of Telemedicine. Telemed J E Health 2022; 28:1293-1299. [PMID: 35007442 DOI: 10.1089/tmj.2021.0486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: Many clinicians and patients tried telemedicine for the first time during the COVID-19 pandemic. In a prior survey, we found that clinicians who were adaptable and willing to incorporate technology into their clinical practice are more likely to utilize telemedicine. Seeking factors associated with current and future use of telemedicine, and identifying its relative advantages and drawbacks, may help determine the role of telemedicine after the pandemic. Questions/Purposes: We asked (1) which demographic factors and personal preferences are associated with current and planned future use of telemedicine, (2) what factors are associated with telemedicine utilization, and (3) what are clinician-reported advantages and disadvantages of telemedicine? Materials and Methods: Approximately 750 clinicians within a national multispecialty hospital group were invited to complete an online survey assessing telemedicine use and preferences, self-reported technology proficiency, and personal characteristics. A total of 284 clinicians started the survey, and 259 complete responses were analyzed using bivariate analysis and multivariable regression. Results: More frequent current telemedicine use was associated with being a nonsurgeon clinician, not primarily practicing in an inpatient setting, preferring either telemedicine or having no preference for discussing sensitive topics, and greater self-reported technological proficiency. Planned future telemedicine use was associated with greater self-reported troubleshoot ability and less desire for a hands-on physical examination. Clinicians reported that the top benefits of telemedicine are decreased barriers for patients and convenience for clinicians, and disadvantages are technical difficulties for both patients and clinicians. Conclusions: Telemedicine continues to be widely utilized by clinicians, particularly those who are confident in their ability to examine patients over video, and who can troubleshoot issues that arise on the platform. With continued reimbursement, telemedicine is likely to remain a convenient and effective method of caring for patients.
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Affiliation(s)
- Ayane Rossano
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Tom Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Jason Reichenberg
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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Omboni S, Padwal RS, Alessa T, Benczúr B, Green BB, Hubbard I, Kario K, Khan NA, Konradi A, Logan AG, Lu Y, Mars M, McManus RJ, Melville S, Neumann CL, Parati G, Renna NF, Ryvlin P, Saner H, Schutte AE, Wang J. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. CONNECTED HEALTH 2022; 1:7-35. [PMID: 35233563 PMCID: PMC7612439 DOI: 10.20517/ch.2021.03] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Varese 21048, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Raj S. Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Tourkiah Alessa
- Biomedical Technology Department, College of Applied Medical Science, King Saud University, Riyadh 11362, Saudi Arabia
| | - Béla Benczúr
- First Department of Internal Medicine (Cardiology-Nephrology), Balassa Janos County Hospital, Szekszard 7100, Hungary
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, WA 98101, USA
| | - Ilona Hubbard
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1011, Switzerland
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi 329-0498, Japan
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Alexandra Konradi
- Almazov National Medical Research Centre, Saint Petersburg 197341, Russia
| | - Alexander G. Logan
- Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario M5G 1X5, Canada
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, CT 06510, USA
| | - Maurice Mars
- Department of TeleHealth, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5042, Australia
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Sarah Melville
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick E2L 4L2, Canada
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano 20126, Italy
- Istituto Auxologico Italiano, IRCCS San Luca, Milano 20149, Italy
| | - Nicolas F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza 5500, Argentina
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1011, Switzerland
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research and Institute for Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney 2042, New South Wales, Australia
- Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom 2520, South Africa
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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185
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Kelly EL, Cunningham A, Sifri R, Pando O, Smith K, Arenson C. Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams. Ann Fam Med 2022; 20:57-62. [PMID: 35074769 PMCID: PMC8786437 DOI: 10.1370/afm.2775] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has dramatically affected all areas of health care. Primary care practices are on the front lines for patients seeking health care during this period. Understanding clinical and administrative staff members' strategies for managing the broad-ranging changes to primary care service delivery is important for the support of workforce well-being, burnout, and commitment to primary care. METHODS Thirty-three staff members from 8 practices within a single health care system completed short, semistructured interviews from May 11, 2020 to July 20, 2020. Interviews were coded using a combination of conventional and directed content analysis. RESULTS Themes emerged from the data that mapped onto the Job Demands-Control-Social Support model. Participants reported that every aspect of primary care service delivery needed to be adapted for COVID-19, which increased their job demands significantly. Several also described pride in their development of new skills, and in most interviews, they expressed that the experience brought staff together. Staff engaged in active cognitive reframing of events during the interviews as they coped with increased workplace stress. However, as the pandemic changed from an acute stress event to a chronic stressor, staff were more likely to indicate signs of burnout. CONCLUSIONS Primary care teams absorbed tremendous burdens during COVID-19 but also found that some stress was offset by increased support from management and colleagues, belief in their own necessity, and new development opportunities. Considering high prepandemic strain levels, the ability of primary care teams to persist under these conditions might erode as the crisis becomes an enduring challenge.
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Affiliation(s)
- Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania .,Center for Social Medicine and Humanities, University of California, Los Angeles, California
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randa Sifri
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Oriana Pando
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kelsey Smith
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christine Arenson
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.,Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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186
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Schenker RB, Laguna MC, Odisho AY, Okumura MJ, Burnett H. Are We Reaching Everyone? A Cross-Sectional Study of Telehealth Inequity in the COVID-19 Pandemic in an Urban Academic Pediatric Primary Care Clinic. Clin Pediatr (Phila) 2022; 61:26-33. [PMID: 34514898 PMCID: PMC8527273 DOI: 10.1177/00099228211045809] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The COVID-19 (coronavirus disease 2019) pandemic brought rapid expansion of pediatric telehealth to maintain patient access to care while decreasing COVID-19 community spread. We designed a retrospective, serial, cross-sectional study to investigate if telehealth implementation at an academic pediatric practice led to disparities in health care access. Significant differences were found in pre-COVID-19 versus during COVID-19 patient demographics. Patients seen during COVID-19 were more likely to be younger, White/Caucasian or Asian, English speaking, and have private insurance. They were less likely to be Black/African American or Latinx and request interpreters. Age was the only significant difference in patient demographics between in-person and telehealth visits during COVID-19. A multivariate regression showed older age as a significant positive predictor of having a video visit and public insurance as a significant negative predictor. Our study demonstrates telehealth disparities based on insurance existed at our clinic as did inequities in who was seen before versus during COVID-19.
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Affiliation(s)
- Rachel B. Schenker
- University of California, San
Francisco, CA, USA,Rachel B. Schenker, Department of
Pediatrics, University of California, 550, 16th Street, Box 0110, San Francisco,
CA 94143, USA.
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187
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Hahn P, Blim JF, Packo K, Jumper JM, Murray T, Awh CC. The Impact of COVID-19 on US and International Retina Specialists, Their Practices, and Their Patients. JOURNAL OF VITREORETINAL DISEASES 2022; 6:40-46. [PMID: 37007725 PMCID: PMC9976225 DOI: 10.1177/24741264211034112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This work analyzes data from a series of surveys developed by the American Society of Retina Specialists (ASRS) that assesses the impact of COVID-19 on physicians, their practices, and their patients. Methods Five surveys were sent by the ASRS between March and July 2020 to more than 2600 US and international retina specialists. Data and trends from these surveys were analyzed. Results Most responding retina specialists (87%-95% in the United States and internationally) reported having no known COVID-related symptoms despite reported limitations in personal protective equipment. Clinic volumes globally were drastically reduced in March 2020 with only partial recovery through July 2020, which was slower internationally than in the United States. Practices were compelled to reduce staff and physician employment levels. Most respondents estimated some degree of delay in patient treatment with corresponding declines in vision and/or anatomy that were attributed most frequently to patients' fears of the pandemic and least frequently to office unavailability. Conclusions The reported impact of COVID-19 on retina specialists, their practices, and their patients has been substantial. Although retina specialists were quickly resilient in optimizing delivery of patient care in a manner safe for patients and providers, the reduction in clinic volume has been devastating in the United States and internationally, with negative impacts on patient outcomes, reductions in practices' volume and employment, and risk to practices' financial health. Future studies will be required to quantify losses associated with these unprecedented and ongoing circumstances caused by the pandemic.
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Affiliation(s)
| | - Jill F. Blim
- American Society of Retina Specialists, Chicago, IL, USA
| | - Kirk Packo
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
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188
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Trends in testing and prevalence of elevated Lp(a) among patients with aortic valve stenosis. Atherosclerosis 2022; 349:144-150. [PMID: 35144769 PMCID: PMC9674369 DOI: 10.1016/j.atherosclerosis.2022.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/25/2022]
Abstract
Background and aims: Lipoprotein(a) [Lp(a)] is causally associated with aortic valve stenosis (AS) but Lp(a) testing among AS patients is not broadly incorporated into clinical practice. We evaluated trends in Lp(a) testing in an academic medical center. Methods: Educational efforts and adding Lp(a) to the lipid panel on the electronic medical record (EMR) and preprocedure order sets were used to increase awareness of Lp(a) as a risk factor in AS. Medical records at University of California San Diego Health (UCSDH) were analyzed from 2010 to 2020 to define the yearly frequency of first time Lp(a) testing in patients with diagnosis codes for AS or undergoing transcatheter aortic valve replacement (TAVR). Results: Lp(a) testing for any indication increased over 5-fold from 2010 to 2020. A total of 3808 patients had a diagnosis of AS and 417 patients had TAVR. Lp(a) levels >30 mg/dL were present in 37% of AS and 35% of TAVR patients. The rates of Lp(a) testing in AS and TAVR were 14.0% and 65.7%, respectively. In AS, Lp(a) testing increased over time from 8.5% in 2010, peaking at 24.2% in 2017, and declining to 13.9% in 2020 (p < 0.001 for trend). Following implementation of EMR order-sets in 2016, Lp(a) testing in TAVR cases increased to a peak of 88.5% in 2018. Conclusions: Elevated Lp(a) is prevalent in AS and TAVR patients. Implementation of educational efforts and practice pathways resulted in increased Lp(a) testing in patients with AS. This study represents a paradigm that may allow increased global awareness of Lp(a) as a risk factor for AS.
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189
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Chapman KA, Machado SS, van der Merwe K, Bryson A, Smith D. Exploring Primary Care Non-Attendance: A Study of Low-Income Patients. J Prim Care Community Health 2022; 13:21501319221082352. [PMID: 35259972 PMCID: PMC8918768 DOI: 10.1177/21501319221082352] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION While evidence has been established on the impact of medical appointment non-attendance on the healthcare system and patient health, previous research has not focused on how poverty and rurality may influence patient experiences with non-attendance. This paper explores patient perceptions of non-attendance among those experiencing poverty in a rural U.S county to better inform providers to the context in which their patients make attendance-related decisions. METHODS Using a grounded theory approach, we conducted semi-structured interviews with 32 U.S. low-income adults in the rural Western U.S. who recurrently missed primary care appointments. We also used a questionnaire to assess individual characteristics related to health, resiliency, personal mastery, medical mistrust, life chaos, and adverse childhood experiences. RESULTS Participants identified 3 barriers to attending appointments: appointment disinterest, competing demands, and insufficient systems. Appointment disinterest stemmed from physical and mental health issues, misalignment between needs and treatment, and comfort with the provider. Competing demands included family responsibilities, employment, and relationships. Finally, participants reported that current scheduling and transportation systems were helpful but insufficient. To provide further context, participants also reported low overall health, moderate levels of medical mistrust, life chaos, and mastery, moderate to low resilience, and very a high number of adverse childhood experiences. CONCLUSIONS Results point to the need for modified structures that allow low-income patients more control over their personal health and highlight opportunities for clinics to address patients' lack of interest and fear in the medical encounter.
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Affiliation(s)
| | - Stephanie S Machado
- Oregon Institute of Technology, Klamath Falls, OR, USA.,California State University, Chico, Chico, CA, USA
| | | | - Ashley Bryson
- Klamath Health Partnership, Klamath Falls, OR, USA.,Oregon Health & Science University, Klamath Falls, OR, USA
| | - Dwight Smith
- Oregon Health & Science University, Klamath Falls, OR, USA
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190
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Prigge K, Holtz KK, Mara K, Meek A. Providing Asthma Management in the Retail Clinic Setting. J Prim Care Community Health 2022; 13:21501319221092256. [PMID: 35465761 PMCID: PMC9036326 DOI: 10.1177/21501319221092256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine whether there are differences in asthma management provided in the retail clinic setting versus in the primary care setting, and whether it would increase the number of well controlled asthmatics as determined by ACT score of 20 or greater, and less than or equal to 1 ED or hospital visit due to asthma, within 6 months. Methods: All asthma patients with an asthma control test (ACT) of 19 or less, received a new or updated asthma action plan (AAP) at the visit. If the patient presented to the retail clinic during an asthma exacerbation or with any asthma symptoms, they were not given an ACT and received usual care. Asthma quality data was retrospectively collected for primary care patients seen in the 6-months prior to as well as up to 6 months after the patient’s enrollment visit. Results: There was no significant difference in the number of admissions between locations in either the pre-implementation period or the post-implementation period for either the pediatric or adult cohort. There was a significant improvement in the percentage of pediatric and adult patients with at least 1 ACT in the post-implementation compared to pre-implementation for both retail clinic and primary care sites. The percentage of pediatric and adult patients with at least 1 AAP increased in the post-implementation compared to pre-implementation for both retail clinic and primary care sites. Conclusion: Retail clinics may be able to provide asthma management with similar outcomes to primary care settings.
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191
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Babenko B, Mitani A, Traynis I, Kitade N, Singh P, Maa AY, Cuadros J, Corrado GS, Peng L, Webster DR, Varadarajan A, Hammel N, Liu Y. Detection of signs of disease in external photographs of the eyes via deep learning. Nat Biomed Eng 2022; 6:1370-1383. [PMID: 35352000 PMCID: PMC8963675 DOI: 10.1038/s41551-022-00867-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/15/2022] [Indexed: 01/14/2023]
Abstract
Retinal fundus photographs can be used to detect a range of retinal conditions. Here we show that deep-learning models trained instead on external photographs of the eyes can be used to detect diabetic retinopathy (DR), diabetic macular oedema and poor blood glucose control. We developed the models using eye photographs from 145,832 patients with diabetes from 301 DR screening sites and evaluated the models on four tasks and four validation datasets with a total of 48,644 patients from 198 additional screening sites. For all four tasks, the predictive performance of the deep-learning models was significantly higher than the performance of logistic regression models using self-reported demographic and medical history data, and the predictions generalized to patients with dilated pupils, to patients from a different DR screening programme and to a general eye care programme that included diabetics and non-diabetics. We also explored the use of the deep-learning models for the detection of elevated lipid levels. The utility of external eye photographs for the diagnosis and management of diseases should be further validated with images from different cameras and patient populations.
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Affiliation(s)
- Boris Babenko
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Akinori Mitani
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA ,Artera, Mountain View, CA, USA
| | - Ilana Traynis
- Google Health via Advanced Clinical, Deerfield, IL USA
| | - Naho Kitade
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Preeti Singh
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - April Y. Maa
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA USA ,grid.484324.d0000 0004 0420 9995Regional Telehealth Services, Technology-based Eye Care Services (TECS) Division, Veterans Integrated Service Network (VISN) 7, Decatur, GA USA
| | | | - Greg S. Corrado
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Lily Peng
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Dale R. Webster
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | | | - Naama Hammel
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Yun Liu
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
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192
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Onimoe G, Angappan D, Chandar MCR, Rikleen S. Effect of COVID-19 Pandemic on Well Child Care and Vaccination. Front Pediatr 2022; 10:873482. [PMID: 35515354 PMCID: PMC9062878 DOI: 10.3389/fped.2022.873482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The COVID-19 virus is highly contagious primarily via aerosol transmission and has a high mortality rate. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. This study aims to enumerate the effect of the pandemic on vaccination rates during the COVID-19 lockdown and the aftermath in pediatric patients aged 6weeks-6 years. STUDY DESIGN A retrospective review of medical records was performed of missed well childcare visits at MetroHealth from March 1, 2020 to June 30, 2020. The sample size of 400 children aged 6 weeks to 6 years were randomly selected. Demographic data, number of calls made to attempt, scheduled WCC, no show rates for clinic appointments, number of missed WCC, location of MH facility, insurance type, vaccination status prior to the pandemic were collected. Statistical analysis was performed with SPSS software (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp). RESULTS From this descriptive study, we found that 43.5% of patients were not up to date on their childhood vaccination. The mean age was 24.38 months (SD 20.15). There were slightly more males (52.8%) in the study than females (47.3%) and most children were of African American descent. More than 50% of patients missed a scheduled well child appointment and 27% had a missed at least two consecutive appointments. CONCLUSION The COVID-19 pandemic has no doubt made a significant mark on health care; the effects would be both immediate and delayed, with vulnerable population being the most impacted. There is an urgent need to prevent a large-scale health disaster of catastrophic potential that could occur if an effective vaccination strategy is not implemented rapidly.
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Affiliation(s)
- Grace Onimoe
- The MetroHealth System, Cleveland, OH, United States.,Case Western Reserve University, Cleveland, OH, United States
| | - Dhanalakshmi Angappan
- The MetroHealth System, Cleveland, OH, United States.,Case Western Reserve University, Cleveland, OH, United States
| | | | - Sarah Rikleen
- The MetroHealth System, Cleveland, OH, United States.,Case Western Reserve University, Cleveland, OH, United States
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193
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Harju A, Neufeld J. Telehealth Utilization During the COVID-19 Pandemic: A Preliminary Selective Review. TELEMEDICINE REPORTS 2022; 3:38-47. [PMID: 35720447 PMCID: PMC8989093 DOI: 10.1089/tmr.2021.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 05/06/2023]
Abstract
Background: The COVID-19 pandemic reduced in-person visit volume and fueled a corresponding explosion in demand for telehealth services, resulting in the enactment of several temporary state and federal policies to allow greater flexibility in delivering telehealth services. This review examines patterns in telehealth utilization during the pandemic by synthesizing available findings from large-scale studies. Methods: To be included in this review, studies must be of original research, include data from 2020 or 2021, have a U.S. study population, and analyze telehealth encounter data across multiple payers and health systems. This review includes 10 studies that fully met the inclusion criteria and 29 studies that examined telehealth use during the pandemic, although not from multipayer, multihealth system data sets. All studies were identified using Ovid MEDLINE and Google Scholar. Results: At its peak, telehealth accounted for roughly 15-50% of visits across the various studied populations and data sets. The more telehealth was utilized, the smaller the decrease in overall visit volume. Audio visits tended to be used more often than video visits, and telehealth utilization varied across geographic regions and medical specialties. There were disparities in telehealth use by race, age, income, and other factors. Discussion: Most telehealth visits during the pandemic would not have been reimbursable without the telehealth policy changes that took place. The variability in telehealth utilization across geographic regions is likely attributed to state-level telehealth policies. Most studies examining disparities in telehealth utilization did not compare disparities from before and during the pandemic, and these disparities may be a characteristic of health care overall rather than of telehealth specifically.
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Affiliation(s)
- Amelia Harju
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
- *Address correspondence to: Amelia Harju, MPH, Institute for Health Informatics, University of Minnesota, 8-100 PWB, MMC912, 420 Delaware Street SE, Minneapolis, MN 55455, USA,
| | - Jonathan Neufeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
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194
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Liberman JN, Bhattacharjee S, Rui P, Ruetsch C, Rothman B, Kulkarni A, Forma F. Impact of the COVID-19 Pandemic on Healthcare Resource Utilization in Individuals with Major Depressive Disorder. Health Serv Res Manag Epidemiol 2022; 9:23333928221111864. [PMID: 35832488 PMCID: PMC9272161 DOI: 10.1177/23333928221111864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To estimate the impact COVID-19 pandemic on healthcare resource utilization (HCRU) among individuals with major depressive disorder (MDD). Method A retrospective cohort study was conducted to compare HCRU in the twelve months prior to and six months following pandemic onset among 1,318,709 individuals with MDD and propensity-score matched controls. Outcomes were monthly rates of all-cause and MDD-specific outpatient, inpatient, and prescription medication HCRU. Piecewise random effects models were used to adjust for patient-level clustering, trends over time, and pre-pandemic factors. Results In the first month following onset, outpatient HCRU declined with primary care visits down 25.1%. Following this initial decline, outpatient HCRU increased, exceeding pre-pandemic rates within three months. By April 2020, three quarters of all psychotherapy sessions were delivered by telehealth, followed by psychiatry (62.3%), and primary care visits (30.1%). The use of telehealth remained highest for psychotherapy and psychiatry (representing 67.6% and 54.2% of visits, respectively, in September 2020). All-cause partial-day hospitalizations declined 50.5% and remained depressed through July 2020 (down 18.3%). Beginning in the first month post-onset, prescription medication HCRU increased for all antidepressant and antipsychotic medication classes: serotonin modulators ( + 11.8%), bupropion ( + 10.4%), SSRIs ( + 9.0%), SNRIs ( + 8.6%), and atypical antipsychotics ( + 7.5%). Conclusions Following pandemic onset, individuals with MDD realized an immediate, but short-lived, reduction in primary care HCRU. Telehealth use remained elevated through the first six months. The most significant and sustained reduction in HCRU was noted for partial-day hospitalizations and all-cause ED visits.
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Affiliation(s)
- Joshua N. Liberman
- Health Analytics, LLC, USA
- Joshua N. Liberman, Health Analytics, LLC, United States.
| | | | | | | | - Brian Rothman
- Otsuka Pharmaceutical Development & Commercialization, Inc, USA
| | - Amit Kulkarni
- Otsuka Pharmaceutical Development & Commercialization, Inc, USA
| | - Felicia Forma
- Former employee of Otsuka Pharmaceutical Development & Commercialization, Inc
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195
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Bliss JW, Yau A, Beideck E, Novak JSS, d'Andrea FB, Blobel NJ, Batavia AS, Charney P. A Medical Student-Run Telehealth Primary Care Clinic During the COVID-19 Pandemic: Maintaining Care for the Underserved. J Prim Care Community Health 2022; 13:21501319221114831. [PMID: 35920022 PMCID: PMC9358338 DOI: 10.1177/21501319221114831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In this report, we outline our approach to implementing a hybrid in-person and virtual clinic model at a student-run free clinic (SRFC) during the COVID-19 pandemic. Individuals of low socioeconomic status (SES) are at an increased risk for COVID-19 infection and severe clinical outcomes. It is unclear if telehealth is a viable continuity of care enabler for the underserved. METHODS The Weill Cornell Community Clinic (WCCC) implemented a novel telehealth clinic model to serve uninsured patients in May 2020. A phone survey of was conducted to assess WCCC patients access to technology needed for telehealth visits (eg, personal computers, smartphones). Patient no-show rates were retrospectively assessed for both in-person (pre-pandemic) and hybrid continuity of care models. RESULTS The phone survey found that 90% of WCCC patients had access to technology needed for telehealth visits. In the 8 months following implementation of the hybrid model, telehealth and in-person no-show rates were 11% (14/128) and 15% (10/67) respectively; the combined hybrid no-show rate was 12% (24/195). For comparison, the in-person 2019 no-show rate was 23% (84/367). This study aligns with previous reports that telehealth improves patient attendance. CONCLUSION Literature on the transition of SRFCs from in-person to telehealth care delivery models is limited. At the WCCC, the reduction in no-show rates supports the feasibility and benefits of adopting telehealth for the delivery of care to underserved patient populations. We believe the hybrid telehealth model described here is a viable model for other student run free clinics to increase access to care in low SES communities.
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Affiliation(s)
- Joshua W Bliss
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Annie Yau
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Elena Beideck
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jesse S S Novak
- Weill Cornell Medicine/Sloan-Kettering/Rockefeller Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Felipe B d'Andrea
- Weill Cornell Medicine/Sloan-Kettering/Rockefeller Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Nicolas J Blobel
- Weill Cornell Medicine/Sloan-Kettering/Rockefeller Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Ashita S Batavia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pamela Charney
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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196
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McAlearney AS, Gaughan AA, Shiu-Yee K, DePuccio MJ. Silver Linings Around the Increased Use of Telehealth After the Emergence of COVID-19: Perspectives From Primary Care Physicians. J Prim Care Community Health 2022; 13:21501319221099485. [PMID: 35588253 PMCID: PMC9130845 DOI: 10.1177/21501319221099485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction/Objectives: With the emergence of COVID-19, the transition from in-person care to
widespread use of telehealth raised many well-described challenges for
primary care providers (PCP). The purpose of this study was to improve
understanding of how this increased use of telehealth impacted PCPs in
positive ways, and specifically focus on any “silver linings” of using
telehealth. Methods: We interviewed PCPs working at a large Midwestern academic medical center
between June and July 2020 and asked for perspectives about the use of
telehealth during the pandemic. Verbatim transcripts were coded and analyzed
using deductive dominant thematic analysis that allowed for categorization
of data and identification of emergent themes. Results: PCPs noted 3 main benefits of using telehealth: (1) demonstrated remote care
was feasible, (2) patients expressed gratitude; and (3) payers fully
reimbursed for telehealth visits. PCPs also described “silver linings” they
perceived for patients: (1) easier access to care, (2) more convenient
follow-up care, and (3) ability to get quick specialty referrals. Conclusions: Study participants offered encouraging feedback regarding the potential for
telehealth to offer a convenient and patient-centric alternative to
in-person care. As a healthcare delivery mode, telehealth can remove
personal and social barriers to care for many patients, but reimbursement
parity and more evidence is needed to inform best practices for ongoing
telehealth use in primary care. With the continuing use of telehealth, it
will be important to monitor health outcomes as well as consider how these
modalities may need to be adapted to mitigate potential care
disparities.
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197
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DeSilva MB, Haapala J, Vazquez-Benitez G, Daley MF, Nordin JD, Klein NP, Henninger ML, Williams JTB, Hambidge SJ, Jackson ML, Donahue JG, Qian L, Lindley MC, Gee J, Weintraub ES, Kharbanda EO. Association of the COVID-19 Pandemic With Routine Childhood Vaccination Rates and Proportion Up to Date With Vaccinations Across 8 US Health Systems in the Vaccine Safety Datalink. JAMA Pediatr 2022; 176:68-77. [PMID: 34617975 PMCID: PMC8498937 DOI: 10.1001/jamapediatrics.2021.4251] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The COVID-19 pandemic has affected routine vaccine delivery in the US and globally. The magnitude of these disruptions and their association with childhood vaccination coverage are unclear. OBJECTIVES To compare trends in pediatric vaccination before and during the pandemic and to evaluate the proportion of children up to date (UTD) with vaccinations by age, race, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This surveillance study used a prepandemic-postpandemic control design with data from 8 health systems in California, Oregon, Washington, Colorado, Minnesota, and Wisconsin in the Vaccine Safety Datalink. Children from age groups younger than 24 months and 4 to 6, 11 to 13, and 16 to 18 years were included if they had at least 1 week of health system enrollment from January 5, 2020, through October 3, 2020, over periods before the US COVID-19 pandemic (January 5, 2020, through March 14, 2020), during age-limited preventive care (March 15, 2020, through May 16, 2020), and during expanded primary care (May 17, 2020, through October 3, 2020). These individuals were compared with those enrolled during analogous weeks in 2019. EXPOSURES This study evaluated UTD status among children reaching specific ages in February, May, and September 2020, compared with those reaching these ages in 2019. MAIN OUTCOMES AND MEASURES Weekly vaccination rates for routine age-specific vaccines and the proportion of children UTD for all age-specific recommended vaccines. RESULTS Of 1 399 708 children in 2019 and 1 402 227 in 2020, 1 371 718 were female (49.0%) and 1 429 979 were male (51.0%); 334 216 Asian individuals (11.9%), 900 226 were Hispanic individuals (32.1%), and 201 619 non-Hispanic Black individuals (7.2%). Compared with the prepandemic period and 2019, the age-limited preventive care period was associated with lower weekly vaccination rates, with ratios of rate ratios of 0.82 (95% CI, 0.80-0.85) among those younger than 24 months, 0.18 (95% CI, 0.16-0.20) among those aged 4 to 6 years, 0.16 (95% CI, 0.14-0.17) among those aged 11 to 13 years, and 0.10 (95% CI, 0.08-0.13) among those aged 16 to 18 years. Vaccination rates during expanded primary care remained lower for most ages (ratios of rate ratios: <24 months, 0.96 [95% CI, 0.93-0.98]; 11-13 years, 0.81 [95% CI, 0.76-0.86]; 16-18 years, 0.57 [95% CI, 0.51-0.63]). In September 2020, 74% (95% CI, 73%-76%) of infants aged 7 months and 57% (95% CI, 56%-58%) of infants aged 18 months were UTD vs 81% (95% CI, 80%-82%) and 61% (95% CI, 60%-62%), respectively, in September 2019. The proportion UTD was lowest in non-Hispanic Black children across most age groups, both during and prior to the COVID-19 pandemic (eg, in May 2019, 70% [95% CI, 64%-75%] of non-Hispanic Black infants aged 7 months were UTD vs 82% [95% CI, 81%-83%] in all infants aged 7 months combined). CONCLUSIONS AND RELEVANCE As of September 2020, childhood vaccination rates and the proportion who were UTD remained lower than 2019 levels. Interventions are needed to promote catch-up vaccination, particularly in populations at risk for underimmunization.
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Affiliation(s)
| | | | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | | | | | | | | | | | | | - Lei Qian
- Kaiser Permanente Southern California, Pasadena
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne Gee
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric S. Weintraub
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
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198
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Keppel G, Cole AM, Ramsbottom M, Nagpal S, Hornecker J, Thomson C, Nguyen V, Baldwin LM. Early Response of Primary Care Practices to COVID-19 Pandemic. J Prim Care Community Health 2022; 13:21501319221085374. [PMID: 35289206 PMCID: PMC8928367 DOI: 10.1177/21501319221085374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The emergence of the COVID-19 pandemic and subsequent public health mitigation strategies resulted in rapid and significant changes to delivery of primary care. The field of primary care faced an unprecedented dual challenge of providing routine care to patients while ensuring patient and staff safety and managing patients with a highly transmissible disease. This study describes how a diverse group of primary care practices addressed these challenges at the start of the COVID-19 pandemic, in Spring 2020. METHODS A cross-sectional electronic survey of representatives from primary care practices in the WWAMI region Practice and Research Network (WPRN). Survey topics included clinical workforce, operations, and use of telemedicine in the first 3 months of the COVID-19 pandemic. RESULTS To safely manage patients with COVID-19 symptoms all clinics modified operations; 81.3% diverted patients with respiratory symptoms to a telemedicine evaluation, 68.8% diverted these patients to be seen in-person at another location, and 75% made in-clinic changes to maintain safety. The set of operational changes employed by clinics was diverse. To continue to provide routine patient care, all clinics employed telemedicine. Over 80% of clinics had never used telemedicine prior to March 2020. CONCLUSIONS A diverse group of primary care clinics all rapidly implemented a variety of operational adaptations to address patient needs and maintain patient and staff safety at the onset of the COVID- 19 pandemic. Telemedicine, together with other measures, provided critical pathways for maintaining delivery of care.
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Affiliation(s)
- Gina Keppel
- University of Washington Department of Family Medicine, Seattle, WA, USA
| | - Allison M Cole
- University of Washington Department of Family Medicine, Seattle, WA, USA
| | | | - Stuti Nagpal
- Sea Mar Marysville Family Medicine Residency Program, Marysville, WA, USA
| | | | - Claire Thomson
- Swedish First Hill Family Medicine Residency, Seattle, WA, USA
| | - Viet Nguyen
- Swedish First Hill Family Medicine Residency, Seattle, WA, USA
| | - Laura-Mae Baldwin
- University of Washington Department of Family Medicine, Seattle, WA, USA
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199
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Greenwood-Hickman MA, Zhou J, Cook A, Mettert KD, Green B, McClure J, Arterburn D, Florez-Acevedo S, Rosenberg DE. Exploring Differences in Older Adult Accelerometer-Measured Sedentary Behavior and Resting Blood Pressure Before and During the COVID-19 Pandemic. Gerontol Geriatr Med 2022; 8:23337214221096007. [PMID: 35506125 PMCID: PMC9051995 DOI: 10.1177/23337214221096007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/16/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
Older adults have higher sedentary behavior (SB), lower physical activity, and are particularly susceptible to negative impacts from the COVID-19 pandemic and associated public health restrictions. Pandemic impacts to SB and health, particularly via objective assessment, are not well documented in the literature. Here we described differences in SB, physical activity, and blood pressure (BP) for older adults before and during the pandemic. Baseline thigh-worn activPAL accelerometer and BP measurements from 95 participants enrolled in a SB intervention trial pre-pandemic were compared to 60 enrolled post-pandemic. We used linear regression models adjusted for demographic and health factors to estimate differences in sample means of SB measures and BP. The post-COVID sample was older (age 67 vs. 70), more female (60% vs. 72%), and included more individuals of color (21% vs. 32%). In fully adjusted models, systolic BP was statistically significantly higher in the post-COVID group (6.8, 95% CI: [0.3,13.3]). After adjustment, activPAL-measured and self-reported activity were non-significant but trended towards greater total sitting (0.4 hours [-0.3, 1.1]), fewer daily steps (-270 [-1078, 538]), and greater self-reported TV time (0.4 hours, [-0.3, 1.1]) post-COVID. Future analyses are warranted to better quantify these impacts and guide clinical care and future interventions.
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Affiliation(s)
| | - Jing Zhou
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Andrea Cook
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Kayne D. Mettert
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Bev Green
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Jennifer McClure
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - David Arterburn
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Stefani Florez-Acevedo
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
- Department of Health Services, University of
Washington, Seattle, WA, USA
| | - Dori E. Rosenberg
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
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Jacobson CL, Foster LC, Arul H, Rees A, Stafford RS. A Digital Health Fall Prevention Program for Older Adults: Feasibility Study. JMIR Form Res 2021; 5:e30558. [PMID: 34837492 PMCID: PMC8738986 DOI: 10.2196/30558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/30/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. Objective We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. Methods Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. Results The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. Conclusions The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults.
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Affiliation(s)
- Claire L Jacobson
- Age Bold Inc, Los Angeles, CA, United States.,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Hari Arul
- Age Bold Inc, Los Angeles, CA, United States
| | - Amanda Rees
- Age Bold Inc, Los Angeles, CA, United States
| | - Randall S Stafford
- Age Bold Inc, Los Angeles, CA, United States.,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
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