201
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Eyrich NW, Andino JJ, Fessell DP. Bridging the Digital Divide to Avoid Leaving the Most Vulnerable Behind. JAMA Surg 2021; 156:703-704. [PMID: 33769441 DOI: 10.1001/jamasurg.2021.1143] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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202
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Samuels-Kalow M, Jaffe T, Zachrison K. Digital disparities: designing telemedicine systems with a health equity aim. Emerg Med J 2021; 38:474-476. [PMID: 33674277 DOI: 10.1136/emermed-2020-210896] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/13/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
The use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.
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Affiliation(s)
| | - Todd Jaffe
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori Zachrison
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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203
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Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States. Health Aff (Millwood) 2021; 40:349-358. [PMID: 33523745 DOI: 10.1377/hlthaff.2020.01786] [Citation(s) in RCA: 263] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Coronavirus disease 2019 (COVID-19) spurred a rapid rise in telemedicine, but it is unclear how use has varied by clinical and patient factors during the pandemic. We examined the variation in total outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020. During the pandemic, 30.1 percent of all visits were provided via telemedicine, and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. Telemedicine use was lower in communities with higher rates of poverty (31.9 percent versus 27.9 percent for the lowest and highest quartiles of poverty rate, respectively). Across specialties, the use of any telemedicine during the pandemic ranged from 68 percent of endocrinologists to 9 percent of ophthalmologists. Across common conditions, the percentage of visits provided during the pandemic via telemedicine ranged from 53 percent for depression to 3 percent for glaucoma. Higher rates of telemedicine use for common conditions were associated with smaller decreases in total weekly visits during the pandemic.
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Affiliation(s)
- Sadiq Y Patel
- Sadiq Y. Patel is a National Institute of Mental Health postdoctoral research fellow in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts
| | - Ateev Mehrotra
- Ateev Mehrotra is an associate professor of health care policy and medicine in the Department of Health Care Policy, Harvard Medical School
| | - Haiden A Huskamp
- Haiden A. Huskamp is the 30th Anniversary Professor of Health Care Policy in Department of Health Care Policy, Harvard Medical School
| | - Lori Uscher-Pines
- Lori Uscher-Pines is a senior policy researcher in social and economic policy at the RAND Corporation in Arlington, Virginia
| | - Ishani Ganguli
- Ishani Ganguli is an assistant professor of medicine in the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, both in Boston
| | - Michael Lawrence Barnett
- Michael Lawrence Barnett is an assistant professor in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston
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204
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Loewenthal J, DuMontier C, Cooper L, Frain L, Waldman LS, Streiter S, Cardin K, Tulebaev S, Javedan H, Orkaby AR, Hshieh T. Adaptation of the comprehensive geriatric assessment to a virtual delivery format. Age Ageing 2021; 50:597-598. [PMID: 33284967 DOI: 10.1093/ageing/afaa257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julia Loewenthal
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Clark DuMontier
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Lisa Cooper
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Laura Frain
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Louis S Waldman
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Shoshana Streiter
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Kristin Cardin
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Samir Tulebaev
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Houman Javedan
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Ariela R Orkaby
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA
| | - Tammy Hshieh
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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205
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Sugarman DE, Horvitz LE, Greenfield SF, Busch AB. Clinicians' Perceptions of Rapid Scale-up of Telehealth Services in Outpatient Mental Health Treatment. Telemed J E Health 2021; 27:1399-1408. [PMID: 33600272 DOI: 10.1089/tmj.2020.0481] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Little is known about specialty mental health and/or substance use disorder (MH/SUD) clinicians' experiences transitioning from in-person to telehealth care, to treat a diagnostically diverse population during the COVID-19 pandemic. Methods: Survey of outpatient MH/SUD clinicians (psychiatrists, nurse practitioners, psychologists, and licensed clinical social workers; N = 107) at a psychiatric hospital. Clinician satisfaction and experiences using telehealth across a variety of services (individual, group or family therapy, initial assessments, evaluation and management, and neuropsychological assessment) were assessed using a mixed-methods approach. Results: Across services, a majority agreed/strongly agreed that telehealth provided an opportunity to build rapport with patients (67-88%) and they could treat their patients' needs well (71-88%). The interest in continuing to use telehealth when in-person visits resume varied by type of service provided (50-71%). Group therapy and initial assessment were lowest (50% and 51%, respectively). Clinicians noted telehealth improved access to care for patients with logistical barriers, competing demands, mobility difficulties, and medical concerns; but was more challenging to care for patients with certain psychiatric characteristics (e.g., psychosis, paranoia, catatonia, high distractibility, and avoidance), high symptom severity, or who needed to improve social skills. Telehealth influenced the therapeutic process (e.g., observations of family dynamic, increased patient/clinician therapeutic alliance). Discussion and Conclusions: MH/SUD clinicians who quickly transitioned to telehealth care during the pandemic were largely satisfied with telehealth, but also identified challenges related to specific patient characteristics, or types of MH/SUD services. These observations warrant additional study to better delineate the role for an expanded use of telehealth postpandemic.
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Affiliation(s)
- Dawn E Sugarman
- McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Shelly F Greenfield
- McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alisa B Busch
- McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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206
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Mullur RS, Kaur Cheema SP, Alano RE, Chang LE. Tele-Integrative Medicine to Support Rehabilitative Care. Phys Med Rehabil Clin N Am 2021; 32:393-403. [PMID: 33814064 DOI: 10.1016/j.pmr.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complementary and integrative health (CIH) modalities have therapeutic value in the multidisciplinary rehabilitation of chronic pain patients. Evidence of such has been seen with the Whole Health Model at the (Veterans Affairs) VA Healthcare system. CIH therapies, including yoga, tai chi, mindfulness meditation, hypnosis, self-massage, and acupressure, are significantly effective for managing chronic pain with little to no negative effects, and can be easily incorporated into telemedicine care with great potential benefit. The future of wellness in telemedicine is evolving with great potential, and needs further attention to addressing barriers of care.
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Affiliation(s)
- Rashmi S Mullur
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, 11301 Wilshire Boulevard, Mail Code 111-D, Los Angeles, CA 90073, USA.
| | - Seetal Preet Kaur Cheema
- Department of Anesthesia (212), VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Ryan Edward Alano
- Department of Physical Medicine and Rehabilitation (1415), VA Greater Los Angeles Healthcare System, 1301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Lynn Elizabeth Chang
- Department of Physical Medicine and Rehabilitation (1415), VA Greater Los Angeles Healthcare System, 1301 Wilshire Boulevard, Los Angeles, CA 90073, USA
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207
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Miller LE, Gray ST, Rathi VK. Moving Toward Equitable Telemedicine in Otolaryngology-Head and Neck Surgery-Reply. JAMA Otolaryngol Head Neck Surg 2021; 147:220. [PMID: 33237262 DOI: 10.1001/jamaoto.2020.4323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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208
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Santos-Parker JR, Cassidy DE, Gomez-Rexrode AE, Englesbe MJ, Valbuena VSM. Meeting Patients at the Dialysis Chair: The Expanding Role of Telemedicine to Address Disparities in Access to Kidney Transplantation. Am J Kidney Dis 2021; 78:5-8. [PMID: 33508398 DOI: 10.1053/j.ajkd.2020.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/31/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Michael J Englesbe
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI.
| | - Valeria S M Valbuena
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
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209
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Affiliation(s)
- Marco Marabelli
- Information and Process Management Department, Bentley University, Waltham, United States
| | - Emmanuelle Vaast
- Information Systems, Desautels Faculty of Management, McGill University, Montreal, Canada
| | - Jingyao Lydia Li
- Information and Process Management Department, Bentley University, Waltham, United States
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210
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Shaverdian N, Gillespie EF, Cha E, Kim SY, Benvengo S, Chino F, Kang JJ, Li Y, Atkinson TM, Lee N, Washington CM, Cahlon O, Gomez DR. Impact of Telemedicine on Patient Satisfaction and Perceptions of Care Quality in Radiation Oncology. J Natl Compr Canc Netw 2021; 19:1174-1180. [PMID: 33395627 DOI: 10.6004/jnccn.2020.7687] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has transformed cancer care with the rapid expansion of telemedicine, but given the limited use of telemedicine in oncology, concerns have been raised about the quality of care being delivered. We assessed the patient experience with telemedicine in routine radiation oncology practice to determine satisfaction, quality of care, and opportunities for optimization. PATIENTS AND METHODS Patients seen within a multistate comprehensive cancer center for prepandemic office visits and intrapandemic telemedicine visits in December 2019 through June 2020 who completed patient experience questionnaires were evaluated. Patient satisfaction between office and telemedicine consultations were compared, patient visit-type preferences were assessed, and factors associated with an office visit preference were determined. RESULTS In total, 1,077 patients were assessed (office visit, n=726; telemedicine, n=351). The telemedicine-consult survey response rate was 40%. No significant differences were seen in satisfaction scores between office and telemedicine consultations, including the appointment experience versus expectation, quality of physician's explanation, and level of physician concern and friendliness. Among telemedicine survey respondents, 45% and 34% preferred telemedicine and office visits, respectively, and 21% had no preference for their visit type. Most respondents found their confidence in their physician (90%), understanding of the treatment plan (88%), and confidence in their treatment (87%) to be better or no different than with an office visit. Patients with better performance status and who were married/partnered were more likely to prefer in-person office visit consultations (odds ratio [OR], 1.04 [95% CI, 1.00-1.08]; P=.047, and 2.41 [95% CI, 1.14-5.47]; P=.009, respectively). Patients with telephone-only encounters were more likely to report better treatment plan understanding with an office visit (OR, 2.25; 95% CI, 1.00-4.77; P=.04). CONCLUSIONS This study is the first to assess telemedicine in routine radiation oncology practice, and found high patient satisfaction and confidence in their care. Optimization of telemedicine in oncology should be a priority, specifically access to audiovisual capabilities that can improve patient-oncologist communication.
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Affiliation(s)
| | | | | | - Soo Young Kim
- 2Department of Psychiatry and Behavior Sciences, and
| | | | | | | | - Yuelin Li
- 2Department of Psychiatry and Behavior Sciences, and.,3Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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211
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Rosenthal JL, O'Neal C, Sanders A, Fernandez Y Garcia E. Differential Use of Pediatric Video Visits by a Diverse Population During the COVID-19 Pandemic: A Mixed-Methods Study. Front Pediatr 2021; 9:645236. [PMID: 34322458 PMCID: PMC8311026 DOI: 10.3389/fped.2021.645236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe and explore pediatric ambulatory video visit use by patient characteristics during the coronavirus disease 2019 (COVID-19) pandemic. Methods: We conducted an explanatory sequential mixed methods study with integration at the design and methods level. Phase 1 was a cross-sectional analysis of general and specialty pediatric ambulatory encounters to profile the use of video visits by patient characteristics. We performed descriptive analyses for each variable of interest and estimated a multivariable logistic regression model to analyze factors associated with the odds of having a video visit. Phase 2 was a qualitative exploration using semi-structured interviews with healthcare team members to understand the contextual factors influencing video visit usage. We used an interview guide to solicit information related to general perceptions about ambulatory video visits, reactions to the quantitative phase data, and strategies for optimizing equitable reach of video visits. Data were analyzed using a combination of deductive and inductive analysis. Results: Among the 5,464 pediatric ambulatory encounters completed between March 11 and June 30, 2020, 2,127 were video visits. Patient factors associated with lower odds of having a video visit rather than an in-person visit included being Spanish-speaking (aOR 0.27, 95% CI 0.20-0.37) and other non-English-speaking (aOR 0.50, 95% CI 0.34-0.75) in comparison to English-speaking. Patients with public insurance also had a lower odds of having a video visit in comparison to privately insured patients (aOR 0.77, 95% CI 0.67-0.88). Qualitative interviews identified five solution-based themes: (1) Promoting video visits in a way that reaches all patient families; (2) Offering video visits to all patient families; (3) Mitigating digital literacy barriers; (4) Expanding health system resources to support families' specific needs; and (5) Engaging and empowering health system personnel to expand video visit access. Conclusion: We identified differences in pediatric ambulatory video visit use by patient characteristics, with lower odds of video visit use among non-English-speaking and publicly insured patients. The mixed-methods approach allowed for the perspectives of our interview participants to contextualize the finding and lead to suggestions for improvement. Both our findings and the approach can be used by other health systems to ensure that all patients and families receive equal video visit access.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - Christina O'Neal
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - April Sanders
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
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212
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Sezgin E, Huang Y, Lin D, Ramtekkar U, Pauline L, Lin S. Documented Reasons of Cancellation and Rescheduling of Telehealth Appointments During the Pandemic. Telemed J E Health 2020; 27:1143-1150. [PMID: 33373553 DOI: 10.1089/tmj.2020.0454] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objective: The COVID-19 pandemic increased the use of telehealth around the world. The aim is to minimize health care service disruption as well as reducing COVID-19 exposure. However, one of the major operational concerns is cancellations and rescheduling (C/Rs). C/Rs may create additional burden and cost to the patient, provider, and the health system. Our aim is to understand the reasons for C/Rs of the telehealth session after the scheduled start time. Materials and Methods: We reviewed electronic health records (EHRs) to identify the C/R reasons for behavioral health and speech language pathology departments. Documented C/Rs in the medical charts were identified from EHR by using a keyword-based and Natural Language Processing (NLP)-supported EHR search engine. From the search results, we randomly selected 200 notes and conducted a thematic analysis. Results: We identified four themes explaining C/R reasons. Most frequent theme was "technicality" (47, 36%), followed by "engagement" (34, 25%), "scheduling" (31, 24%), and "unspecified" (20, 15%). The findings showed that technical reasons are the leading cause of C/Rs, constituting 36% of the cases (95% confidence interval [CI]: 29-43%). Notably, "engagement" constituted a sizeable 25% (95% CI: 19-31%) of C/Rs, as a result of the inability to engage a patient to complete the telehealth session. Conclusions: The study shows that engagement is one of the new challenges to the pediatric telehealth visits. Future studies of new engagement models are needed for the success of telehealth. Our findings will help fill the literature gaps and may help with enhancing the digital experience for both caregivers and providers, reducing wasted time and resources due to preventable C/Rs, improving clinical operation efficiency, and treatment adherence.
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Affiliation(s)
- Emre Sezgin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Yungui Huang
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Deborah Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ujjwal Ramtekkar
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Psychiatry, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lindsey Pauline
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Simon Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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213
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Severe J, Tang R, Horbatch F, Onishchenko R, Naini V, Blazek MC. Factors Influencing Patients' Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey. JMIR Form Res 2020; 4:e25469. [PMID: 33320823 PMCID: PMC7758083 DOI: 10.2196/25469] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 01/16/2023] Open
Abstract
Background Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients’ initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective This paper seeks to examine factors influencing patients’ initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor’s stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8%) initially chose to receive psychiatric care through video visits, while 13.5% (n=33) chose telephone visits and 1.2% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95% CI 0.02-0.06). Patients aged ≥44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth.
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Affiliation(s)
- Jennifer Severe
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ruiqi Tang
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Faith Horbatch
- University of Michigan Medical School, Ann Arbor, MI, United States
| | | | - Vidisha Naini
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Mary Carol Blazek
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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214
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Reyes AM, Thunell J, Zissimopoulos J. Addressing the Diverse Needs of Unpaid Caregivers Through New Health-Care Policy Opportunities. ACTA ACUST UNITED AC 2020; 31:19-23. [PMID: 33462551 DOI: 10.1093/ppar/praa039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Adriana M Reyes
- Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Johanna Thunell
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA
| | - Julie Zissimopoulos
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, USA
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215
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Gilson SF, Umscheid CA, Laiteerapong N, Ossey G, Nunes KJ, Shah SD. Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis. JMIR Med Inform 2020; 8:e24544. [PMID: 33191247 PMCID: PMC7721629 DOI: 10.2196/24544] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.
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Affiliation(s)
- Sarah F Gilson
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Craig A Umscheid
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Graeme Ossey
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Digital Health, University of Chicago Medicine, Chicago, IL, United States
| | - Kenneth J Nunes
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Sachin D Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Department of Pediatrics, University of Chicago, Chicago, IL, United States
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216
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Crotty BH, Somai M. The Bugs In the Virtual Clinic: Confronting Telemedicine’s Challenges Through Empathy and Support (Preprint). J Particip Med 2020; 14:e25688. [PMID: 35452399 PMCID: PMC9077509 DOI: 10.2196/25688] [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: 11/11/2020] [Revised: 12/28/2020] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Although telemedicine has been an important conduit for clinical care during the COVID-19 pandemic, not all patients have been able to meaningfully participate in this mode of health care provision. Challenges with accessing telemedicine using consumer technology can interfere with the ability of patients and clinicians to meaningfully connect and lead to significant investments in time by clinicians and their staff. In this narrative case, we identify issues related to patients’ use of technology, make comparisons between telehealth adoption and the deployment of electronic health records, and propose that building intuitive and supported digital care experiences for patients is required to make virtual care sustainable.
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Affiliation(s)
- Bradley H Crotty
- Inception Labs, Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Melek Somai
- Inception Labs, Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, WI, United States
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217
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Affiliation(s)
- David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA 93105, USA.
| | - Namino Glantz
- Sansum Diabetes Research Institute, Santa Barbara, CA 93105, USA
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218
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Kerr D, Warshaw H. Clouds and Silver Linings: COVID-19 Pandemic Is an Opportune Moment to Democratize Diabetes Care Through Telehealth. J Diabetes Sci Technol 2020; 14:1107-1110. [PMID: 33050727 PMCID: PMC7645128 DOI: 10.1177/1932296820963630] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the recent pivot to telehealth as a direct result of the COVID-19 pandemic, there is an imperative to ensure that access to affordable devices and technologies with remote monitoring capabilities for people with diabetes becomes equitable. In addition, expanding the use of remote Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) services will require new strategies for achieving long-term, effective, continuous, data-driven care. The current COVID-19 pandemic has especially impacted underserved US communities that were already disproportionately impacted by diabetes. Historically, these same communities have faced barriers in accessing timely and effective diabetes care including access to DSMES and MNT services, and diabetes technologies. Our call to action encourages all involved to urge US Federal representatives to widen access to the array of technologies necessary for successful telehealth-delivered care beyond COVID-19.
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Affiliation(s)
- David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
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219
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Hsu M, Ahern DK, Suzuki J. Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic. JMIR Ment Health 2020; 7:e21814. [PMID: 33031044 PMCID: PMC7592462 DOI: 10.2196/21814] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/14/2020] [Accepted: 09/25/2020] [Indexed: 01/19/2023] Open
Abstract
Due to the COVID-19 pandemic, many clinical addiction treatment programs have been required to transition to telephonic or virtual visits. Novel solutions are needed to enhance substance use treatment during a time when many patients are disconnected from clinical care and social support. Digital phenotyping, which leverages the unique functionality of smartphone sensors (GPS, social behavior, and typing patterns), can buttress clinical treatment in a remote, scalable fashion. Specifically, digital phenotyping has the potential to improve relapse prediction and intervention, relapse detection, and overdose intervention. Digital phenotyping may enhance relapse prediction through coupling machine learning algorithms with the enormous amount of collected behavioral data. Activity-based analysis in real time can potentially be used to prevent relapse by warning substance users when they approach locational triggers such as bars or liquor stores. Wearable devices detect when a person has relapsed to substances through measuring physiological changes such as electrodermal activity and locomotion. Despite the initial promise of this approach, privacy, security, and barriers to access are important issues to address.
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Affiliation(s)
- Michael Hsu
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - David K Ahern
- Digital Behavioral Health and Informatics Research Program, Brigham and Women's Hospital, Boston, MA, United States
| | - Joji Suzuki
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
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220
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Patel NA, Harris JA, Ji YD, Odera SL. A Telemedicine Checklist for Effective Communication During Virtual Surgical Visits. J Oral Maxillofac Surg 2020; 79:510-512. [PMID: 33212034 PMCID: PMC7578845 DOI: 10.1016/j.joms.2020.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Nisarg A Patel
- Resident, Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA; and Research Affiliate, Department of Biomedical Informatics, Harvard Medical School, Boston, MA.
| | - Jack A Harris
- DMD Candidate, Harvard School of Dental Medicine, Boston, MA
| | - Yisi D Ji
- MD Candidate, Harvard Medical School, Boston, MA
| | - Sampeter L Odera
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA
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