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Katzow MW, Steinway C, Capossela E, Chen J, Chen V, Fenster T, Galagedera N, Hamill M, Lin E, Mamauag E, Moriarty S, Pathania S, Pliskin L, Ripp A, Ronay A, Santiago MT, Yang M, Jan S. Utilization and Patient-Reported Outcomes of Direct-to-Consumer Telemedicine During the First 6 Weeks of the COVID-19 Pandemic in the Largest Pediatric Ambulatory Network in New York State. Telemed J E Health 2024; 30:e1944-e1953. [PMID: 38597957 DOI: 10.1089/tmj.2023.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective: We aimed to (1) describe telemedicine utilization and usability during the first 6 weeks of the pandemic and (2) determine if usability varied by individual- or visit-level characteristics. Methods: We conducted a retrospective cohort study of ambulatory pediatric telemedicine visits occurring between March 10, 2020, and April 18, 2020, across a large academic health system. We performed manual chart review to assess individual- and visit-level characteristics and invited caregivers to respond to an adapted Telehealth Usability Questionnaire (TUQ). We used multiple logistic regression to determine predictors of high usability. Results: There were 3,197 ambulatory pediatric telemedicine visits, representing 2,967 unique patients. Patients were racially/ethnically diverse (42.5% non-Hispanic White) and primarily English-speaking (89.2%). Surveys were completed by 441 (17%) of those invited. Every item of the TUQ had agreement or strong agreement from the majority of respondents. Compared with non-Hispanic White, non-Hispanic Asian identity was associated with lower usability in three domains and overall, and non-Hispanic Black identity was associated with higher satisfaction and future use. As compared with caregivers of infants younger than 1 year, caregivers of older patients reported lower usability in the three domains. Conclusions: Telemedicine was successfully implemented across 18 ambulatory pediatric specialties in the largest health system in New York State at the onset of COVID-19, and caregivers found it usable and acceptable. Usability scores did not vary by visit-level characteristics but did vary by race/ethnicity and age. Further research is necessary to identify modifiable drivers of the patient experience, particularly in non-Hispanic Asian communities and older adolescents.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Errica Capossela
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital, La Jolla, California, USA
| | - Jack Chen
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Talia Fenster
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Nirupa Galagedera
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Megan Hamill
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Elaine Lin
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA
| | - Erica Mamauag
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shannon Moriarty
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Shivany Pathania
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Gastroenterology, Brown University/Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Lyndsey Pliskin
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Asher Ripp
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Avy Ronay
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Maria T Santiago
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Margaret Yang
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
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Ren AZ, Sung V. Factors that influence health service access in deaf and hard-of-hearing children: a narrative review. Int J Audiol 2024; 63:171-181. [PMID: 37335176 DOI: 10.1080/14992027.2023.2223357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children. DESIGN A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022. STUDY SAMPLES Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies. RESULTS The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19. CONCLUSION This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access.
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Affiliation(s)
- Angela Z Ren
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Sung
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia
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Cunha AS, Pedro AR, V Cordeiro J. Challenges of Using Telemedicine in Hospital Specialty Consultations during the COVID-19 Pandemic in Portugal According to a Panel of Experts. ACTA MEDICA PORT 2024; 37:198-206. [PMID: 38430471 DOI: 10.20344/amp.19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/12/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified. METHODS This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives. RESULTS This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient's journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions. CONCLUSION This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.
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Affiliation(s)
- Ana Soraia Cunha
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Ana Rita Pedro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - João V Cordeiro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Interdisciplinary Center of Social Sciences. Universidade NOVA de Lisboa. Lisbon. Portugal
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Zeineddin S, Macy ML, Bouchard ME, Carroll MS, Linton S, De Boer C, Abdullah F, Ghomrawi H. Disparities in Telemedicine Use Among Children Seen in Surgical Clinics During the COVID-19 Pandemic: Experience of One Tertiary Care Freestanding Children's Hospital. Telemed J E Health 2024; 30:642-650. [PMID: 37910777 DOI: 10.1089/tmj.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background: Telemedicine use dramatically increased during the COVID-19 pandemic. However, the effects of telemedicine on pre-existing disparities in pediatric surgical access have not been well described. We describe our center's early experience with telemedicine and disparities in patients' access to outpatient surgical care. Methods: A retrospective study of outpatient visits within all surgical divisions from May to December 2020 was conducted. We assessed the rates of scheduled telemedicine visits during that period, as well as the rate of completing a visit after it has been scheduled. Descriptive and logistic regression analyses were used to test for associations between these rates and patient characteristics. Results: Over the study period, 109,601 visits were scheduled. Telemedicine accounted for 6.1% of all visits with lower cancellation rates than in-person visits (26.9% vs. 34.7%). More scheduled telemedicine encounters were observed for older patients, White, English speakers, those with private insurance, and those living in rural areas. Lower odds of telemedicine visit completion were observed among patients with public insurance (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.64-0.77), Spanish language preference (OR 0.84, 95% CI 0.72-0.97), and those living in rural areas (OR 0.73, 95% CI 0.64-0.84). In contrast, higher odds of telemedicine visit completion were associated with a higher Social Deprivation Index score (OR 1.41, 95% CI 1.27-1.58). Telemedicine visit completion was also associated with increasing community-level income and distance from the hospital. Conclusions: Telemedicine use for outpatient surgical care was generally low during the peak of the pandemic, and certain populations were less likely to utilize it. These findings call for further action to bridge gaps in telemedicine use.
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Affiliation(s)
- Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michelle L Macy
- Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Bouchard
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael S Carroll
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Hassan Ghomrawi
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Medicine (Rheumatology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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5
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Lee ML, Wei EX, Kandathil C, Most SP. Telehealth Usage in Otolaryngology: A Comparative Study Pre- and Post-COVID-19. OTO Open 2024; 8:e109. [PMID: 38282795 PMCID: PMC10821753 DOI: 10.1002/oto2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/31/2023] [Indexed: 01/30/2024] Open
Abstract
The COVID-19 pandemic led to increased telehealth utilization in outpatient otolaryngology settings. While other studies on telehealth usage in otolaryngology settings have focused on demographic disparities during the pandemic, none have yet assessed how these demographic disparities have evolved from before versus after the pandemic. This study examines 4 recent consecutive years of demographic and clinical data from a large hospital system to investigate how the COVID-19 pandemic has changed demographic patterns in telehealth utilization. We demonstrate substantial increases in the number of otolaryngology patients participating in telehealth since the beginning of the COVID-19 pandemic but with no differences in patient distributions by race or ethnicity over time. We also found that telehealth patients, on average, were younger, more likely to be English-speaking, and more likely to be female. While these disparities widened slightly after the start of the pandemic, they were also present prior to the pandemic.
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Affiliation(s)
- Max L. Lee
- Department of Otolaryngology–Head and Neck SurgeryStanford Health CarePalo AltoCaliforniaUSA
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck SurgeryStanford Health CarePalo AltoCaliforniaUSA
| | - Cherian Kandathil
- Department of Otolaryngology–Head and Neck SurgeryStanford Health CarePalo AltoCaliforniaUSA
| | - Sam P. Most
- Department of Otolaryngology–Head and Neck SurgeryStanford Health CarePalo AltoCaliforniaUSA
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6
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Katzow MW, Steinway C, Zuzarte A, Chen J, Fishbein J, Jan S. Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19. Telemed J E Health 2024; 30:57-66. [PMID: 37579076 DOI: 10.1089/tmj.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Objective: Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person. Methods: We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model. Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year. Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrea Zuzarte
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Jack Chen
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Rameau A, Cox SR, Sussman SH, Odigie E. Addressing disparities in speech-language pathology and laryngology services with telehealth. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106349. [PMID: 37321106 PMCID: PMC10239150 DOI: 10.1016/j.jcomdis.2023.106349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic disproportionately affected the health and well-being of marginalized communities, and it brought greater awareness to disparities in health care access and utilization. Addressing these disparities is difficult because of their multidimensional nature. Predisposing factors (demographic information, social structure, and beliefs), enabling factors (family and community) and illness levels (perceived and evaluated illness) are thought to jointly contribute to such disparities. Research has demonstrated that disparities in access and utilization of speech-language pathology and laryngology services are the result of racial and ethnic differences, geographic factors, sex, gender, educational background, income level and insurance status. For example, persons from diverse racial and ethnic backgrounds have been found to be less likely to attend or adhere to voice rehabilitation, and they are more likely to delay health care due to language barriers, longer wait times, a lack of transportation and difficulties contacting their physician. The purpose of this paper is to summarize existing research on telehealth, discuss how telehealth offers the potential to eliminate some disparities in the access and utilization of voice care, review its limitations, and encourage continued research in this area. A clinical perspective from a large volume laryngology clinic in a major city in northeastern United States highlights the use of telehealth in the provision of voice care by a laryngologist and speech-language pathologist during and after the COVID19 pandemic.
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, United States of America.
| | - Steven R Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, United States of America
| | - Scott H Sussman
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, United States of America
| | - Eseosa Odigie
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, United States of America
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Kronforst K, Barrera L, Casale M, Smith TL, Schinasi D, Macy ML. Pediatric Telehealth Access and Utilization in Chicago During the First Year of the COVID-19 Pandemic. Telemed J E Health 2023; 29:1324-1331. [PMID: 36730746 PMCID: PMC10468546 DOI: 10.1089/tmj.2022.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The COVID-19 pandemic demanded rapid development of telemedicine services for pediatric care and highlighted disparities for marginalized communities. Objective: To understand the demographic characteristics of patients with completed and incomplete telemedicine visits at Ann and Robert H. Lurie Children's Hospital of Chicago. Methods: This was a cross-sectional retrospective analysis of telemedicine visits for patients <25 years old scheduled between March 21, 2020, and March 17, 2021. We examined visit outcomes and compared outcomes by race/ethnicity, language, and payer using logistic regression. Geographic information system mapping and linear regression were used to examine the relationship between incomplete visits and broadband access within Cook County. Results: A total of 13,655 eligible video visits were scheduled for children within 147 ZIP codes during the study time frame. Patient characteristics included median age 9 years, 53% female, 42% non-Latinx White, 31% Latinx, 13% non-Latinx Black, 11% non-Latinx other, and 3% declined/unknown. Preferred language was 89% English, 10% Spanish, and 1% other. Payer was 56% private, 43% public, and <1% other/self-pay. Overall, 86% video visits were completed, 7% cancelled, and 7% no-show with significant variation by patient demographic. Odds of incomplete visits were higher for Latinx patients (odds ratio [OR] 1.93) and non-Latinx Black patients (OR 2.33) than for non-Latinx White patients, patients with preferred language other than English (OR 1.53), and patients not privately insured (OR 1.89). Incomplete visit rates and broadband access were inversely related. Conclusion: System and policy solutions are needed to ensure equitable access and address disparities in incomplete telemedicine visits for marginalized populations in urban areas with lower broadband.
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Affiliation(s)
- Kenny Kronforst
- Department of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Telehealth and Digital Health Programs, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Leonardo Barrera
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Mia Casale
- Department of Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tracie L. Smith
- Department of Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Dana Schinasi
- Telehealth and Digital Health Programs, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michelle L. Macy
- Telehealth and Digital Health Programs, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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9
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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Jones JW, Saravia A, Mamidi IS, Torres JI, Evans AK. Telehealth Adoption and Perspectives Among Pediatric Otolaryngologists Following the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2022:34894221129014. [PMID: 36217956 DOI: 10.1177/00034894221129014] [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: 11/15/2022]
Abstract
OBJECTIVES To assess use of and physician experiences with pediatric otolaryngology telehealth visits as impacted by the COVID-19 pandemic. STUDY DESIGN/SETTING Cross sectional survey. METHODS A 15-question survey was electronically distributed to 656 members of the American Society of Pediatric Otolaryngology in August 2021, addressing member demographics, experiential practice elements, and use pre-pandemic, during the initial shutdown period of March-May 2020, and current use at the time of survey inquiry. RESULTS There were 124 respondents (response rate = 18.9%). Incident use pre-pandemic and during the shutdown were 21.0% (n = 26), and 92.7% (n = 115), respectively. Current use was 83.9% (n = 104) and the percentage of new current users (79.5%, n = 78) was significant (P < .0001,95% CI = 70.6%-86.4%). Estimated median telehealth visit rates pre-pandemic, during shutdown, and currently were 0 to 1, 4 to 5, and 2 to 3 per week, respectively (P < .0001). A difference in post-covid adoption rates was noted only for location (P = .008), with no differences for years out of training or practice type. Compared to in-person visits, physician satisfaction with telehealth visits was rated equivalent (49.0%) or worse/much worse (48.1%). The most common telehealth uses were follow-up visits (83.7%), pre-operative counseling (76.9%), and post-operative evaluation (69.2%). The need for a detailed exam (89.4%) and initial visits (32.7%) were reasons a telehealth visit was not offered. CONCLUSIONS The COVID-19 pandemic appears to have precipitated a rapid increase in telehealth adoption among surveyed pediatric otolaryngologists, regardless of age or practice type. The most significant limitations remain the need for a detailed exam, perceived low patient technological literacy, and limitations to interpretive services. Technology-based optimization of these barriers could lead to increased use and physician satisfaction.
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Affiliation(s)
- Joel W Jones
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ari Saravia
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ishwarya S Mamidi
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jairo I Torres
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Adele K Evans
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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11
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Inequity in Access and Delivery of Virtual Care Interventions: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159411. [PMID: 35954768 PMCID: PMC9367842 DOI: 10.3390/ijerph19159411] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/27/2023]
Abstract
The objectives of this review were to map and summarize the existing evidence from a global perspective about inequity in access and delivery of virtual care interventions and to identify strategies that may be adopted by virtual care services to address these inequities. We searched MEDLINE, EMBASE, and CINAHL using both medical subject headings (MeSH) and free-text keywords for empirical studies exploring inequity in ambulatory services offered virtually. Forty-one studies were included, most of them cross-sectional in design. Included studies were extracted using a customized extraction tool, and descriptive analysis was performed. The review identified widespread differences in accessing and using virtual care interventions among cultural and ethnic minorities, older people, socioeconomically disadvantaged groups, people with limited digital and/or health literacy, and those with limited access to digital devices and good connectivity. Potential solutions addressing these barriers identified in the review included having digitally literate caregivers present during virtual care appointments, conducting virtual care appointments in culturally sensitive manner, and having a focus on enhancing patients’ digital literacy. We identified evidence-based practices for virtual care interventions to ensure equity in access and delivery for their virtual care patients.
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12
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Fang CH, Smith RV. COVID-19 and the resurgence of telehealth in otolaryngology. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2022; 33:158-164. [PMID: 35505953 PMCID: PMC9047697 DOI: 10.1016/j.otot.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objective of this review is to examine the impact of the ongoing Coronavirus disease 2019 (COVID-19) pandemic on the use of telehealth in Otolaryngology. The use of telemedicine rose dramatically during the pandemic to meet the need for continued patient care while allowing for physical separation of providers and patients. Telemedicine has been used to evaluate patients with a variety of pathologies including dysphonia, vertigo, and anosmia. Innovative use of at-home exams, such as video-otoscopy has aided providers in overcoming challenges associated with a highly specialized physical exam. The use of telemedicine in Otolaryngology will likely remain essential in the post-pandemic era and has promising results for improving clinical efficiency.
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Affiliation(s)
- Christina H Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
| | - Richard V Smith
- Department of Otorhinolaryngology, Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
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13
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Barcat L, Pont-Thibodeau GD, Jutras C, Harrington K, MacDonald S, Ducharme-Crevier L. Impact of the Covid-19 Pandemic on Children and Families in PICU Follow-Up Clinic. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1747927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic disrupted the lives of many families, especially those of children with chronic health problems. Little is known about the impact of this pandemic on the health and well-being of critically ill children and their families after their discharge from pediatric intensive care unit (PICU) hospitalization. This study describes the repercussions of the COVID-19-related lockdown on the physical and psychological wellbeing, quality of life, and access to resources of PICU survivors and their families. This was a prospective cohort study of children and families followed at the Centre Hospitalier Universitaire Ste-Justine PICU follow-up clinic from October 2018 to February 2020. Families were contacted by phone to complete validated questionnaires (Pediatric Quality of Life Inventory, Hospital Anxiety and Depression Scale) and to evaluate the impact of the COVID-19 pandemic on their access to medical care and extrafamilial support. Fifty-five families were contacted between November and December 2020. Quality of life scores were 88.1 ± 16.9 and 83.8 ± 13.9 for physical and psychosocial aspects, respectively. Symptoms of anxiety and depression were detected in 23.6 and 3.6% of respondent parents, respectively. A significant proportion of families reported canceled or delayed health care appointments (65.5%) and difficulty with medication access (12.7%). Twenty-five families (45.5%) reported a significant decrease in income. We could not identify any statistically significant predictors for lower quality of life scores. Difficulty accessing medical care was associated with higher symptoms of anxiety and/or depression in parents on multivariate analysis (p = 0.02). In conclusion, the COVID-19 pandemic has had a significant negative impact on PICU survivors' access to medical resources and extrafamilial support.
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Affiliation(s)
- Lucile Barcat
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte Justine, Université de Montréal. Montréal, Québec, Canada
| | - Geneviève Du Pont-Thibodeau
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte Justine, Université de Montréal. Montréal, Québec, Canada
| | - Camille Jutras
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte Justine, Université de Montréal. Montréal, Québec, Canada
| | - Karen Harrington
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte Justine, Université de Montréal. Montréal, Québec, Canada
| | - Simon MacDonald
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte Justine, Université de Montréal. Montréal, Québec, Canada
| | - Laurence Ducharme-Crevier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte Justine, Université de Montréal. Montréal, Québec, Canada
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14
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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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15
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Manski-Nankervis JA, Davidson S, Hiscock H, Hallinan C, Ride J, Lingam V, Holman J, Baird A, McKeown E, Sanci L. Primary care consumers' experiences and opinions of a telehealth consultation delivered via video during the COVID-19 pandemic. Aust J Prim Health 2022; 28:224-231. [PMID: 35287793 DOI: 10.1071/py21193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
This study examined consumers' experiences and opinions of a videoconference with a primary healthcare professional, and estimated the value of travel and time savings for consumers compared with face-to-face consultations. The online survey was conducted in Melbourne, Australia, between October 2020 and May 2021. The sample (n = 499) was highly educated (Bachelor degree or higher, 79%; 393/499), predominately female (70%; 347/499), mainly spoke English at home (78%; 390/499) and had a mean age of 31.8 years (s.d. 11.40). Reduced travel time (27%; 271/499) and avoiding exposure to COVID-19 (23%; 228/499) were the main reasons consumers chose a videoconference. Mental health and behavioural issues were the main reason for the consultation (38%; 241/499) and 69% (346/499) of consultations were with a general practitioner. Perceptions of the quality of care were uniformly high, with 84% (419/499) of respondents believing videoconference was equivalent to a face-to-face consultation. No association was found between reporting that telehealth was equivalent to a face-to-face consultation and education, language, health status, reason for consultation or provider type. The average time saved per consultation was 1 h and 39 min, and the average transport-related saving was A$14.29. High rates of acceptance and substantial cost savings observed in this study warrant further investigation to inform the longer-term role of videoconferences, and telehealth more broadly, in the Australian primary care system.
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Affiliation(s)
- Jo-Anne Manski-Nankervis
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia; and Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Sandra Davidson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
| | - Harriet Hiscock
- Health Services Research Unit, The Royal Children's Hospital, 50 Flemington Road, Melbourne, Vic. 3052, Australia; and Health Services, Murdoch Children's Research Institute, 50 Flemington Road, Melbourne, Vic. 3052, Australia; and Department of Paediatrics, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Christine Hallinan
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
| | - Jemimah Ride
- Health Economics Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Vignesh Lingam
- South Eastern Melbourne Primary Health Network, Heatherton, Vic. 3202, Australia
| | - Jessica Holman
- North Western Melbourne Primary Health Network, Parkville, Vic. 3052, Australia
| | - Andrew Baird
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
| | - Emma McKeown
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia; and North Western Melbourne Primary Health Network, Parkville, Vic. 3052, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
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16
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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [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: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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17
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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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18
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Brodie KD, Fakurnejad S, Czechowicz JA, Nadaraja GS. Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era. Int J Pediatr Otorhinolaryngol 2022; 152:110971. [PMID: 34782175 PMCID: PMC9754654 DOI: 10.1016/j.ijporl.2021.110971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the impact of demographic factors and telehealth on access to pediatric otolaryngology care during the COVID-19 pandemic, as measured by attendance. METHODS Retrospective, observational study of all referrals to pediatric otolaryngology at a single, tertiary care pediatric hospital system in the US. All referrals placed to pediatric otolaryngology from March through December 2020 were compared with referrals between March and December 2019. Data on patient demographics, date of referral, duration between referral and appointment, appointment type, and diagnosis acuity were collected. A multivariate linear regression was used to evaluate the impact of the patient age, ethnicity, language, insurance, diagnosis acuity, time to appointment, and appointment type on attendance. RESULTS This study included 1988 referrals placed between March 16th-December 31st, 2020 and 3704 referrals placed between March 16th-December 31st, 2019. In 2020, attendance proportions were significantly higher at 72% compared to 62% during 2019 (p < 0.001). In 2020, there was a significantly shorter duration between referral and appointment, averaging 10 days as compared to 26 days in 2019 (p < 0.001). Overall, Black and Hispanic patients, children over the age of one, publicly insured patients, and those with longer wait times were less likely to attend their appointments. Primary language and use of telehealth did not predict attendance. CONCLUSION Early evidence has found significant healthcare access and outcome disparities across ethnicities during the COVID pandemic. However, there is limited data evaluating the effect of demographic factors or telehealth on access to pediatric otolaryngology care. This study identifies age, race and insurance type as predictors of access to pediatric otolaryngologic care, as measured by attendance.
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Affiliation(s)
| | - Shayan Fakurnejad
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, USA.
| | | | - Garani S. Nadaraja
- Corresponding author. 2233 Post Street, 3rd Floor, Box 1225, San Francisco, CA, USA
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19
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Patel TA, McCoy JL, Belsky MA, Sim ES, Konanur A, Yan A, Jabbour N, Padia R. Effect of Insurance Type on Postoperative Tympanostomy Tube Follow-up. Otolaryngol Head Neck Surg 2021; 166:1078-1084. [PMID: 34962848 DOI: 10.1177/01945998211067504] [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: 11/15/2022]
Abstract
OBJECTIVE Bilateral myringotomy with tube insertion (BMT) is a common procedure performed in children. Appropriate follow-up is necessary to ensure management of postoperative sequalae. The objectives are to investigate (1) the relationship between insurance type and postoperative follow-up attendance and (2) the effect of follow-up on need for further care after BMT. STUDY DESIGN Retrospective cohort study. SETTING The study included patients <3 years of age undergoing BMT for recurrent acute otitis media at a tertiary care children's hospital within a single year and followed for 3 years. Patients were excluded if they had received a prior BMT; underwent a concurrent otolaryngologic procedure; or had a syndromic diagnosis, craniofacial abnormality, or any significant cardiac or respiratory comorbidity. METHODS Number of follow-up appointments, demographics, socioeconomic status, and postoperative outcomes were analyzed. RESULTS A total of 734 patients were included with mean (SD) age of 1.4 years (0.50). The majority of patients had private insurance (520/734, 70.8%). Patients with public insurance attended fewer postoperative appointments (1.5 vs 1.8, P < .001) and had a higher incidence of BMT-related emergency department (ED) visits (10.3% vs 3.8%, P = .001). There was no significance found when different insurance providers were compared. An adjusted multivariate regression analysis showed that patients with private insurance were more likely to attend postoperative appointments (odds ratio, 3.52 [95% CI, 2.12-5.82]; P < .001) and less likely to have a BMT-related ED visit (odds ratio, 0.42 [95% CI, 0.20-0.89]; P = .024). CONCLUSION Insurance type is related to outcomes after the treatment of recurrent acute otitis media with BMT. Future studies that survey individuals will help identify barriers that contribute to patient absence at follow-ups and need for subsequent ED visits.
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Affiliation(s)
- Terral A Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael A Belsky
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward S Sim
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anisha Konanur
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Annie Yan
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Reema Padia
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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20
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Hoi KK, Brazina SA, Kolar-Anderson R, Zopf DA, Bohm LA. A Longitudinal Comparison of Telemedicine Versus In-Person Otolaryngology Clinic Efficiency and Patient Satisfaction During COVID-19. Ann Otol Rhinol Laryngol 2021; 131:34894211055349. [PMID: 34861781 DOI: 10.1177/00034894211055349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Telemedicine was increasingly adopted in otolaryngology as a result of the COVID-19 pandemic, but how it compares to in-person visits over the longitudinal course of the pandemic has not been characterized. This study compares telemedicine visits to in-person visits on measures of clinical efficiency and patient satisfaction. METHODS We examined all in-person and telemedicine encounters that occurred during the 13-month period from April 1, 2020 to April 30, 2021 at a pediatric otolaryngology clinic associated with a large tertiary care children's hospital. We compared patient demographics, primary encounter diagnoses, completions, cancellations, no-shows, cycle time, and patient satisfaction. RESULTS A total of 19 541 (90.5%) in-person visits and 2051 (9.5%) telemedicine visits were scheduled over the study period. There was no difference in patient age or gender between the visit types. There was a difference in race (75% White or Caucasian for in-person and 73% for telemedicine, P = .007) and average travel distance (53.3 miles for in-person vs 71.0 for telemedicine, P = .000). The most common primary diagnosis was Eustachian tube dysfunction for in-person visits (11.8%) and sleep disordered breathing for telemedicine visits (13.7%). Completion rate was greater for telemedicine visits (52.4% in-person vs 62.5% telemedicine). Cancellations were greater for in-person visits (42.6% in-person vs 24.2% telemedicine), but no-shows were greater for telemedicine (5.0% in-person vs 13.3% telemedicine, all P = .000). Average cycle time was shorter for telemedicine visits (56.5 minutes in-person vs 47.6 minutes telemedicine, P = .000). Patient satisfaction with provider interactions and overall care experience was high for both visit types. CONCLUSIONS Telemedicine was utilized more during months of heightened COVID-19 cases, with higher completion rates, fewer cancellations, shorter cycle times, saved travel distance, and comparable patient satisfaction to in-person visits. Telemedicine has the potential to remain an efficient mode of care delivery in the post-pandemic era.
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Affiliation(s)
- Karen K Hoi
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Rachel Kolar-Anderson
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Biomedical Engineering, Michigan Engineering, Ann Arbor, MI, USA
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
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21
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DeVries J, Ren Y, Purdy J, Carvalho D, Kari E. Exploring Factors Responsible for Delay in Pediatric Cochlear Implantation. Otol Neurotol 2021; 42:e1478-e1485. [PMID: 34608001 DOI: 10.1097/mao.0000000000003321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify and characterize demographic and socioeconomic factors associated with delays in cochlear implantation (CI) in children. STUDY DESIGN Retrospective. SETTING Tertiary pediatric CI referral center. PATIENTS All patients under 18 years of age receiving CI between March 2018 and February 2020. INTERVENTIONS CI. MAIN OUTCOME MEASURES Primary outcome measures included age at implantation and time from hearing loss diagnosis and candidacy evaluation to CI. RESULTS Seventy-two patients were identified (44% women, average age at implantation 4.9 yr). Age at implantation was older in patients with public, rather than private, insurance (6.0 ± 0.8 yr versus 3.1 ± 0.7 yr, p = 0.007) and those from low-income areas (8.6 ± 7.6 yr versus 2.4 ± 3.0 yr, p = 0.007). Time between hearing loss diagnosis and implantation was longer in publicly insured patients (4.1 ± 0.6 yr versus 2.2 ± 0.5 yr, p = 0.014). Time between identification as a CI candidate and implantation was longer in publicly insured patients (721 ± 107d versus 291 ± 64 d, p = 0.001). Among children with congenital profound hearing loss, publicly insured patients continued to be older at implantation (1.9 ± 0.2 versus 1.0 ± 0.2 yr, p = 0.008). Latinx children were more often publicly insured whereas white children were more often privately insured (p < 0.05). Publicly insured patients had delays in the pre-CI workup, including, in no particular order, vestibular evaluation (621 ± 132 d versus 197 ± 67 d, p = 0.007), developmental evaluation (517 ± 106 d versus 150 ± 56 d, p = 0.003), speech evaluation (482 ± 107 d versus 163 ± 65 d, p = 0.013), and children's implant profile (ChIP) assessment (572 ± 107d versus 184 ± 59d, p = 0,002). On ChIP evaluation, concerns regarding educational environment and support were higher in Spanish-speaking children (p = 0.024; p = 2.6 × 10-4) and children with public insurance (p = 0.016; p = 0.002). CONCLUSIONS Disparities in access to CI continue to affect timing of pediatric cochlear implantation.
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Affiliation(s)
- Jacquelyn DeVries
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California
| | - Yin Ren
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California
| | - Julie Purdy
- Division of Otolaryngology, Rady Children's Hospital, San Diego, California
| | - Daniela Carvalho
- Division of Otolaryngology, Rady Children's Hospital, San Diego, California
| | - Elina Kari
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California
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22
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Ohlstein JF, Ahmed OG, Garner J, Takashima M. Telemedicine in Otolaryngology in the COVID-19 Era: A Year Out. Cureus 2021; 13:e20794. [PMID: 35111474 PMCID: PMC8794398 DOI: 10.7759/cureus.20794] [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] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 02/07/2023] Open
Abstract
One year ago, shortly after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we published our initial experience with telemedicine. We showed that during the early pandemic, there was a dramatic shift to telemedicine and that 70% of our patients would decline telemedicine in favor of an in-person visit. As clinical limitations and stay-at-home orders relaxed, we sought to define how we have used telemedicine since. After the initial month of the pandemic, our utilization of telemedicine fell to an average of only 5% of visits over the past year. Nearly 80% of all telemedicine visits were routine follow-up visits, with its usage being unaffected by local policy and pandemic surges. The usefulness and applications of telemedicine have been well described; however, after our initial reliance on telemedicine, its use has been minimal. Moving forward, attention will need to focus on innovation and expanding comprehensive virtual examinations for otolaryngology to fully embrace this technology.
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Affiliation(s)
- Jason F Ohlstein
- Department of Otolaryngology - Head and Neck Surgery, St. Luke's University Hospital, Bethlehem, USA.,Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
| | - Omar G Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
| | - Jordan Garner
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
| | - Masayoshi Takashima
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
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23
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Al-Hazmi AM, Sheerah HA, Arafa A. Perspectives on Telemedicine during the Era of COVID-19; What Can Saudi Arabia Do? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10617. [PMID: 34682363 PMCID: PMC8535869 DOI: 10.3390/ijerph182010617] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has represented a challenge to medical practice in Saudi Arabia and worldwide. In contrary to the increasing numbers of COVID-19 patients, there was a limitation in the capacity of medical practices and access to healthcare. A growing body of evidence from healthcare settings in Saudi Arabia and worldwide has suggested a possible role for telemedicine in responding to this evolving need. Telemedicine can be used for triage, direct care, follow-up, and consultation. It could be delivered through synchronous, asynchronous, and mixed approaches. While telemedicine has several advantages, such as accessibility and cost-effectiveness, its diagnostic reliability should be further investigated. The Saudi Vision (2030) has drawn up a roadmap to invest in digital healthcare during the coming decade; however, some barriers related to using telemedicine in Saudi healthcare settings, including cultural issues and technical difficulties, should be openly discussed. In addition, before putting telemedicine in practice on a wide scale in Saudi Arabia, more efforts should be carried out to issue updated legislation and regulations, discuss and respond to ethical concerns, and ensure data security.
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Affiliation(s)
- Ali Mohsen Al-Hazmi
- Health Promotion and Health Education Research Chair, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.M.A.-H.); (A.A.)
- Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Haytham A. Sheerah
- Health Promotion and Health Education Research Chair, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.M.A.-H.); (A.A.)
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Ahmed Arafa
- Health Promotion and Health Education Research Chair, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.M.A.-H.); (A.A.)
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
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24
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Bašković M. The impact of telemedicine on the quality and satisfaction with the health care provided during the COVID-19 pandemic in the field of pediatrics with special reference to the surgical professions. POLISH JOURNAL OF SURGERY 2021; 93:53-60. [DOI: 10.5604/01.3001.0015.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The COVID-19 pandemic has forced healthcare systems around the world to adopt telemedicine at an unprecedented rate.
Visits to telemedicine have increased to provide access and maintain continuity of care. Internet access has almost become
a necessity, and new technologies allow for the easy flow of data from patient to doctor and vice versa. Doctors of all specialties
were forced to adapt to the pandemic and emerging conditions. The provision of surgical services and the learning ability of
surgeons are particularly disrupted, and the pediatric surgical community is not exempt. During the pandemic, telemedicine
proved to be a viable and safe technique for providing health services. In an environment of a health system that is constantly
facing a shortage of resources, effective telemedicine placement can come with a high benefit-cost ratio and quality of care,
while ensuring patient satisfaction.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Croatia
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25
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Choi JS, Yin V, Wu F, Bhatt NK, O'Dell K, Johns M. Utility of Telemedicine for Diagnosis and Management of Laryngology-Related Complaints during COVID-19. Laryngoscope 2021; 132:831-837. [PMID: 34403152 PMCID: PMC8441886 DOI: 10.1002/lary.29838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022]
Abstract
Objectives/Hypothesis To investigate the concordance in diagnosis and management between initial telemedicine visits and subsequent in‐person visits with laryngoscopy for laryngology‐related complaints during COVID‐19. Study Design Retrospective cohort study. Methods Patients who presented to a tertiary care center with laryngology‐related complaints (voice, swallowing, airway, general throat complaints and others) and completed initial telemedicine visits and subsequent in‐person visits with laryngoscopy between March and October 2020 were included (n = 250). Preliminary diagnoses and managements provided during initial telemedicine visits were compared with the diagnoses and managements during subsequent in‐person visits with laryngoscopy. Multivariable logistic regression analysis was performed to compare concordance rates in diagnosis and management by chief complaint categories after adjusting for relevant demographic and clinical factors. Results Overall concordance rates in diagnosis and management between the initial telemedicine visit and subsequent laryngoscopy exam were 86.1% and 93.7%, respectively. Mean (standard deviation) days until laryngoscopy from the initial visit were 21.2 (23.0). Concordance rates were not associated with patient's age, gender, preferred language, provider, telemedicine visit duration, or days until laryngoscopy. Management concordance rate was relatively lower among patients with general throat complaints in comparison with voice‐related complaints (odds ratio: 0.27; 95% confidence interval: 0.08–0.90). Management changes after laryngoscopy included need for further imaging, procedures, voice therapy, and referral to other specialists. Conclusion Concordance rates in diagnosis and management remained high between the initial telemedicine visit and subsequent in‐person visit with laryngoscopy for new patients presenting with laryngology‐related complaints during the COVID‐19 pandemic. While laryngoscopy is still essential to confirm diagnosis and provide appropriate management, telemedicine may be a feasible alternative to provide suitable empiric therapy until laryngoscopy can be safely performed. Level of Evidence 4 Laryngoscope, 132:831–837, 2022
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Affiliation(s)
- Janet S Choi
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Victoria Yin
- XXX, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Franklin Wu
- XXX, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Neel K Bhatt
- Department of Otolaryngology - Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Karla O'Dell
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Michael Johns
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
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26
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Su-Velez BM, Khoury H, Azar SS, Shapiro NL, Bhattacharyya N. Barriers to Receiving Necessary Hearing Care Among US Children. Otolaryngol Head Neck Surg 2021; 166:1085-1091. [PMID: 34311611 DOI: 10.1177/01945998211032113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aim to clarify the national scope of unmet pediatric hearing care needs and identify specific barriers to hearing care. STUDY DESIGN Cross-sectional study of a nationally representative data set. SETTING This study is based on the combined 2016 and 2017 National Survey of Children's Health. This survey covers the physical and emotional health, access to care, and social context of US children and adolescents aged 0 to 17 years. METHODS Analysis of parent-reported responses of children's hearing status, access to care, and perceived barriers. RESULTS Overall, 0.3% (n = 206,200) of US children surveyed reported needing hearing care, which was not received. A further 1.3% (n = 934,000) reported deafness or problems with hearing, and of these, 6.4% (n = 60,000) reported not receiving necessary hearing care. Rates of insurance coverage between children with deafness/hearing problems and the general population were similar (91.7% vs 93.9%); however, deaf or hard-of-hearing children with unmet hearing care needs were more likely to be from non-White backgrounds (P = .009) and to lack health insurance coverage (P = .001). Rates of unfulfilled hearing care by reason were as follows: 57.5% without eligibility for the service, 45.4% reporting the service was not available in their area, 53.7% with difficulty obtaining an appointment, and 53.5% reporting issues with cost. CONCLUSION Over 200,000 children annually do not receive necessary hearing-related care despite high rates of insurance coverage, and nearly 60,000 of these children are deaf or hard of hearing. Cost, eligibility for and distribution of services, and timely appointments are the primary barriers to hearing health care.
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Affiliation(s)
- Brooke M Su-Velez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Habib Khoury
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Nina L Shapiro
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye & Ear and Harvard Medical School, Boston, Massachusetts, USA
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27
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Bain JM, Dyer CA, Galvin M, Goldman S, Selman J, Silver WG, Tom SE. How Providers in Child Neurology Transitioned to Telehealth During COVID-19 Pandemic. Child Neurol Open 2021; 8:2329048X211022976. [PMID: 34350304 PMCID: PMC8293845 DOI: 10.1177/2329048x211022976] [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: 02/28/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022] Open
Abstract
To understand child neurology care practices in telehealth (TH), we conducted an online survey interested in identifying which patients should be triaged for in-person evaluations in lieu of telehealth management. We also sought to identify provider and patient/parent limitations of the TH experience. One hundred fourteen clinicians completed the online survey. The majority of child neurologists transitioned within 3 weeks of the pandemic onset and found it inappropriate to evaluate a child under 1 year of age via TH. We identified specific disorders considered inappropriate for initial evaluation via TH, including neuromuscular disease, neuropathy, weakness, autoimmune disease and autism spectrum disorders. Patient and parent technical and economic issues are significant limitations of TH. We suggest quality improvement measures to provide additional training, focusing on particular disorders and increased access for those patients currently excluded from or limited in using or accessing TH.
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Affiliation(s)
- Jennifer M Bain
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, NY, USA.,New York Presbyterian, Morgan Stanley Children's Hospital, NY, USA
| | - Codi-Ann Dyer
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, NY, USA.,New York Presbyterian, Morgan Stanley Children's Hospital, NY, USA
| | - Megan Galvin
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, NY, USA.,New York Presbyterian, Morgan Stanley Children's Hospital, NY, USA
| | - Sylvie Goldman
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, NY, USA.,New York Presbyterian, Morgan Stanley Children's Hospital, NY, USA.,Department of Neurology, G.H. Sergievsky Center, Columbia University Irving Medical Center, NY, USA
| | - Jay Selman
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, NY, USA.,New York Presbyterian, Morgan Stanley Children's Hospital, NY, USA
| | - Wendy G Silver
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, NY, USA.,New York Presbyterian, Morgan Stanley Children's Hospital, NY, USA
| | - Sarah E Tom
- Division of Neurology Clinical Outcomes Research and Population Science, Department of Neurology, G.H. Sergievsky Center, Columbia University Irving Medical Center, NY, USA.,Department of Epidemiology, Columbia University Irving Medical Center, NY, USA
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28
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Nguyen OT, Watson AK, Motwani K, Warpinski C, McDilda K, Leon C, Khanna N, Nall RW, Turner K. Patient-Level Factors Associated with Utilization of Telemedicine Services from a Free Clinic During COVID-19. Telemed J E Health 2021; 28:526-534. [PMID: 34255572 DOI: 10.1089/tmj.2021.0102] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Disparities in telemedicine use by race, age, and income have been consistently documented. To date, research has focused on telemedicine use among patients with adequate insurance coverage. To address this gap, this study identifies patient-level factors associated with telemedicine use during the coronavirus (COVID-19) pandemic among one free clinic network's patients who are underinsured or uninsured. Materials and Methods: Electronic health record data were reviewed for patient-level data on patients seen from March 2020 to September 2020. Patients were grouped by telemedicine use history. We controlled for sociodemographic factors (e.g., age, race/ethnicity) and comorbidities. Logistic regression analyses were conducted. Results: Across 198 adult patients, 56.6% received telemedicine care. Of these, 99.1% elected for audio-only telemedicine instead of video telemedicine. Telemedicine use was more likely among those living within 15 miles of their clinic (adjusted odds ratio [aOR] = 4.43, 95% confidence interval [CI] 1.70-11.53). It was less likely to be used by older patients (aOR = 0.97, 95% CI 0.94-1.00), patients of male sex (aOR = 0.85, 95% CI 0.18-0.92), and those establishing care as a new patient (aOR = 0.01, 95% CI 0.00-0.07). Conclusion: The moderate usage of telemedicine suggests that its implementation in free clinics may be feasible. Solutions specific to patients with smartphone-only internet access are needed to improve the use of video telemedicine as smartphone-specific factors (e.g., data use limits) may influence the ability for underserved patients to receive video telemedicine.
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Affiliation(s)
- Oliver T Nguyen
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Amelia K Watson
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kartik Motwani
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Chloe Warpinski
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA
| | - Katelin McDilda
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Carlos Leon
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Neel Khanna
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ryan W Nall
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Division of General Internal Medicine, University of Florida, Gainesville, Florida, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
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29
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Barie PS, Ho VP, Hunter CJ, Kaufman EJ, Narayan M, Pieracci FM, Schubl SD, Heffernan DS, Huston JM. Surgical Infection Society Guidance for Restoration of Surgical Services during the Coronavirus Disease-2019 Pandemic. Surg Infect (Larchmt) 2021; 22:818-827. [PMID: 33635145 DOI: 10.1089/sur.2020.421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: As the coronavirus disease-2019 (COVID-19) pandemic continues globally, high numbers of new infections are developing nationwide, particularly in the U.S. Midwest and along both the Atlantic and Pacific coasts. The need to accommodate growing numbers of hospitalized patients has led facilities in affected areas to suspend anew or curtail normal hospital activities, including elective surgery, even as earlier-affected areas normalized surgical services. Backlogged surgical cases now number in the tens of millions globally. Facilities will be hard-pressed to address these backlogs, even absent the recrudescence of COVID-19. This document provides guidance for the safe and effective resumption of surgical services as circumstances permit. Methods: Review and synthesis of pertinent international peer-reviewed literature, with integration of expert opinion. Results: The "second-wave" of serious infections is placing the healthcare system under renewed stress. Surgical teams likely will encounter persons harboring the virus, whether symptomatic or not. Continued vigilance and protection of patients and staff remain paramount. Reviewed are the impact of COVID-19 on the surgical workforce, considerations for operating on a COVID-19 patient and the outcomes of such operations, the size and nature of the surgical backlog, and the logistics of resumption, including organizational considerations, patient and staff safety, preparation of the surgical candidate, and the role of enhanced recovery programs to reduce morbidity, length of stay, and cost by rational, equitable resource utilization. Conclusions: Resumption of surgical services requires institutional commitment (including teams of surgeons, anesthesiologists, nurses, pharmacists, therapists, dieticians, and administrators). Structured protocols and equitable implementation programs, and iterative audit, planning, and integration will improve outcomes, enhance safety, preserve resources, and reduce cost, all of which will contribute to safe and successful reduction of the surgical backlog.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vanessa P Ho
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Catherine J Hunter
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Elinore J Kaufman
- Department of Surgery, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mayur Narayan
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Fredric M Pieracci
- Department of Surgery, DenverHealth Medical Center, University of Colorado Anschutz School of Medicine, Denver, Colorado, USA
| | - Sebastian D Schubl
- Department of Surgery, University of California-Irvine, Orange, California, USA
| | - Daithi S Heffernan
- Department of Surgery, Providence Veterans Affairs Medical Center, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared M Huston
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.,Department of Science Education, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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30
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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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