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Hogue GD, Liu DS, Kaushal SG, Tavabi N, Feldman L, Stracciolini A, Shore B, Hedequist D, Bae D, Meehan W, Kim YJ, Kocher M, Murray MM, Kiapour AM. Telehealth Potential in Pediatric Orthopaedics and Sports Medicine Care is Comparable to In-Person Care But Disparities Remain. J Pediatr Orthop 2024; 44:379-385. [PMID: 38512171 DOI: 10.1097/bpo.0000000000002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Understanding the challenges and potential of telehealth visits (THVs) in a large population can inform future practice and policy discussion for pediatric orthopaedic and sports medicine (OSM) care. We comprehensively assess telehealth challenges and potential in a large pediatric OSM population based on access, visit completion, patient satisfaction, and technological challenges. METHODS Demographics, address, insurance, visit information, patient feedback, experience with video visits, and technical challenges of all 2019 to 2020 visits at our hospital were assessed (3,278,006 visits). We evaluated the differences in rate of telehealth utilization, rate of patient adherence, disparities in care access and patient satisfaction, and technological issues. RESULTS Compared with in-person prepandemic visits, THVs had lower ratios of non-White patients (by 5.8%; P <0.001), Hispanic patients (by 2.8%; P <0.001) and patients with public insurance (by 1.8%; P <0.001), and a higher mean distance between the patient's residence and clinic (by 18.8 miles; P <0.001). There were minimal differences in median household income (average $2297 less in THV; P <0.001) and social vulnerability index (average 0.01 points lower in THV; P <0.001) between groups. THVs had comparable patient satisfaction to in-person visits. Non-White patients, Hispanics, and those with public insurance had lower ratings for both in-person visits and THVs and had more technical difficulties during their THV. CONCLUSIONS Telehealth is a viable method of care for a range of pediatric OSM conditions, providing a similar quality of care as in-person visits with a greater geographic reach. However, in its current format, reduced disparities were not observed in pediatric OSM THVs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Grant D Hogue
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Bajwa NM, Perron NJ, Braillard O, Achab S, Hudelson P, Dao MD, Lüchinger R, Mazouri-Karker S. Has telemedicine come to fruition? Parents' and pediatricians' perceptions and preferences regarding telemedicine. Pediatr Res 2024:10.1038/s41390-024-03172-w. [PMID: 38555380 DOI: 10.1038/s41390-024-03172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Telemedicine has increasingly become a viable option for patient care and may increase access to care. The aim of our study was to evaluate both parent and pediatrician perceptions, preferences, and acceptability regarding the use of different telemedicine modalities. METHODS We conducted a cross-sectional survey of both parents and pediatricians in Geneva, Switzerland in 2021. The questionnaire focused on digital literacy, preferences, acceptability, advantages, and disadvantages regarding telemedicine (phone, email, video, and instant message). Descriptive statistics and comparisons of preferences and perceptions (Pearson Chi2 and logistic regression) were performed. RESULTS Two hundred and twenty-two parents and 45 pediatricians participated. After face-to-face consultations, parents and pediatricians preferred the phone for simple medical advice, discussion of parameters, acute or chronic problems, and psychological support. Email was preferred for communication of results and prescription renewal. Main reasons for using telemedicine were avoiding travel and saving time. Disadvantages were lack of physical examination, technical problems, and unsuitability of the reason for consultation. CONCLUSIONS Understanding the factors that influence acceptance and satisfaction with telemedicine is vital for its successful implementation. Convenience, quality of care, trust, strong pediatrician-parent relationships, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping parent and pediatrician attitudes toward telemedicine. IMPACT The COVID-19 pandemic spurred the expansion of the use of telemedicine in pediatric care. Few studies have addressed parent and pediatrician perceptions and preferences regarding telemedicine. Both parents and pediatricians consider certain telemedicine modalities (phone, email, video, and instant message) pertinent in only specific clinical situations. Advantages of telemedicine outweigh disadvantages with parents and pediatricians appreciating the increased access to care, time savings, and avoiding transport. However, the lack of a physical examination remains a significant disadvantage. Convenience, quality of care, trust, strong pediatrician-parent relationship, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping attitudes towards telemedicine.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
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Burns SK, Krishnamurti T, Doan TT, Hanmer J, Hoberman A, Kahn JM, Schweiberger K, Ray KN. Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study. JMIR Pediatr Parent 2024; 7:e49170. [PMID: 38227360 PMCID: PMC10828946 DOI: 10.2196/49170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). OBJECTIVE This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. METHODS We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. RESULTS Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). CONCLUSIONS In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.
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Affiliation(s)
- Sarah K Burns
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Department of Medicine, University Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Janel Hanmer
- Department of Medicine, University Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jeremy M Kahn
- Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Kassa AM, Nyström N, Waldenvik K, Engstrand Lilja H. Experiences and satisfaction of video follow up of children with paediatric gastrointestinal conditions linking tertiary centre with guardians and clinicians at the local hospital: a cross-sectional study. BMC Pediatr 2024; 24:6. [PMID: 38172717 PMCID: PMC10763293 DOI: 10.1186/s12887-023-04475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Children with complicated gastrointestinal conditions are dependent on follow up by tertiary care specialists throughout childhood to prevent and treat complications. In Sweden, paediatric surgical- and intestinal rehabilitation centres are centralised which means that many patients and guardians have to travel long distances to access tertiary referral centres. Our tertiary referral centre has developed a model of shared care with video conferences for follow up with our centre and the patient and guardians attending together with the responsible professionals at the local hospital. This study aimed to investigate the experiences and satisfaction with video follow-up visits (VFV) between a tertiary referral centre and guardians and clinicians at their local hospital. METHODS Eligible participants were families with children with oesophageal atresia, intestinal failure and intestinal motility disorders and their local clinicians attending VFV with our tertiary referral centre from 2015 to 2020. Questionnaires included fixed-response alternatives, a 6-point Likert scale and open questions. RESULTS Fifty-seven out of 102 families (56%) and 19 out of 27 local clinicians (70%) responded the questionnaires. In 68% of the VFV, two guardians attended compared to 35% in the physical visits. Of the guardians attending VFV, 82% lost ≤ half a working day and 91% attending physical visits lost ≥ one full working day. Median distance to the tertiary referral centre was 267 km and attending VFV avoided emissions of 7.2 metric tonnes of CO2. Of the guardians, 90% and of the clinicians 95% were satisfied with VFV. Advantages were avoidance of travelling and the participants shared the same information. CONCLUSIONS VFV is an appropriate alternative to physical visits with a high grade of satisfaction among the guardians and clinicians. VFV was time-saving for the families and reduced CO2 emissions.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Paediatric Surgery unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden.
| | - Niklas Nyström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Paediatric gastroenterology unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden
| | - Kajsa Waldenvik
- Paediatric gastroenterology unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden
| | - Helene Engstrand Lilja
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Paediatric Surgery unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden
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Reilly K, Walters J, Xu Y, Burkhardt MC. Seventy-Two-Hour Reutilization After Telemedicine Visits in Academic Pediatric Primary Care. Clin Pediatr (Phila) 2023; 62:1537-1542. [PMID: 36995024 DOI: 10.1177/00099228231165633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Telemedicine has expanded due to the COVID-19 pandemic. However, the health care usage after telemedicine visits compared with similar in-person visits is not known. This study compared the 72-hour health care reutilization after telemedicine visits and in-person acute encounters in a pediatric primary care office. A retrospective cohort analysis was performed in a single quaternary pediatric health care system between March 1, 2020, and November 30, 2020. Reutilization information was collected for 72 hours following the index visit and included subsequent encounters within the health care system. The 72-hour reutilization rate for telemedicine encounters was 4.1% compared with 3.9% for in-person acute visits. Of revisits, patients who had a telemedicine visit most often sought additional care at the medical home, and patients with an in-person visit most often sought additional care to the emergency department or urgent care. Telemedicine does not result in higher total health care reutilization.
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Affiliation(s)
| | - Jessica Walters
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mary Carol Burkhardt
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Bajgain B, Rabi S, Ahmed S, Kiryanova V, Fairie P, Santana MJ. Patient-reported experiences and outcomes of virtual care during COVID-19: a systematic review. J Patient Rep Outcomes 2023; 7:126. [PMID: 38038800 PMCID: PMC10692047 DOI: 10.1186/s41687-023-00659-8] [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] [Received: 12/26/2022] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION The onset of COVID-19 has caused an international upheaval of traditional in-person approaches to care delivery. Rapid system-level transitions to virtual care provision restrict the ability of healthcare professionals to evaluate care quality from the patient's perspective. This poses challenges to ensuring that patient-centered care is upheld within virtual environments. To address this, the study's objective was to review how virtual care has impacted patient experiences and outcomes during COVID-19, through the use of patient-reported experience and outcome measures (PREMs and PROMs), respectively. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to evaluate patient responsiveness to virtual care during COVID-19. Using an exhaustive search strategy, relevant peer-reviewed articles published between January 2020 and 2022 were pulled from MEDLINE, CINAHL, EMBASE, and PsychInfo databases. Study quality was independently assessed by two reviewers using the Mixed Methods Appraisal Tool. A patient partner was consulted throughout the study to provide feedback and co-conduct the review. RESULTS After removing duplicates, 6048 articles underwent title and abstract review, from which 644 studies were included in the full-text review stage. Following this, 102 articles were included in the study. Studies were published in 20 different countries, were predominantly cross-sectional, and reported on the delivery of virtual care in specialized adult outpatient settings. This review identified 29 validated PREMs and 43 PROMs. Several advantages to virtual care were identified, with patients citing greater convenience, (such as saving travel time and cost, less waiting experienced to see care providers) and increased protection from viral spread. Some studies also reported challenges patients and caregivers faced with virtual care, including feeling rushed during the virtual care appointment, lack of physical contact or examination presenting barriers, difficulty with communicating symptoms, and technology issues. CONCLUSION This review provides supportive evidence of virtual care experiences during the COVID-19 pandemic from patient and caregiver perspectives. This research provides a comprehensive overview of what patient-reported measures can be used to record virtual care quality amid and following the pandemic. Further research into healthcare professionals' perspectives would offer a supportive lens toward a strong person-centered healthcare system.
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Affiliation(s)
- Bishnu Bajgain
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sarah Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sadia Ahmed
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada.
| | - Veronika Kiryanova
- Patient and Community Engagement Research, University of Calgary, Calgary, AB, Canada
| | - Paul Fairie
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada
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Cockrell H, Wayne D, Wandell G, Wang X, Greenberg SLM, Kieran K, Dick A, Bonilla-Velez J. Understanding Hispanic Patient Satisfaction with Telehealth During COVID-19. J Pediatr Surg 2023; 58:1783-1788. [PMID: 36635160 PMCID: PMC9771577 DOI: 10.1016/j.jpedsurg.2022.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and satisfaction with pediatric surgical telemedicine among Hispanic patients. METHODS We conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling. RESULTS The pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61-0.90), listening (IRR 0.76, 95% CI: 0.63-0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60-0.89). There were no differences in FES responses based on insurance status or degree of medical complexity. CONCLUSIONS Telehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hannah Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - David Wayne
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Grace Wandell
- Department of Otolaryngology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Xing Wang
- Children's Core for Biomedical Statistics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle WA 98105, USA
| | - Sarah L M Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - André Dick
- Division of Transplant Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Juliana Bonilla-Velez
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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Boggs KM, Glew D, Rahman KN, Gao J, Boyle TP, Samuels-Kalow ME, Sullivan AF, Zachrison KS, Camargo CA. Pediatric Telehealth Use in U.S. Emergency Departments in 2019. Telemed J E Health 2023; 29:551-559. [PMID: 36103263 PMCID: PMC10079250 DOI: 10.1089/tmj.2022.0310] [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] [Received: 04/13/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives: Little is known about the recent usage of pediatric telehealth across all emergency departments (EDs) in the United States. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory-USA survey characterized all U.S. EDs open in 2019. Among EDs reporting receipt of pediatric telehealth services, we selected a random sample (n = 130) for a second survey on pediatric telehealth usage (2019 ED Pediatric Telehealth Survey). We also recontacted a random sample of EDs that responded to a prior, similar 2017 ED Pediatric Telehealth Survey (n = 107), for a total of 237 EDs in the 2019 ED Pediatric Telehealth Survey sample. Results: Overall, 193 (81%) of the 237 EDs responded to the 2019 Pediatric Telehealth Survey. There were 149 responding EDs that confirmed pediatric telehealth receipt in 2019. Among these, few reported ever having a pediatric emergency medicine (PEM) physician (10%) or pediatrician (9%) available for emergency care. Although 96% of EDs reported availability of pediatric telehealth services 24 h per day, 7 days per week, the majority (60%) reported using services less than once per month and 20% reported using services every 3-4 weeks. EDs most frequently used pediatric telehealth to assist with placement and transfer coordination (91%). Conclusions: Most EDs receiving pediatric telehealth in 2019 had no PEM physician or pediatrician available. Most EDs used pediatric telehealth services infrequently. Understanding barriers to assimilation of telehealth once adopted may be important to enable improved access to pediatric emergency care expertise.
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Affiliation(s)
- Krislyn M. Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorsey Glew
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kashfia N. Rahman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tehnaz P. Boyle
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kodjebacheva GD, Culinski T, Kawser B, Coffer K. Satisfaction with telehealth compared to non-telehealth services among pediatric patients and their caregivers: A systematic review of the literature. JMIR Pediatr Parent 2023; 6:e41554. [PMID: 37000504 PMCID: PMC10176140 DOI: 10.2196/41554] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/10/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Telehealth is the use of technology to deliver healthcare in a virtual format. The COVID-19 pandemic prompted an increase in the use of telehealth. OBJECTIVE To review satisfaction with pediatric care only in studies that have at least one group of pediatric patients and/or their caregivers receiving telehealth during the COVID-19 pandemic and at least one comparison group of those receiving non-telehealth services. METHODS We searched for peer-reviewed studies published in English that compared satisfaction with pediatric care between pediatric patients and/or their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving non-telehealth services. Because of stay-at-home orders, studies with comparison groups for non-telehealth services that took place either before or during the pandemic were eligible. We conducted the search on January 5, 2023, in the PubMed, EMBASE, CINAHL, and PsycInfo databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers independently screened titles and abstracts prior to reviewing the full-text of remaining articles. The following information from each eligible study was extracted: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. RESULTS All eligible 14 studies assessed satisfaction among caregivers and/or pediatric patients participating in video and/or telephone visits during the COVID-19 pandemic compared to those having in-person appointments either prior to or during the pandemic. In 5 of the 14 studies, comparison non-telehealth services took place before the pandemic, and in the remaining 9 investigations, non-telehealth services took place during the pandemic. Thirteen studies were observational investigations with different designs and one study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 out of the 14 studies, satisfaction with telehealth services was higher compared to that during in-person visits. Reasons caregivers were satisfied with video visits were the ease of use and the reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider and technological challenges. Caregivers participating in telehealth expressed concerns about the lack of a physical examination. Those participating in non-telehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction among patients where adolescents completed their own surveys; a higher percentage of adolescents using telehealth reported effective communication with the provider compared to patients using in-person visits. CONCLUSIONS Telehealth services tended to receive more favorable or comparable satisfaction ratings than in-person visits in most studies. Needed improvements in telehealth included strategies to address technological challenges and develop better rapport between the patient/caregiver and medical provider. Interventions on the effectiveness of pediatric telehealth compared to pediatric non-telehealth services on improving satisfaction and health outcomes will be valuable. CLINICALTRIAL
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Affiliation(s)
- Gergana Damianova Kodjebacheva
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, US
- International Institute, University of Michigan, Ann Arbor, US
| | - Taylor Culinski
- Department of Behavioral Sciences, College of Arts and Sciences, University of Michigan-Flint, Fint, US
| | - Bushra Kawser
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, US
| | - Katelynn Coffer
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, US
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Schulson LB, Predmore Z, Sousa JL, McCullough CM, Magit A, Lerner C, Chinnock R, Barkley S, Marcin JP, McGuire T, Browne MA, Uscher-Pines L. Perceptions of Pediatric Endocrinologists and Neurologists on the Drivers of Telehealth Use. Acad Pediatr 2023; 23:271-278. [PMID: 35940573 DOI: 10.1016/j.acap.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the extent and drivers of telehealth use variation across clinicians within the same pediatric subspecialties. METHODS In this mixed methods study, 8 pediatric medical groups in California shared data for eleven subspecialties. We calculated the proportion of total visits delivered via telehealth by medical group for each subspecialty and identified the 8 most common International Classification of Diseases 10 diagnoses for telehealth and in-person visits in endocrinology and neurology. We conducted semi-structured interviews with 32 pediatric endocrinologists and neurologists and applied a positive deviance approach comparing high versus low utilizers to identify factors that influenced their level of telehealth use. RESULTS In 2019, medical groups that submitted quantitative data conducted 1.8 million visits with 549,306 unique pediatric patients. For 3 subspecialties, there was relatively little variation in telehealth use across medical groups: urology (mean: 16.5%, range: 9%-23%), orthopedics (mean: 7.2%, range: 2%-14%), and cardiology (mean: 11.2%, range: 2%-24%). The remaining subspecialties, including neurology (mean: 58.6%, range: 8%-93%) and endocrinology (mean: 49.5%, range: 24%-92%), exhibited higher levels of variation. For both neurology and endocrinology, the top diagnoses treated in-person were similar to those treated via telehealth. There was limited consensus on which clinical conditions were appropriate for telehealth. High telehealth utilizers were more comfortable conducting telehealth visits for new patients and often worked in practices with innovations to support telehealth. CONCLUSIONS Clinicians perceive that telehealth may be appropriate for a range of clinical conditions when the right supports are available.
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Affiliation(s)
- Lucy B Schulson
- RAND Corporation, Health Care (LB Schulson, Z Predmore, and JL Sousa), Boston, Mass; General Internal Medicine, Boston University School of Medicine (LB Schulson), Boston, Mass.
| | - Zachary Predmore
- RAND Corporation, Health Care (LB Schulson, Z Predmore, and JL Sousa), Boston, Mass
| | - Jessica L Sousa
- RAND Corporation, Health Care (LB Schulson, Z Predmore, and JL Sousa), Boston, Mass
| | | | - Anthony Magit
- UC San Diego Department of Otolaryngology, Rady Children's Hospital San Diego (A Magit), San Diego, Calif
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Lerner), Los Angeles, Calif
| | - Richard Chinnock
- Department of Pediatrics, Loma Linda University Health (R Chinnock), Loma Linda, Calif
| | - Steven Barkley
- Department of Neonatology, Cottage Children's Medical Center (S Barkley), Santa Barbara, Calif
| | - James P Marcin
- Pediatric Intensive Care, UC Davis Children's Hospital (JP Marcin), Sacramento, Calif
| | - Troy McGuire
- Division of General Pediatrics, Children's Hospital Los Angeles (T McGuire), Los Angeles, Calif
| | - Michael-Anne Browne
- Department of Pediatrics, Stanford Children's Health (M-A Browne), Palo Alto, Calif
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11
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Factors Impacting Patient Perspectives on Telehealth and Remote Healthcare during COVID-19: A Mixed Methods Study. TELEMATICS AND INFORMATICS REPORTS 2022. [PMCID: PMC9712143 DOI: 10.1016/j.teler.2022.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A rapid transformation to telehealth was a necessary precaution during the pandemic. This research sought a better understanding of factors impacting patients’ decisions on choosing telehealth. A mixed methods study was conducted with a sample of 276 patients. An online survey was used to collect qualitative and quantitative data. This study found that technical issues were the most significant factor preventing patients from using telehealth, among other factors such as waiting time and privacy concern. The results inform policy-makers and healthcare providers on how to optimize telehealth. The limitations of this study and future research directions are also discussed.
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12
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Southgate G, Yassaee AA, Harmer MJ, Livesey H, Pryde K, Roland D. Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review. J Med Internet Res 2022; 24:e38267. [DOI: 10.2196/38267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers.
Objective
This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings.
Methods
This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness.
Results
Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs.
Conclusions
There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.
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13
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Patient and Clinician Attitudes Toward Telemedicine for Allergy and Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2493-2499. [PMID: 35618214 PMCID: PMC9124630 DOI: 10.1016/j.jaip.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 01/02/2023]
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14
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Wagner J, Cummings C, Feinn R, Kanc K, Kos M. Impact of COVID on Professionals Addressing Psychosocial Needs of People With Diabetes: An International Survey. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:828719. [PMID: 36992771 PMCID: PMC10012139 DOI: 10.3389/fcdhc.2022.828719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
We investigated how COVID-19 has disrupted the work of health professionals who address behavioral and psychosocial needs of people with diabetes (PWD). English language emails were sent to members of five organizations that address psychosocial aspects of diabetes, inviting them to complete a one-time, anonymous, online survey. On a scale from 1=no problem, to 5=serious problem, respondents reported problems with the healthcare system, their workplaces, technology, and concerns about the PWD with whom they work. Respondents (n=123) were from 27 countries, primarily in Europe and North America. The typical respondent was a woman, aged 31-40 years, who worked in an urban hospital in medicine or psychology/psychotherapy. Most judged that the COVID lockdown in their region was moderate or severe. Over half felt moderate to serious levels of stress/burnout or mental health issues. Most participants reported moderate to severe problems due to the lack of clear public health guidelines, concerns with COVID safety of themselves, PWD, and staff, and a lack of access or knowledge on the part of PWD to use diabetes technology and telemedicine. In addition, most participants reported concerns with the psychosocial functioning of PWD during the pandemic. Overall, the pattern of findings reveals a high level of detrimental impact, some of which may be ameliorated with changes in policy and additional services for both health professionals and the PWD with whom they work. Concerns about PWD during the pandemic must go beyond their medical management and also consider the health professionals who provide them with behavioral and psychosocial support.
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Affiliation(s)
- Julie Wagner
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut, Farmington, CT, United States
- Department of Psychiatry, School of Medicine, University of Connecticut, Farmington, CT, United States
- *Correspondence: Julie Wagner,
| | - Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Karin Kanc
- Jazindiabetes, Private Diabetes Centre, Ljubljana, Slovenia
| | - Miha Kos
- Ustanova Hiša eksperimentov, Ljubljana, Slovenia
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15
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March CA, Muzumdar R, Libman I. How Do Virtual Visits Compare? Parent Satisfaction With Pediatric Diabetes Telehealth During the COVID-19 Pandemic. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:794493. [PMID: 36994343 PMCID: PMC10012131 DOI: 10.3389/fcdhc.2021.794493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022]
Abstract
BackgroundIn response to the COVID-19 pandemic, many countries relaxed restrictions on telemedicine, allowing for a robust transition to virtual visits for routine care. In response, centers rapidly instituted and scaled telemedicine for pediatric diabetes care. Despite numerous center reports on their experience, little is known about parent perspectives on the widespread increase of telemedicine for pediatric diabetes appointments.ObjectiveTo assess parent satisfaction with virtual care for pediatric diabetes during the COVID-19 pandemic.MethodsWe conducted an online, cross-sectional survey of parents of youth with diabetes who receive care at a large, academic diabetes center regarding their perspectives on newly introduced virtual appointments. Parents were surveyed at two time points during the pandemic using a validated scale which was adapted for diabetes. We explored demographic and clinical factors which may influence parental satisfaction.ResultsOverall, parents expressed high levels of satisfaction (>90%) with functional aspects of the visit, though only approximately half (56%) felt the visit was as good as an in-person encounter. Nearly three-quarters (74%) would consider using telemedicine again in the future. Prior use of telemedicine significantly influenced parent satisfaction, suggesting that parent preferences may play a role in continued use of telemedicine in the future. There was no difference in responses across the two timepoints, suggesting high satisfaction early in the pandemic which persisted.ConclusionsIf permissive policies for telemedicine continue, diabetes centers could adopt hybrid in-person and virtual care models, while considering various stakeholder perspectives (providers and patients) and equity in access to virtual care.
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16
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Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. SENSORS INTERNATIONAL 2021; 2:100117. [PMID: 34806053 PMCID: PMC8590973 DOI: 10.1016/j.sintl.2021.100117] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Ravi Pratap Singh
- Department of Industrial and Production Engineering, Dr B R Ambedkar National Institute of Technology, Jalandhar, Punjab, India
| | - Rajiv Suman
- Department of Industrial & Production Engineering, G.B. Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
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17
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Pooni R, Lee T. The Emerging Telehealth Landscape in Pediatric Rheumatology. Rheum Dis Clin North Am 2021; 48:259-270. [PMID: 34798951 DOI: 10.1016/j.rdc.2021.08.005] [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: 11/29/2022]
Abstract
This article provides an in-depth review of telemedicine and its use in pediatric rheumatology. Historical barriers to the use of telemedicine in pediatric chronic care are described, and recent policy changes that have supported the use of telemedicine are discussed. Future directions and suggestions for the evaluation of telemedicine in pediatric rheumatology care are provided with a special focus on clinical outcomes, its use in research, patient acceptability, and health equity.
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Affiliation(s)
- Rajdeep Pooni
- Division of Allergy, Immunology and Rheumatology, Department of Pediatric Rheumatology, Stanford Children's Health, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA.
| | - Tzielan Lee
- Division of Allergy, Immunology and Rheumatology, Department of Pediatric Rheumatology, Stanford Children's Health, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA
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18
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Dauletbaev N, Kuhn S, Holtz S, Waldmann S, Niekrenz L, Müller BS, Bellinghausen C, Dreher M, Rohde GGU, Vogelmeier C. Implementation and use of mHealth home telemonitoring in adults with acute COVID-19 infection: a scoping review protocol. BMJ Open 2021; 11:e053819. [PMID: 34580103 PMCID: PMC8478582 DOI: 10.1136/bmjopen-2021-053819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION mHealth refers to digital technologies that, via smartphones, mobile apps and specialised digital sensors, yield real-time assessments of patient's health status. In the context of the COVID-19 pandemic, these technologies enable remote patient monitoring, with the benefit of timely recognition of disease progression to convalescence, deterioration or postacute sequelae. This should enable appropriate medical interventions and facilitate recovery. Various barriers, both at patient and technology levels, have been reported, hindering implementation and use of mHealth telemonitoring. As systematised and synthesised evidence in this area is lacking, we developed this protocol for a scoping review on mHealth home telemonitoring of acute COVID-19. METHODS AND ANALYSIS We compiled a search strategy following the PICO (Population, Intervention, Comparator, Outcome) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for Scoping Reviews) guidelines. MEDLINE, Embase and Web of Science will be searched from 1 March 2020 to 31 August 2021. Following the title and abstract screening, we will identify, systematise and synthesise the available knowledge. Based on pilot searches, we preview three themes for descriptive evidence synthesis. The first theme relates to implementation and use of mHealth telemonitoring, including reported barriers. The second theme covers the interactions of the telemonitoring team within and between different levels of the healthcare system. The third theme addresses how this telemonitoring warrants the continuity of care, also during disease transition into deterioration or postacute sequelae. ETHICS AND DISSEMINATION The studied evidence is in the public domain, therefore, no specific ethics approval is required. Evidence dissemination will be via peer-reviewed publications, conference presentations and reports to the policy makers.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
- Department of Pediatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada
| | - Sebastian Kuhn
- Department of Digital Medicine, Bielefeld University Faculty of Medicine, Bielefeld, Germany
| | - Svea Holtz
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Susanne Waldmann
- Central Medical Library, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| | - Lukas Niekrenz
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Beate S Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Gernot G U Rohde
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Claus Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
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19
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Brown CL, Montez K, Amati JB, Simeonsson K, Townsend JD, Orr CJ, Palakshappa D. Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115734. [PMID: 34071783 PMCID: PMC8199093 DOI: 10.3390/ijerph18115734] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0–18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Correspondence: ; Tel.: +1-(336)-716-4987
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Jane Blakely Amati
- Department of Pediatrics, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA;
| | - Kristina Simeonsson
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA; (K.S.); (J.D.T.)
| | - John D. Townsend
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA; (K.S.); (J.D.T.)
| | - Colin J. Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Deepak Palakshappa
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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20
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Xie J, Prahalad P, Lee TC, Stevens LA, Meister KD. Pediatric Subspecialty Adoption of Telemedicine Amidst the COVID-19 Pandemic: An Early Descriptive Analysis. Front Pediatr 2021; 9:648631. [PMID: 33928058 PMCID: PMC8076568 DOI: 10.3389/fped.2021.648631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Telemedicine has rapidly expanded in many aspects of pediatric care as a result of the COVID-19 pandemic. However, little is known about what factors may make pediatric subspeciality care more apt to long-term adoption of telemedicine. To better delineate the potential patient, provider, and subspecialty factors which may influence subspecialty adoption of telemedicine, we reviewed our institutional experience. The top 36 pediatric subspecialties at Stanford Children's Health were classified into high telemedicine adopters, low telemedicine adopters, and telemedicine reverters. Distance from the patient's home, primary language, insurance type, institutional factors such as wait times, and subspecialty-specific clinical differences correlated with differing patterns of telemedicine adoption. With greater awareness of these factors, institutions and providers can better guide patients in determining which care may be best suited for telemedicine and develop sustainable long-term telemedicine programming.
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Affiliation(s)
- James Xie
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States.,Information Services Department, Stanford Children's Health, Stanford, CA, United States
| | - Priya Prahalad
- Information Services Department, Stanford Children's Health, Stanford, CA, United States.,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Tzielan C Lee
- Information Services Department, Stanford Children's Health, Stanford, CA, United States.,Division of Pediatric Rheumatology, Department of Pediatrics, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Lindsay A Stevens
- Information Services Department, Stanford Children's Health, Stanford, CA, United States.,Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Kara D Meister
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
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