1
|
Chilukuri N, Links AR, Prichett L, Tschudy M, Showell N, Polk S, Perrin EM, Hughes HK. Comparison of Telemedicine Usage at Two Distinct Medicaid-Focused Pediatric Clinics. Telemed J E Health 2024. [PMID: 38938205 DOI: 10.1089/tmj.2023.0707] [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: 06/29/2024] Open
Abstract
Objective: To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Methods: Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Results: Out of 17,142 total visits, 13% of encounters at Site A (n = 987) and 25% of encounters at Site B (n = 2,421) were conducted using telemedicine. Around 13.8% of well-child care (n = 1,515/10,997), 36.2% of mental health care (n = 572/1,581), and 25.0% of acute care/follow-up (n = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Conclusions: Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.
Collapse
Affiliation(s)
- Nymisha Chilukuri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Anne R Links
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Prichett
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Megan Tschudy
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nakiya Showell
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Polk
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eliana M Perrin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Helen K Hughes
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Hampton F, Larson J, Hobson A, Hughes D. The Role of Telemedicine in Rural Specialty Care: Priorities and Recommendations From Rural Primary Care Physicians. Kans J Med 2024; 17:6-10. [PMID: 38694180 PMCID: PMC11060778 DOI: 10.17161/kjm.vol17.21290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/23/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The study goal was to understand telemedicine's role in improving access to rural specialty care. Other outcomes included assessing specialty availability and frequency of referrals at rural sites. Methods This mixed methods study included surveys and semi-structured interviews of rural primary care physicians (PCPs). Survey data were analyzed with summary statistics and cross-tabulations. Interview transcripts were inductively thematically analyzed. Results Of the 19 PCPs who completed the survey, 37% agreed/strongly agreed current telemedicine practices connected patients to better specialty care; 90% agreed/strongly agreed it had such potential. Interviews revealed telemedicine could improve care when local specialists were unavailable and provided the most benefit in acute care settings or specialist follow-ups. Most survey respondents reported outreach specialists were highly effective in addressing rural specialty care needs. Respondents reported cardiology, general surgery, orthopedic surgery, ENT/otolaryngology, and dermatology as the most frequently referred-to specialties. In-person neurology, gastroenterology, and dermatology were unavailable in many communities. Respondents identified psychiatry as a high priority for telemedicine and discussed clinic-to-clinic visits to optimize telemedicine use. Conclusions The perceived discrepancy between the current and potential roles of telemedicine in rural specialty care suggests that telemedicine may not fully align with the needs of rural patients and could be optimized for rural practice settings. While local, in-person access to specialists remains a priority, telemedicine can reduce patient burdens and improve care when in-person specialists are unavailable. Telemedicine proponents can identify high-priority areas for implementation through quantitative assessment of specialty care utilization and access as reported by PCPs.
Collapse
Affiliation(s)
- Faith Hampton
- University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Jeremy Larson
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Alyssa Hobson
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Dorothy Hughes
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Population Health
| |
Collapse
|
3
|
Pamungkas DR, O'Sullivan B, McGrail M, Chater B. Tools, frameworks and resources to guide global action on strengthening rural health systems: a mapping review. Health Res Policy Syst 2023; 21:129. [PMID: 38049824 PMCID: PMC10694960 DOI: 10.1186/s12961-023-01078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action. OBJECTIVE This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building. METHODS This study collected peer-reviewed materials published in 15-year period (2005-2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems). RESULTS The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%). CONCLUSION This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening.
Collapse
Affiliation(s)
- Dewi Retno Pamungkas
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia.
| | - Belinda O'Sullivan
- Toowoomba Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD, Australia.
- Murray Primary Health Network, Bendigo, VIC, Australia.
| | - Matthew McGrail
- Rockhampton Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, QLD, Australia
| | - Bruce Chater
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia
| |
Collapse
|
4
|
Lucas R, Kahn N, Bocek K, Tordoff DM, Karrington B, Richardson LP, Sequeira GM. Telemedicine Utilization Among Transgender and Gender-Diverse Adolescents Before and After the COVID-19 Pandemic. Telemed J E Health 2023; 29:1304-1311. [PMID: 36791325 DOI: 10.1089/tmj.2022.0382] [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: 02/17/2023] Open
Abstract
Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.
Collapse
Affiliation(s)
- Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicole Kahn
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kevin Bocek
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Baer Karrington
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| |
Collapse
|
5
|
Anvari S, Neumark S, Jangra R, Sandre A, Pasumarthi K, Xenodemetropoulos T. Best Practices for the Provision of Virtual Care: A Systematic Review of Current Guidelines. Telemed J E Health 2023; 29:3-22. [PMID: 35532969 DOI: 10.1089/tmj.2022.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care. The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters. Methods: A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data were synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) tool was used to evaluate the quality of evidence. Results: A total of 60 guidelines for virtual care encounters were included; 52% of these were published in the context of the COVID-19 pandemic. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included guidelines, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. Thirty-one guidelines also provided guidance to patients or caregivers. Overall guideline quality was poor. Discussion: General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation before a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices and guidelines on patient attitudes and outcomes to further optimize the provision of virtual care for specific patient populations.
Collapse
Affiliation(s)
- Sama Anvari
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Samuel Neumark
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rhea Jangra
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anthony Sandre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Keerthana Pasumarthi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ted Xenodemetropoulos
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Joseph MM, Mahajan P, Snow SK, Ku BC, Saidinejad M. Optimizing Pediatric Patient Safety in the Emergency Care Setting. Pediatrics 2022; 150:189658. [PMID: 36189487 DOI: 10.1542/peds.2022-059674] [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] [Accepted: 08/26/2022] [Indexed: 02/25/2023] Open
Abstract
Patient safety is the foundation of high-quality health care and remains a critical priority for all clinicians caring for children. There are numerous aspects of pediatric care that increase the risk of patient harm, including but not limited to risk from medication errors attributable to weight-dependent dosing and need for appropriate equipment and training. Of note, the majority of children who are ill and injured are brought to community hospital emergency departments. It is, therefore, imperative that all emergency departments practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This technical report outlined the challenges and resources necessary to minimize pediatric medical errors and to provide safe medical care for children of all ages in emergency care settings.
Collapse
Affiliation(s)
- Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, University of Florida Health Sciences Center-Jacksonville, Jacksonville, Florida
| | - Prashant Mahajan
- Departments of Pediatrics and Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sally K Snow
- Independent Consultant in Pediatric Emergency and Trauma Nursing; Graham, Texas
| | - Brandon C Ku
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | | |
Collapse
|
7
|
Optimizing Pediatric Patient Safety in the Emergency Care Setting. Ann Emerg Med 2022; 80:e83-e92. [DOI: 10.1016/j.annemergmed.2022.08.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
|
8
|
Joseph MM, Mahajan P, Snow SK, Ku BC, Saidinejad M. Optimizing Pediatric Patient Safety in the Emergency Care Setting. Pediatrics 2022; 150:189657. [PMID: 36189490 DOI: 10.1542/peds.2022-059673] [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] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
This is a revision of the previous American Academy of Pediatrics policy statement titled "Patient Safety in the Emergency Care Setting," and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergency care setting. Caring for children in the emergency setting can be prone to medical errors because of a number of environmental and human factors. The emergency department (ED) has frequent workflow interruptions, multiple care transitions, and barriers to effective communication. In addition, the high volume of patients, high-decision density under time pressure, diagnostic uncertainty, and limited knowledge of patients' history and preexisting conditions make the safe care of critically ill and injured patients even more challenging. It is critical that all EDs, including general EDs who care for the majority of ill and injured children, understand the unique safety issues related to children. Furthermore, it is imperative that all EDs practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This policy statement outlines the recommendations necessary for EDs to minimize pediatric medical errors and to provide safe care for children of all ages.
Collapse
Affiliation(s)
- Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, University of Florida Health Sciences Center, Jacksonville, Jacksonville, Florida
| | - Prashant Mahajan
- Departments of Pediatrics and Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sally K Snow
- Independent Consultant in Pediatric Emergency and Trauma Nursing
| | - Brandon C Ku
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | |
Collapse
|
9
|
Joseph MM, Mahajan P, Snow SK, Ku BC, Saidinejad M. Optimizing Pediatric Patient Safety in the Emergency Care Setting. J Emerg Nurs 2022; 48:652-665. [DOI: 10.1016/j.jen.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 11/05/2022]
|
10
|
Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers. J Gen Intern Med 2022; 37:707-713. [PMID: 34919208 PMCID: PMC8680069 DOI: 10.1007/s11606-020-06395-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Care delivered using telemedicine has been steadily growing in the USA but represented a small fraction of overall visits before the COVID-19 pandemic as few clinicians had been providing care using telemedicine. Understanding how experienced clinicians have practiced telemedicine can help guide today's exponential adoption of telemedicine. OBJECTIVE The objective of this study was to explore barriers and facilitators to providing effective, high-quality urgent care using telemedicine ("tele-urgent care") from the perspective of clinicians experienced in telemedicine. APPROACH We conducted semi-structured interviews between July 2018 and March 2019 of clinicians who had been providing tele-urgent care services to patients as a part of their routine clinical practice. Themes were identified using content analysis with a constant comparative coding approach. KEY RESULTS Among the 20 clinicians interviewed, the majority were female (90%) and nurse practitioners (65%). We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. Communication and exam techniques from in-person encounters were adapted to tele-urgent care including active listening skills and teaching patients to conduct specific exam maneuvers virtually. The convenience of tele-urgent care should be preserved to support improvements in access to care. Finally, patients and clinicians occasionally had mismatched expectations about what could or would be provided during a tele-urgent care encounter. Managing the added tension that can occur during a telemedicine encounter was important. CONCLUSION As telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future.
Collapse
|
11
|
Van Cleave J, Stille C, Hall DE. Child Health, Vulnerability, and Complexity: Use of Telehealth to Enhance Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S34-S40. [PMID: 35248246 DOI: 10.1016/j.acap.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/14/2022]
Abstract
Telehealth, or the use of telecommunications technology and infrastructure to deliver health-related services and information that support patient care, has the potential to improve the quality of care, particularly deficiencies related to access and patient experience of care. Telehealth may also reduce disparities for children and youth with special health care needs (CYSHCN) with barriers to accessing in-person care, for example, those residing in rural areas and children with medical complexity who are particularly fragile. While important foundational work has been done to study telehealth's effectiveness and implementation, key gaps remain regarding its use for CYSHCN. The CYSHCNet national research agenda development process, described in a companion article, identified as key priority areas for future research telehealth as an innovative care delivery model for all CYSHCN and as a mechanism to address rural-urban disparities in health care access. Here, we review the current knowledge around telehealth, identify populations for whom telehealth could be especially beneficial, discuss the important gaps identified, and make recommendations for specific studies that will move the field forward. There are ample opportunities for telehealth to improve health and patient/family experience of care and quality of life for CYSHCN while requiring less time and resources from families accessing this care. Innovative research to inform best practices around incorporation and implementation of telehealth will improve its efficiency and effectiveness and achieve optimal outcomes.
Collapse
Affiliation(s)
- Jeanne Van Cleave
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado (J Van Cleave and C Stille), Aurora, Colo.
| | - Christopher Stille
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado (J Van Cleave and C Stille), Aurora, Colo
| | - David E Hall
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt (DE Hall), Nashville, Tenn
| |
Collapse
|
12
|
Olszewski C, Thomson S, Strauss L, Graham R, Ezzeddine M, Dodenhoff K, Ambrosini A, Smith LD, Silla L, Schreiber A, Caraci C, Guzik A, Strowd RE. Patient Experiences With Ambulatory Telehealth in Neurology: Results of a Mixed-Methods Study. Neurol Clin Pract 2022; 11:484-496. [PMID: 34992956 DOI: 10.1212/cpj.0000000000001072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/28/2021] [Indexed: 01/01/2023]
Abstract
Objective To assess patient experiences with rapid implementation of ambulatory telehealth during the coronavirus disease 2019 (COVID-19) pandemic. Methods A mixed-methods study was performed to characterize the patients' experience with neurology telehealth visits during the first 8 weeks of the COVID-19 response. Consecutive patients who completed a telehealth visit were contacted by telephone. Assenting patients completed a survey quantifying satisfaction with the visit followed by a semistructured telephone interview. Qualitative data were analyzed using the principles of thematic analysis. Results A total of 2,280 telehealth visits were performed, and 753 patients (33%) were reached for postvisit feedback. Of these, 47% of visits were by video and 53% by telephone. Satisfaction was high, with 77% of patients reporting that all needs were met, although only 51% would consider telehealth in the future. Qualitative themes were constructed, suggesting that positive patient experiences were associated not only with the elimination of commute time and associated costs but also with a positive physician interaction. Negative patient experiences were associated with the inability to complete the neurologic examination. Overall, patients tended to view telehealth as a tool that should augment, and not replace, in-person visits. Conclusion In ambulatory telehealth, patients valued convenience, safety, and physician relationship. Barriers were observed but can be addressed.
Collapse
Affiliation(s)
- Carly Olszewski
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Sharon Thomson
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Lauren Strauss
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Rachel Graham
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Mustapha Ezzeddine
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Kristen Dodenhoff
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Alexander Ambrosini
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Laura Daniela Smith
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Laura Silla
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Allysen Schreiber
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Caroline Caraci
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Amy Guzik
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Roy E Strowd
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| |
Collapse
|
13
|
Cahan EM, Maturi J, Bailey P, Fernandes S, Addala A, Kibrom S, Krissberg JR, Smith SM, Shah S, Wang E, Saynina O, Wise PH, Chamberlain LJ. The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization. Acad Pediatr 2022; 22:1375-1383. [PMID: 35318159 PMCID: PMC8933868 DOI: 10.1016/j.acap.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic. METHODS Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March-June 2019 and March-June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses. RESULTS Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (P < .0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments. CONCLUSIONS Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.
Collapse
Affiliation(s)
- Eli M. Cahan
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,New York University School of Medicine (EM Cahan), New York, NY,Address correspondence to Eli M. Cahan, MS, Department of Pediatrics, Stanford School of Medicine, 770 Welch Road, #100, Stanford, CA 94305
| | - Jay Maturi
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paige Bailey
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Susan Fernandes
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Medicine (S Fernandes), Stanford School of Medicine, Stanford, Calif
| | - Ananta Addala
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sara Kibrom
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Jill R. Krissberg
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Stephanie M. Smith
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sejal Shah
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Ewen Wang
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Emergency Medicine (E Wang), Stanford School of Medicine, Stanford, Calif
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paul H. Wise
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Lisa J. Chamberlain
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| |
Collapse
|
14
|
Bele S, Cassidy C, Curran J, Johnson DW, Bailey JAM. Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary-Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study. J Med Internet Res 2021; 23:e28610. [PMID: 34941561 PMCID: PMC8734914 DOI: 10.2196/28610] [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: 03/08/2021] [Revised: 05/27/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children’s Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. Objective The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. Methods This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. Results Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary–regional relationships. Conclusions This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers’ and family members’ perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. International Registered Report Identifier (IRRID) RR2-10.1186/s12913-018-3859-2
Collapse
Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - David W Johnson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada
| | - J A Michelle Bailey
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
15
|
Finkelstein JB, Tremblay ES, Van Cain M, Farber-Chen A, Schumann C, Brown C, Shah AS, Rhodes ET. Pediatric Clinicians' Use of Telemedicine: Qualitative Interview Study. JMIR Hum Factors 2021; 8:e29941. [PMID: 34860669 PMCID: PMC8686477 DOI: 10.2196/29941] [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] [Received: 04/26/2021] [Revised: 08/05/2021] [Accepted: 08/31/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Bedside manner describes how clinicians relate to patients in person. Telemedicine allows clinicians to connect virtually with patients using digital tools. Effective virtual communication or webside manner may require modifications to traditional bedside manner. OBJECTIVE This study aims to understand the experiences of telemedicine providers with patient-to-provider virtual visits and communication with families at a single large-volume children's hospital to inform program development and training for future clinicians. METHODS A total of 2 focus groups of pediatric clinicians (N=11) performing virtual visits before the COVID-19 pandemic, with a range of experiences and specialties, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semistructured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded, and the corresponding transcripts were reviewed for data analysis. The transcripts were coded based on the identified main themes and subthemes. On the basis of a higher-level analysis of these codes, the study authors generated a final set of key themes to describe the collected data. RESULTS Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialties and practices. A total of 3 key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt that telemedicine required new skills for patient interaction, and not all were comfortable with their training. CONCLUSIONS Telemedicine provides benefits as well as challenges to health care delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. The inclusion of webside manner instructions within training curricula is crucial as telemedicine becomes an established modality for providing health care.
Collapse
Affiliation(s)
- Julia B Finkelstein
- Department of Urology, Boston Children's Hospital, Boston, MA, United States
| | - Elise S Tremblay
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
| | - Melissa Van Cain
- Department of Medical Informatics, School of Community Medicine, University of Oklahoma, Tulsa, OK, United States
| | - Aaron Farber-Chen
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Caitlin Schumann
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Christina Brown
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Ankoor S Shah
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
16
|
Rankine J, Yeramosu D, Matheo L, Sequeira GM, Miller E, Ray KN. Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design. JMIR Hum Factors 2021; 8:e25568. [PMID: 34383665 PMCID: PMC8380586 DOI: 10.2196/25568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. OBJECTIVE This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. METHODS We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. RESULTS Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. CONCLUSIONS Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.
Collapse
Affiliation(s)
- Jacquelin Rankine
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Deepika Yeramosu
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Loreta Matheo
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Gina M Sequeira
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
17
|
Chitungo I, Mhango M, Dzobo M, Denhere K, Chimene M, Musuka G, Dzinamarira T. Towards virtual doctor consultations: A call for the scale-up of telemedicine in sub-Saharan Africa during COVID-19 lockdowns and beyond. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2021; 21:100207. [PMID: 36570120 PMCID: PMC9757988 DOI: 10.1016/j.smhl.2021.100207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/24/2021] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
The outbreak of COVID-19 has resulted in adoption and implementation of mitigatory policies, including movement restrictions (lockdowns) to curb its spread. These lockdowns have brought unintended consequences such as increasing the inequalities in health delivery. In the context of these restrictions, telemedicine provides an opportunity for continuation of essential health care provision. This review aimed to map available literature on the current status of telemedicine in sub-Saharan Africa to proffer recommendations for scale up during COVID-19 and beyond. Our review highlighted the lack of meaningful investment in the area. The literature identified resistance to telemedicine, infrastructural barriers, and the lack of policy and budgetary support as main deterrents to current implementation. We recommend the region to leverage on the rapid expansion of internet and telecommunication in addition to adopting a mix of strategies to set up an infrastructure for providing scale up of telemedicine and overcome barriers to implementation. There is an urgent need for policy formulation and the provision of budgetary support through sustainable business models.
Collapse
Affiliation(s)
- Itai Chitungo
- Department of Diagnostic Medicine and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Malizgani Mhango
- School of Public Health, University of Western Cape, 7535, Cape Town, South Africa
| | - Mathias Dzobo
- Department of Diagnostic Medicine and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Munashe Chimene
- COVID-19 Response Team, Chinhoyi Provincial Hospital, Chinhoyi, Zimbabwe
| | | | - Tafadzwa Dzinamarira
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa,Corresponding author. Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| |
Collapse
|
18
|
Shah AC, Badawy SM. Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e22696. [PMID: 33556030 PMCID: PMC8078694 DOI: 10.2196/22696] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). OBJECTIVE We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients' and care providers' satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. METHODS Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author's name, publication year, participants' characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. RESULTS In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73%) or cluster randomized trials (3/11, 27%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27%), asthma (2/11, 18%), mental health conditions (1/11, 9%), otitis media (1/11, 9%), skin conditions (1/11, 9%), type 1 diabetes (1/11, 9%), attention deficit hyperactivity disorder (1/11, 9%), and cystic fibrosis-related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45%), smartphone-based interventions (3/11, 27%), telephone counseling (2/11, 18%), and telemedicine-based screening visits (1/11, 9%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. CONCLUSIONS Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.
Collapse
Affiliation(s)
- Aashaka C Shah
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Djalalinia S, Hejabi A, Bolhari J, Asadi A, Naseri H, Sadeghi MM, Mehrabadi MS, Dejman M, Eftekhari M, Atoofi MK. Situation Analysis for Promotion of Hot-Lines: An Experience from Iran. Int J Prev Med 2020; 11:183. [PMID: 33456739 PMCID: PMC7804869 DOI: 10.4103/ijpvm.ijpvm_175_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The hot line services were developed in response to the perceived need for 24-hour help services in crises ranging from suicide to unwanted pregnancy. This study is aimed at analyzing the strengths, weaknesses, challenges, and suggestions of improving the performance of the help centers from the perspective of key stakeholders. Methods: We conducted a qualitative study to elicit the key informants' opinion regarding the performance of Iranian hot-lines. All the conversations were audio-recorded with the permission of the participants. To reach the saturation limit, the number of interviews was completed in the saturation of data. Data was gathered from 15 individual in-depth interviews. Collecting and analyses of data was based on content analysis through which simultaneously during texts open coding, main concepts were extracted and then in axial coding similar concepts were categorized. Results: According to the study results, there is no specific and independent system for assessing the hot- lines. One of the major weaknesses was the lack of standard protocols. Most participants believed that most of these guidelines came from the general principles of counseling and are not standard. As another point, the existence of referral services is one of the main problems of counseling lines. The most important suggestion from the majority of experts were the development of services and modification of their investments. Conclusions: The findings, in addition to providing the applied data for policy-making in the health system, will significantly contribute to the creation of scientific, technical, and skillful personnel in the community of researchers.
Collapse
Affiliation(s)
- Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Ahmad Hejabi
- Mental, Social, and Addiction Office, Ministry of Health and Medical Education, Tehran, Iran.,Research Center for Addiction and Risky Behavior, Department of Psychiatric, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Asadi
- Mental, Social, and Addiction Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Hossein Naseri
- Deputy of Prevention, Welfare Organization of Iran, Tehran, Iran
| | | | - Mohammad Shams Mehrabadi
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Monir Eftekhari
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehrdad Kazemzadeh Atoofi
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
21
|
Hakim A, Gaviria-Agudelo C, Edwards K, Olson D. Pre-Coronavirus Disease 2019 Telehealth Practices Among Pediatric Infectious Diseases Specialists in the United States. J Pediatric Infect Dis Soc 2020; 10:485-491. [PMID: 33196843 PMCID: PMC7717292 DOI: 10.1093/jpids/piaa146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/14/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Telehealth (TH) practices among pediatric infectious disease (PID) specialists prior to the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. METHODS In 2019, the Pediatric Infectious Diseases Society (PIDS) Telehealth Working Group surveyed PIDS members to collect data on the use of TH modalities, adoption barriers, interest, extent of curbside consultations (CCs), and reimbursement. RESULTS Of 1213 PIDS members, 161 (13.3%) completed the survey, and the responses of 154 (12.7%) from the United States were included in our report. Medical school (63.6%) and hospital (44.8%) were the commonest work settings with 16.9% practicing in both of them. The most common TH modalities used were synchronous provider-patient virtual visits (20.8%) and synchronous provider-provider consultations (13.6%). TH services included outpatient consultations (48.1%), vaccine recommendations (43.5%), inpatient consultations (39.6%), and travel advice (39.6%). Barriers perceived by respondents included reimbursement (55.8%), lack of experience with TH (55.2%), lack of institutional support (52.6%), lack of administrative support (50%), and cost of implementation (48.7%). Most of the respondents (144, 93.5%) were interested in implementing a wide range of TH modalities. CCs accounted for 1-20 hours/week among 148 respondents. CONCLUSIONS Most of the PIDS survey respondents reported low utilization of TH and several perceived barriers to TH adoption before the COVID-19 pandemic. Nonetheless, they expressed a strong interest in adopting different TH modalities. They also reported spending considerable time on non-reimbursed CCs from within and outside their institutions. The results of this survey provide baseline information that will allow comparisons with post-COVID-19 changes in the adoption of TH in PID.
Collapse
Affiliation(s)
- Amin Hakim
- EMZ Solutions, New York, NY,Corresponding author: Amin Hakim,
| | | | - Kathryn Edwards
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel Olson
- Department of Pediatrics, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO
| | | |
Collapse
|
22
|
O'Hara VM, Johnston SV, Browne NT. The paediatric weight management office visit via telemedicine: pre- to post-COVID-19 pandemic. Pediatr Obes 2020; 15:e12694. [PMID: 32627434 PMCID: PMC7361154 DOI: 10.1111/ijpo.12694] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Telemedicine is a powerful tool that erases many logistical barriers to care and may increase access. Due to the need for social distancing, the COVID-19 pandemic has temporarily reduced in-person visits for clinical care. Providers, clinical staff and patients are pressed to acutely learn new skills and adapt clinical care through the use of telemedicine whilst administrators, policy makers and regulatory organizations make changes to existing policies to meet this national emergency. Our tertiary care, interdisciplinary paediatric weight management clinic began the use of telemedicine 5 years ago to bring access to an underserved, rural population at their primary care office, which has allowed our clinic to pivot seamlessly to in-home telemedicine visits during the pandemic. Telemedicine rules and regulations are rapidly changing to meet the COVID-19 national emergency, but many supports for new telemedicine providers are already in place. In this article, we provide an overview of telemedicine components, policies and regulations. We review the operationalization of our clinic's telemedicine visit prior to the pandemic. We discuss how telemedicine services are impacted by COVID-19 and key resources are provided. Finally, we reimagine telemedicine services post-pandemic to expand effective, coordinated health care, particularly for patients with chronic needs such as obesity.
Collapse
Affiliation(s)
- Valerie M. O'Hara
- Northern Light Health, Eastern Maine Medical Center, Department of PediatricsWOW Pediatric & Adolescent Weight & Cardiometabolic ClinicOronoMaineUSA
| | - Starr V. Johnston
- Northern Light Health, Eastern Maine Medical Center, Department of PediatricsWOW Pediatric & Adolescent Weight & Cardiometabolic ClinicOronoMaineUSA
| | - Nancy T. Browne
- Northern Light Health, Eastern Maine Medical Center, Department of PediatricsWOW Pediatric & Adolescent Weight & Cardiometabolic ClinicOronoMaineUSA
| |
Collapse
|
23
|
Strowd RE, Strauss L, Graham R, Dodenhoff K, Schreiber A, Thomson S, Ambrosini A, Thurman AM, Olszewski C, Smith LD, Cartwright MS, Guzik A, Wells RE, Munger Clary H, Malone J, Ezzeddine M, Duncan PW, Tegeler CH. Rapid Implementation of Outpatient Teleneurology in Rural Appalachia: Barriers and Disparities. Neurol Clin Pract 2020; 11:232-241. [PMID: 34484890 DOI: 10.1212/cpj.0000000000000906] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 01/01/2023]
Abstract
Objective To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States. Methods A retrospective cohort of consecutive patients seen in the first 4 weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video, and when unable, phone-only visits were scheduled. Patients were divided into 2 groups based on the telehealth visit type: video or phone only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured postvisit telephone call. Results Of 1,011 telehealth patient visits, 44% were video and 56% phone only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p < 0.001), more likely to be female (63% vs 55%, p < 0.007), be White or Caucasian (p = 0.024), and not have Medicare or Medicaid insurance (p < 0.001). The most common barrier to scheduling video visits was technology limitations (46%). Although patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%, p = 0.05). Conclusion Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, Black patients with Medicare or Medicaid insurance were less likely to complete video visits.
Collapse
Affiliation(s)
- Roy E Strowd
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Lauren Strauss
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Rachel Graham
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Kristen Dodenhoff
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Allysen Schreiber
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Sharon Thomson
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Alexander Ambrosini
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Annie Madeline Thurman
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Carly Olszewski
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - L Daniela Smith
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Michael S Cartwright
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Amy Guzik
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Rebecca Erwin Wells
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Heidi Munger Clary
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - John Malone
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Mustapha Ezzeddine
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Pamela W Duncan
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Charles H Tegeler
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| |
Collapse
|
24
|
COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist. J Pediatr Gastroenterol Nutr 2020; 70:734-740. [PMID: 32443021 PMCID: PMC7273955 DOI: 10.1097/mpg.0000000000002749] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Nagata JM. Rapid Scale‐Up of Telehealth During the COVID‐19 Pandemic and Implications for Subspecialty Care in Rural Areas. J Rural Health 2020; 37:145. [DOI: 10.1111/jrh.12433] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics University of California San Francisco California
| |
Collapse
|
26
|
Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 2019; 19:974. [PMID: 31852493 PMCID: PMC6921587 DOI: 10.1186/s12913-019-4815-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.
Collapse
Affiliation(s)
- Melissa E Cyr
- School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Anna G Etchin
- VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA, 02130, USA
| | - Barbara J Guthrie
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
| |
Collapse
|
27
|
Napi NM, Zaidan AA, Zaidan BB, Albahri OS, Alsalem MA, Albahri AS. Medical emergency triage and patient prioritisation in a telemedicine environment: a systematic review. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00357-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
28
|
Tomines A. Pediatric Telehealth: Approaches by Specialty and Implications for General Pediatric Care. Adv Pediatr 2019; 66:55-85. [PMID: 31230700 DOI: 10.1016/j.yapd.2019.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alan Tomines
- Department of Pediatrics, UCLA Geffen School of Medicine, Los Angeles, CA, USA; Enterprise Information Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| |
Collapse
|
29
|
Okumura MJ, Knauer HA, Calvin KE, Takayama JI. Caring for Children with Special Health Care Needs: Profiling Pediatricians and Their Health Care Resources. Matern Child Health J 2019; 22:1042-1050. [PMID: 29497983 DOI: 10.1007/s10995-018-2484-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an "above average proportion" of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access. Results Our response rate was 50.2% (n = 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10-59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN. Conclusions Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN.
Collapse
Affiliation(s)
- Megumi J Okumura
- Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA. .,Division of General Internal Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118, USA.
| | - Heather A Knauer
- Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA.,School of Public Health, University of California, 50 University Hall #7360, Berkeley, CA, 94720-7360, USA
| | - Kris E Calvin
- American Academy of Pediatrics, California Foundation, American Academy of Pediatrics, 921 11th Street Suite 1100, Sacramento, CA, 95814, USA
| | - John I Takayama
- Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA
| |
Collapse
|
30
|
Bele S, Cassidy C, Curran J, Johnson DW, Saunders C, Bailey JAM. Barriers and enablers to implementing a virtual tertiary-regional Telemedicine Rounding and Consultation (TRAC) model of inpatient pediatric care using the Theoretical Domains Framework (TDF) approach: a study protocol. BMC Health Serv Res 2019; 19:29. [PMID: 30634969 PMCID: PMC6330415 DOI: 10.1186/s12913-018-3859-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
Background Over-occupancy at the two tertiary pediatric care hospitals in Alberta, Canada is steadily increasing with simultaneous decline in occupancy of pediatric beds at regional hospitals. Over-occupancy negatively impacts timeliness and potentially, the safety of patient care provided at these two tertiary hospitals. In contrast, underutilization of pediatric beds at regional hospitals poses the risk of losing beds provincially, dilution of regional pediatric expertise and potential erosion of confidence by regional providers. One approach to the current situation in provincial pediatric care capacity is development of telemedicine based innovative models of care that increase the population of patients cared for in regional pediatric beds. A Telemedicine Rounding and Consultation (TRAC) model involves discussing patient care or aspects of their care using telemedicine by employing visual displays, audio and information sharing between tertiary and regional hospitals. To facilitate implementation of a TRAC model, it is essential to understand the perceived barriers among its potential users in local context. The current study utilizes qualitative methodologies to assess these perceived clinician barriers to inform a future pilot and evaluation of this innovative virtual pediatric tertiary-regional collaborative care model in Alberta. Methods We will use a qualitative descriptive design guided by the Theoretical Domain Framework (TDF) to systematically identify the tertiary and regional clinical stakeholder’s perceived barriers and enablers to the implementation of proposed TRAC model of inpatient pediatric care. Semi-structured interviews and focus groups with pediatricians, nurses and allied health professionals, administrators, and family members will be conducted to identify key barriers and enablers to implementation of the TRAC model using TDF. Appropriate behaviour change techniques will be identified to develop potential intervention strategies to overcome identified barriers. These intervention strategies will facilitate implementation of the TRAC model during the pilot phase. Discussion The proposed TRAC model has the potential to address the imbalance between utilization of regional and tertiary inpatient pediatric facilities in Alberta. Knowledge generated regarding barriers and enablers to the TRAC model and the process outlined in this study could be used by health services researchers to develop similar telemedicine-based interventions in Canada and other parts of the world. Electronic supplementary material The online version of this article (10.1186/s12913-018-3859-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Chad Saunders
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
| | | |
Collapse
|
31
|
Pediatric and Adolescent Issues in Underserved Populations. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
32
|
Yu JA, Ray KN, Park SY, Barry A, Smith CB, Ellis PG, Schenker Y. System-Level Factors Associated With Use of Outpatient Specialty Palliative Care Among Patients With Advanced Cancer. J Oncol Pract 2019; 15:e10-e19. [PMID: 30407881 PMCID: PMC7010434 DOI: 10.1200/jop.18.00234] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The proportion of patients with advanced cancer who receive outpatient specialty palliative care (OSPC) is as low as 2.0%. Improved understanding of the system-level factors influencing use of OSPC could inform adaptations to the delivery of palliative care to maximize access. We examined associations between OSPC use among patients with advanced solid tumors and oncology-OSPC clinic colocation and patient travel time to an OSPC clinic. PATIENTS AND METHODS We conducted a retrospective cohort study of patients with advanced solid tumors receiving oncologic treatment between January 1 and December 31, 2016, within a comprehensive cancer center network with well-established, oncology-specific OSPC clinics. Multivariable logistic regression analysis was used to evaluate the associations of clinic colocation and geographic access with OSPC use. RESULTS Of 9,485 patients with advanced solid tumors, 478 (5.0%) received OSPC services in 2016. After controlling for age, sex, marital status, cancer type, insurance, treatment intent, and illness severity, patients whose oncologist practices were colocated with OSPC clinics were more likely to use OSPC (odds ratio [OR], 19.2; 95% CI, 14.1 to 26.2). Compared with patients who lived > 90 minutes from an OSPC clinic, patients with travel times of < 30 minutes (OR, 3.2; 95% CI, 2.2 to 4.6) and 31 to 60 minutes (OR, 2.4; 95% CI, 1.6 to 3.6) were also more likely to use OSPC. CONCLUSION Among patients with advanced solid tumors, colocation of oncology and OSPC clinics and shorter patient travel time were associated with greater odds of using OSPC. Future efforts to increase OSPC use in this population should consider clinic colocation and travel burden.
Collapse
Affiliation(s)
- Justin A. Yu
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kristin N. Ray
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Seo Young Park
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | - Peter G. Ellis
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yael Schenker
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
33
|
Stone JM, Gibbons TE. Telemedicine in Pediatric Gastroenterology: An Overview of Utility. Telemed J E Health 2017; 24:577-581. [PMID: 29271722 DOI: 10.1089/tmj.2017.0234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The availability of pediatric subspecialty services is a problem evident throughout the United States. Access to pediatric gastroenterology services, especially in rural areas, can be scarce. Telemedicine has been proposed as a tool capable of decreasing healthcare costs while extending medical care. OBJECTIVE The purpose of this article is to review available literature regarding the utility of telemedicine as it applies to pediatric gastroenterology, specifically its role in eliminating healthcare disparities. METHODS Research articles were identified through a PubMed search with key words focusing on telemedicine initiatives in pediatric gastroenterology, pediatric subspecialty, rural pediatric care, and adult gastroenterology. Studies were categorized based on the following areas of application: financial, time management, communication/community, and patient health and satisfaction. RESULTS We reached the conclusion that evidence-supported trends in available literature provide a framework for pediatric gastroenterology telemedicine initiatives that can provide resource-sparing, community-enriching, and physician-improving services that ultimately serve to better patient health.
Collapse
Affiliation(s)
- John M Stone
- 1 Department of Pediatrics, Kentucky Children's Hospital , Lexington, Kentucky
| | - Troy E Gibbons
- 2 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Kentucky College of Medicine, Kentucky Children's Hospital , Lexington, Kentucky
| |
Collapse
|
34
|
Ray KN, Ashcraft LE, Mehrotra A, Miller E, Kahn JM. Family Perspectives on Telemedicine for Pediatric Subspecialty Care. Telemed J E Health 2017; 23:852-862. [PMID: 28430021 DOI: 10.1089/tmj.2016.0236] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Children often have difficulty accessing subspecialty care, and telemedicine may improve access to subspecialty care, but information is lacking on how best to implement telemedicine programs to maximize acceptance and, ultimately, maximize impact for patients and their families. METHODS AND MATERIALS To understand how subspecialty telemedicine is perceived and to identify design elements with the potential to improve telemedicine uptake and impact, we conducted and analyzed semi-structured interviews with 21 informants, including parents and caregivers of children with subspecialty care needs and adolescent and young adult patients with subspecialty care needs. RESULTS Although informants saw the potential value of using telemedicine to replace in-person subspecialty visits, they were more enthusiastic about using telemedicine to complement rather than replace in-person visits. For example, they described the potential to use telemedicine to facilitate previsit triage encounters to assess whether the patient was being scheduled with the correct subspecialist and with the appropriate level of urgency. They also felt that telemedicine would be useful for communication with subspecialists after scheduled in-person visits for follow-up questions, care coordination, and to discuss changes in health status. Informants felt that it was important for telemedicine programs to have transparent and reliable scheduling, same-day scheduling options, continuity of care with trusted providers, clear guidelines on when to use telemedicine, and preservation of parent choice regarding method of care delivery. CONCLUSIONS Parents and patients articulated preferences regarding pediatric subspecialty telemedicine in this qualitative, hypothesis-generating study. Understanding and responding to patient and caregiver perceptions and preferences will be crucial to ensure that telemedicine drives true innovation in care delivery rather than simply recapitulating prior models of care.
Collapse
Affiliation(s)
- Kristin N Ray
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura Ellen Ashcraft
- 2 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Ateev Mehrotra
- 3 Department of Health Care Policy and Medicine, Harvard Medical School and RAND Corporation , Boston, Massachusetts
| | - Elizabeth Miller
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeremy M Kahn
- 2 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,4 Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health , Pittsburgh, Pennsylvania
| |
Collapse
|
35
|
Abstract
Children and adolescents in underserved populations have health care risks that are different from those of the adult population. Providers need to be aware of these needs and the available resources. Providers should work with school and community organizations to provide timely and appropriate preventive health care and screen for medical and mental health problems that occur more commonly in these high-risk patient populations.
Collapse
Affiliation(s)
- Neerav Desai
- Division of Adolescent Medicine & Young Adult Health, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, One Hundred Oaks, 719 Thompson Lane, Suite 36300, Nashville, TN 37204, USA.
| | - Mary Elizabeth Romano
- Division of Adolescent Medicine & Young Adult Health, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, One Hundred Oaks, 719 Thompson Lane, Suite 36300, Nashville, TN 37204, USA
| |
Collapse
|
36
|
Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children's Hospital PICU. Pediatr Crit Care Med 2016; 17:516-21. [PMID: 27099972 DOI: 10.1097/pcc.0000000000000761] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the severity of illness and outcomes among children admitted to a children's hospital PICU from referring emergency departments with and without access to a pediatric critical care telemedicine program. DESIGN Retrospective cohort study. SETTING Tertiary academic children's hospital PICU. PATIENTS Pediatric patients admitted directly to the PICU from referring emergency departments between 2010 and 2014. INTERVENTIONS None. MEASUREMENTS Demographic factors, severity of illness, and clinical outcomes among children receiving care in emergency departments with and without access to pediatric telemedicine, as well as a subcohort of children admitted from emergency departments before and after the implementation of telemedicine. MAIN RESULTS Five hundred eighty-two patients from 15 emergency departments with telemedicine and 524 patients from 60 emergency departments without telemedicine were transferred and admitted to the PICU. Children admitted from emergency departments using telemedicine were younger (5.6 vs 6.9 yr; p< 0.001) and less sick (Pediatric Risk of Mortality III score, 3.2 vs 4.0; p < 0.05) at admission to the PICU compared with children admitted from emergency departments without telemedicine. Among transfers from emergency departments that established telemedicine programs during the study period, children arrived significantly less sick (mean Pediatric Risk of Mortality III scores, 1.2 units lower; p = 0.03) after the implementation of telemedicine (n = 43) than before the implementation of telemedicine (n = 95). The observed-to-expected mortality ratios of posttelemedicine, pretelemedicine, and no-telemedicine cohorts were 0.81 (95% CI, 0.53-1.09), 1.07 (95% CI, 0.53-1.60), and 1.02 (95% CI, 0.71-1.33), respectively. CONCLUSIONS The implementation of a telemedicine program designed to assist in the care of seriously ill children receiving care in referring emergency departments was associated with lower illness severity at admission to the PICU. This study contributes to the body of evidence that pediatric critical care telemedicine programs assist referring emergency departments in the care of critically ill children and could result in improved clinical outcomes.
Collapse
|
37
|
Abstract
This article examines the current role of telehealth as a tool in the delivery of pediatric health care. It defines telemedicine and telehealth and provides an overview of different types of telehealth services. The article then explores the potential of telehealth to improve pediatric health care quality and safety through increased access to care, enhanced communication, expanded educational opportunities, and better resource utilization. It also discusses current challenges to the implementation of telehealth, including technological, financial, and licensing barriers, as well as provider, patient, and legal concerns.
Collapse
Affiliation(s)
- Levon Utidjian
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1024, Room 1080, Philadelphia, PA 19104, USA.
| | - Erika Abramson
- Department of Pediatrics, Weill Cornell Medicine, 525 E 68th Street, Rm M610A, New York, NY 10065, USA; Healthcare Policy and Research, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA
| |
Collapse
|