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Bhatia R. Telehealth and COVID-19: Using technology to accelerate the curve on access and quality healthcare for citizens in India. TECHNOLOGY IN SOCIETY 2021; 64:101465. [PMID: 33814651 PMCID: PMC8008321 DOI: 10.1016/j.techsoc.2020.101465] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/01/2020] [Accepted: 11/25/2020] [Indexed: 05/06/2023]
Abstract
The current COVID-19 pandemic has reinstated the importance of telehealth as a business model for accelerating the accessibility of healthcare and improving the quality of healthcare for citizens of a country. Telehealth service has a tremendous potential in a developing country like India where the healthcare facilities in India are heavily concentrated in urban cities while their majority (67%) of the population resides in rural areas. At the same time, a high teledensity of almost 90% supports telehealth overall reach. However, the growth of telehealth in India till now has been sluggish but the corona virus (COVID-19) crisis has redefined the telehealth ecosystem by reducing the risk of infection through person-to-person contact. In this study, we explore the perception of healthcare users towards telehealth services and analyze the key enablers for the telehealth services in the current scenario. We collected data from 1170 participants through personal interview. The results of the study shows a considerable segment of the population is having high healthcare need, have aspirations for accessing better healthcare for themselves and their family members and use ICT to a significant extent. At the same time, they have positive attitude towards telehealth and socio-demographic factors like age, geographical location, educational qualification, family size affects the attitude towards telehealth services. The results of the study shows there is a significant market for telehealth services in India to be explored by the technology firms, hospitals and other healthcare stakeholders and going forward it has an enormous capability to transform the complete healthcare ecosystem, especially in developing countries like India post the COVID-19 crisis.
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Affiliation(s)
- Ridhi Bhatia
- Faculty of Management Studies, Manav Rachna International Institute of Research and Studies, India
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2
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Morin KA, Parrotta MD, Eibl JK, Marsh DC. A Retrospective Cohort Study Comparing In-Person and Telemedicine-Based Opioid Agonist Treatment in Ontario, Canada, Using Administrative Health Data. Eur Addict Res 2021; 27:268-276. [PMID: 33706309 PMCID: PMC8259071 DOI: 10.1159/000513471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study evaluated how telemedicine as a modality for opioid agonist treatment compares to in-person care. METHODS We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015, in Ontario, Canada. We compared patients who received opioid agonist treatment predominantly in person, mixed, and predominantly by telemedicine. We used a logistic regression model to evaluate mortality, a Cox proportional hazard model to assess retention, and a negative binomial regression model to evaluate emergency department visits and hospitalizations. The study was performed using administrative health data with physician billing data from the Ontario Health Insurance Plan and prescription data from the Ontario Drug Benefit databases. RESULTS A total of 55,924 individuals were included in the study. Receiving opioid agonist treatment by predominantly telemedicine was not associated with all-cause mortality (OR = 0.9, 95% CI: 0.8-1.0), 1-year treatment retention (OR = 1.0, 95% CI: 0.9-1.1), or opioid-related emergency department visits and hospitalizations when compared to in-person care. The rate of emergency department visits (IRR = 1.4), the rate of mental health-related emergency department visits (IRR = 1.5), and the rate of mental health-related hospitalizations per year (IRR = 1.2) was higher for patients who received opioid agonist treatment predominantly by telemedicine compared to in person. CONCLUSION Our findings support the conclusion that telemedicine is equal to in-person care regarding mortality opioid-related emergency department visits and retention, and is a viable option for those seeking opioid agonist treatment.
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Affiliation(s)
- Kristen A. Morin
- Northern Ontario School of Medicine Sudbury, Sudbury, Ontario, Canada
| | | | - Joseph K. Eibl
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine Sudbury, Sudbury, Ontario, Canada,Health Sciences North Research Institute, Sudbury, Ontario, Canada,ICES North, Sudbury, Ontario, Canada,Canadian Addiction Treatment Centres, Markham, Ontario, Canada,*David C. Marsh, Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6 (Canada),
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3
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Crispo A, Montagnese C, Perri F, Grimaldi M, Bimonte S, Augustin LS, Amore A, Celentano E, Di Napoli M, Cascella M, Pignata S. COVID-19 Emergency and Post-Emergency in Italian Cancer Patients: How Can Patients Be Assisted? Front Oncol 2020; 10:1571. [PMID: 32850461 PMCID: PMC7431560 DOI: 10.3389/fonc.2020.01571] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
Italy and worldwide are experiencing an outbreak of a new coronavirus-related disease, named COVID-19, declared by the WHO COVID-19 a pandemic. The fragility of cancer patients is well-known, with many cases affecting aged patients or those with several comorbidities that frequently result in a loss of independency and functionality. Therefore, cancer patients have been greatly affected by this health emergency and, due to their vulnerability to COVID-19, oncologic patient visits have been often delayed or canceled leading to possible under-treatment. Different solutions can be adopted for reducing travels to cancer screening centers and the overall impact of cancer screening visits. As a consequence, it has been recommended that, when possible, the follow-up visits for cancer patients treated with oral anticancer drugs could be performed telematically. Furthermore, many patients refuse hospital visits, even if necessary, because of fear of contagion. Moreover, in some regions in Italy even the very first non-urgent visits have been postponed with the consequent delay in diagnosis, which may negatively affect disease prognosis. For these reasons, new approaches are needed such as the telemedicine tool. Throughout organized and appropriate tools, it would be possible to manage patients' visits and treatments, to avoid the dangerous extension of waiting lists when the standard activities will resume. In this context, a number of hospital visits can be substituted with visits at small local health centers, and general practitioners'office, taking in turn, advantage of well-defined telemedicine path which will be developed in the post-emergency phase.
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Affiliation(s)
- Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy,*Correspondence: Anna Crispo,
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesco Perri
- Head and Neck Medical and Experimental Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Sabrina Bimonte
- Department of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Livia Silvia Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alfonso Amore
- Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marilena Di Napoli
- Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Department of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
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Greenberg-Worisek A, Ferede L, Balls-Berry J, Marigi I, Valentin Mendez E, Bajwa N, Ouk M, Orellana M, Enders F. Differences in Electronic Personal Health Information Tool Use Between Rural and Urban Cancer Patients in the United States: Secondary Data Analysis. JMIR Cancer 2020; 6:e17352. [PMID: 32773369 PMCID: PMC7445607 DOI: 10.2196/17352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/11/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. OBJECTIVE Few studies have explored whether there is a difference in cancer patients' current use of health information technology tools by residential location. METHODS Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. RESULTS Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95% CI 0.32-0.84). CONCLUSIONS The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions.
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Affiliation(s)
| | - Liaa Ferede
- University of Minnesota Rochester, Rochester, MN, United States
| | - Joyce Balls-Berry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Ian Marigi
- Washington University in St Louis, St Louis, MO, United States
| | - Emily Valentin Mendez
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico, United States Minor Outlying Islands
| | - Numra Bajwa
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Melody Ouk
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Minerva Orellana
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Felicity Enders
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
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Moloney ME, Dunfee M, Rutledge M, Schoenberg N. Evaluating the Feasibility and Acceptability of Internet-Based Cognitive Behavioral Therapy for Insomnia in Rural Women. WOMEN'S HEALTH REPORTS 2020; 1:114-122. [PMID: 32617531 PMCID: PMC7325489 DOI: 10.1089/whr.2020.0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Insomnia, one of the most common sleep disorders among women in midlife, is associated with multiple negative health outcomes. Rural Appalachian women are disproportionately affected by insufficient sleep, but their barriers to care (e.g., health care shortages, cultural norms) may prevent intervention. This study assessed the feasibility and acceptability of Sleep Healthy Using the Internet (SHUTi) an Internet-based version of cognitive behavioral therapy for insomnia in Appalachian women ages 45+ years. Materials and Methods: We used mixed methods to assess feasibility (through summaries of recruitment and retention data) and acceptability (quantitatively through online survey scales and qualitatively through interviews). Subject-level responses for satisfaction, adherence, and helpfulness scales were averaged over the multiple response domains and reported as percentages. Interviews were transcribed and coded using a multistage coding process. Results: Forty-six women (average age 55 years) enrolled; 38 completed the SHUTi program (retention = 82.6%). The majority of participants (61%) indicated that SHUTi made things "somewhat better" or "a lot better." Seventy-six percent reported that they followed the SHUTi protocol "most of the time" or "consistently." Most participants (84%) ranked SHUTi as "moderately" or "very" helpful. Participants expressed enthusiasm about SHUTi and offered minor suggestions for improvement. Conclusions: This study was the first to asses SHUTi in the health disparity population of Appalachian women. Rich insights gained through quantitative and qualitative data suggest that SHUTi was feasible and acceptable for middle-aged Appalachian women. Given rural Appalachian women's documented barriers to utilizing technology, these results hold promise for SHUTi's utility in other rural populations. Future research should incorporate a randomized case-control design within a larger sample and consider participants' suggestions for improvement.
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Affiliation(s)
- Mairead Eastin Moloney
- Department of Sociology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Madeline Dunfee
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew Rutledge
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Nancy Schoenberg
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Huot S, Ho H, Ko A, Lam S, Tactay P, MacLachlan J, Raanaas RK. Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals. Int J Circumpolar Health 2020; 78:1571385. [PMID: 30696379 PMCID: PMC6352934 DOI: 10.1080/22423982.2019.1571385] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Lack of access to healthcare services for people living in the Circumpolar North may have important consequences for their health and well-being, both in terms of the actual treatment and other possible health-related consequences intertwined with their life situation. The aim of the present study was to identify the specific challenges to healthcare service delivery and access for populations in the Circumpolar North that are addressed in contemporary literature. A scoping review of literature published between 2005 and 2016 was conducted and 43 articles were selected for inclusion into the review. The review findings address 4 main themes identified in the literature: (1) the influence of physical geography, (2) healthcare provider-related barriers, (3) the importance of culture and language and (4) the impact of systemic factors. The review of the literature enabled us to identify existing gaps in both health service access and issues discussed in the available literature, particularly for informing healthcare services in the Circumpolar North, as well as point towards opportunities for future research. The thematic findings drawn from interdisciplinary and international literature inform understandings of the impact of health system barriers on healthcare services and the opportunities for Northern residents to support their own health.
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Affiliation(s)
- S Huot
- a Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , Canada
| | - H Ho
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - A Ko
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - S Lam
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - P Tactay
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - J MacLachlan
- c Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - R K Raanaas
- d Department of Public Health Science , Norwegian University of Life Sciences , Ås , Norway
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7
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Sikka N, Gross H, Joshi AU, Shaheen E, Baker MJ, Ash A, Hollander JE, Cheung DS, Chiu AR, Wessel CB, Robinson M, Lowry G, Guyette FX. Defining emergency telehealth. J Telemed Telecare 2019; 27:527-530. [PMID: 31825766 DOI: 10.1177/1357633x19891653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The American College of Emergency Physicians Emergency Telehealth Section was charged with development of a working definition of emergency telehealth that aligns with the College's definition of emergency medicine. A modified Delphi method was used by the section membership who represented telehealth providers in both private and public health-care delivery systems, academia and industry, rural and urban settings. Presented in this manuscript is the final definition of emergency telehealth developed with an additional six clarifying statements to address the context of the definition. Emergency telehealth is a core domain of emergency medicine and is inclusive of remotely providing all types of care for acute conditions of any kind requiring expeditious care irrespective of any prior relationship. The development of this definition is important to the global community of emergency physicians and all patients seeking acute care to ensure that appropriately trained clinicians are providing the highest quality of emergency services via the telehealth modality. We recommend implementing emergency telehealth in a manner that ensures appropriate qualifications of providers, appropriate/parity reimbursement for telehealth services and, most importantly, the delivery of quality care to patients in a safe, efficient, timely and cost-effective manner.
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Affiliation(s)
- Neal Sikka
- Department of Emergency Medicine, The George Washington University, USA
| | - Hartmut Gross
- Medical College of Georgia at Augusta University, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University Hospital, USA
| | - Edward Shaheen
- Shaheen Consulting, a division of On Call Specialists, Inc., USA
| | | | - Adam Ash
- Progressive Emergency Physicians, USA
| | | | | | - Alexander R Chiu
- Faculty, Health + Hospitals/Coney Island Hospital, USA.,State University of New York Downstate College of Medicine, USA.,mHealth Technology and Distance Learning SIG, American Telemedicine Association, USA
| | | | | | - Gregory Lowry
- Department of Emergency Medicine, University of Pittsburgh
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8
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Natafgi N, Mohr NM, Wittrock A, Bell A, Ward MM. The Association Between Telemedicine and Emergency Department (ED) Disposition: A Stepped Wedge Design of an ED-Based Telemedicine Program in Critical Access Hospitals. J Rural Health 2019; 36:360-370. [PMID: 31013552 DOI: 10.1111/jrh.12370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To study the relationship between the availability and activation of emergency department-based telemedicine (teleED) and patient disposition in Critical Access Hospitals (CAHs). METHODS A non randomized stepped wedge design examined 133,396 ED visits in 15 CAHs that subscribe to a single teleED provider. Data were available for at least 12 months prior to teleED implementation and at least 12 months of post-implementation. Primary analyses were conducted using multinomial logistic regression models with teleED availability (indicator of post-teleED implementation period) and activation (indicator of utilization of teleED service) predicting discharge disposition adjusting for age, sex, and clinical diagnosis. RESULTS Patients for whom teleED was activated were more likely to be transferred [adjusted odds ratio (aOR) = 12.04; 95% confidence interval (CI), 10.97-13.21] and more likely to be admitted to the local hospital (aOR = 3.23; 95% CI, 2.84-3.67) than to be routinely discharged. This pattern was confirmed for patients presenting with chest pain, mental illness, and injury/poisoning. However, in the period following teleED implementation, patients presenting to EDs after telemedicine was available, but not necessarily utilized, were less likely to be admitted to the local hospital (aOR = 0.79; 95% CI, 0.76-0.82) than to be routinely discharged. CONCLUSIONS Telemedicine availability in CAH EDs is associated with a higher likelihood of routine discharges from the ED possibly due to changes in care associated with teleED implementation. The relationship between teleED use and disposition may be related to selection in activating teleED for cases more likely to require hospital inpatient care.
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Affiliation(s)
- Nabil Natafgi
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa.,Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | | | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
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O'Hoski S, Butler S, Dubois-Webster J, Brooks D, Goldstein R. Use of telemedicine in the assessment of patients referred for pulmonary rehabilitation. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2017.1391055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sachi O'Hoski
- School of Rehabilitation Science, McMaster University and West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Stacey Butler
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | - Dina Brooks
- Department of Physical Therapy, University of Toronto and West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger Goldstein
- Departments of Medicine and Physical Therapy, University of Toronto and Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
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Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians. Telemed J E Health 2017; 24:268-276. [PMID: 28805545 DOI: 10.1089/tmj.2017.0161] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. INTRODUCTION Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. MATERIALS AND METHODS Nationally representative randomly sampled survey of 5,000 FPs. RESULTS Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. DISCUSSION Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. CONCLUSION Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.
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Affiliation(s)
- Anuradha Jetty
- 1 Robert Graham Center , Washington, District of Columbia
| | - Miranda A Moore
- 2 Department of Family and Preventive Medicine, Emory University , Atlanta, Georgia
| | - Megan Coffman
- 1 Robert Graham Center , Washington, District of Columbia
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11
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Eibl JK, Gauthier G, Pellegrini D, Daiter J, Varenbut M, Hogenbirk JC, Marsh DC. The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting. Drug Alcohol Depend 2017; 176:133-138. [PMID: 28535455 DOI: 10.1016/j.drugalcdep.2017.01.048] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. METHODS We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (<25% appointments by telemedicine), mixed (25-75% by telemedicine), or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records. RESULTS A total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n=1590; aOR=1.27; 95% CI 1.14-1.41; p<0.001). Telemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n=418; aOR=1.26; 95% CI 1.08-1.47; p=0.001) and had a retention rate of 47% at one year. CONCLUSION Telemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions.
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Affiliation(s)
- Joseph K Eibl
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - Graham Gauthier
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - David Pellegrini
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - Jeffery Daiter
- Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, ON L4E 4L6, Canada
| | - Michael Varenbut
- Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, ON L4E 4L6, Canada
| | - John C Hogenbirk
- Center for Rural and Northern Health Research, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada; Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, ON L4E 4L6, Canada.
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12
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Greenberg AJ, Haney D, Blake KD, Moser RP, Hesse BW. Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States. J Rural Health 2017; 34 Suppl 1:s30-s38. [PMID: 28075508 DOI: 10.1111/jrh.12228] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency. METHODS Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics. FINDINGS In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77). CONCLUSIONS The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.
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Affiliation(s)
- Alexandra J Greenberg
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Danielle Haney
- Office of Science Policy, Engagement, Education, and Communications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kelly D Blake
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard P Moser
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford W Hesse
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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O'Gorman LD, Hogenbirk JC, Warry W. Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network. Telemed J E Health 2015; 22:473-9. [PMID: 26544163 PMCID: PMC4892212 DOI: 10.1089/tmj.2015.0166] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction:Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km2. The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province.Materials and Methods:We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care.Results:There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south.Conclusions:Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.
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Affiliation(s)
- Laurel D O'Gorman
- Center for Rural and Northern Health Research, Laurentian University , Sudbury, Ontario, Canada
| | - John C Hogenbirk
- Center for Rural and Northern Health Research, Laurentian University , Sudbury, Ontario, Canada
| | - Wayne Warry
- Center for Rural and Northern Health Research, Laurentian University , Sudbury, Ontario, Canada
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