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Fitzpatrick JH, Willard A, Edwards JR, Harhay MN, Schinasi LH, Matthews J, May N. Time Series Analysis: Associations Between Temperature and Primary Care Utilization in Philadelphia, Pennsylvania. Am J Prev Med 2024:S0749-3797(24)00208-3. [PMID: 38908724 DOI: 10.1016/j.amepre.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Earth's temperature has risen by an average of 0.11°F per decade since 1850 and experts predict continued global warming. Studies have shown that exposure to extreme temperatures is associated with adverse health outcomes. Missed primary care visits can lead to incomplete preventive health screenings and unmanaged chronic diseases. This study examines the associations between extreme temperature conditions and primary care utilization among adult Philadelphians. METHODS A total of 1,048,575 appointments from 91,580 patients age ≥ 18 years enrolled in the study at thirteen university-based outpatient clinics in Philadelphia from January 1, 2009 to December 31, 2019. Statistical analysis was performed from June to December 2023. Data on attended and missed appointments was linked with measures of daily maximum temperature and precipitation, stratified by warm and cold seasons. Sociodemographic variables and associations with chronic disease status were explored. RESULTS Rates of missed appointments increased by 0.72% for every 1°F decrease in daily maximum temperatures below 39°F and increased by 0.64% for every 1°F increase above 89°F. Individuals ≥ 65 years and those with chronic conditions had stronger associations with an increased rate of missed appointments. CONCLUSIONS Temperature extremes were associated with higher rates of missed primary care appointments. Individuals with chronic diseases were more likely to have missed appointments associated with extreme temperatures. The findings suggest the need for primary care physicians to explore different modes of care delivery to support vulnerable populations, such as making telemedicine during extreme weather events a viable and affordable option.
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Affiliation(s)
- Janet H Fitzpatrick
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Adrienne Willard
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Janelle R Edwards
- Department of Environmental & Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Meera N Harhay
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Penn Transplant Institute, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Leah H Schinasi
- Department of Environmental & Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Janet Matthews
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Nathalie May
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania.
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Yarger J, Hopkins K, Elmes S, Rossetto I, Van Liefde D, De La Melena S, Harper CC. Use of telemedicine to obtain contraception among young adults: Inequities by health insurance. Contraception 2024; 134:110419. [PMID: 38467325 PMCID: PMC11191717 DOI: 10.1016/j.contraception.2024.110419] [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: 09/12/2023] [Revised: 12/19/2023] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES The objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage. STUDY DESIGN We analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state. RESULTS Our analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31-0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29-0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25-0.69). CONCLUSIONS Few young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states. IMPLICATIONS Although telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults' access to telemedicine for contraception and address insurance disparities.
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Affiliation(s)
- Jennifer Yarger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Sarah Elmes
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Danielle Van Liefde
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Stephanie De La Melena
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Cynthia C Harper
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
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Spaulding EM, Fang M, Commodore-Mensah Y, Himmelfarb CR, Martin SS, Coresh J. Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey. J Med Internet Res 2024; 26:e52124. [PMID: 38728070 PMCID: PMC11127137 DOI: 10.2196/52124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 02/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. OBJECTIVE This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. METHODS We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. RESULTS We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. CONCLUSIONS Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States
| | - Seth S Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, United States
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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Montoya-Williams D, Gualy S, Mazur M, Huber M, Peña MM, DeMauro SB, Duncan AF. Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model. Am J Perinatol 2024; 41:e1075-e1083. [PMID: 36452972 PMCID: PMC10349908 DOI: 10.1055/a-1990-8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges. STUDY DESIGN To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020-July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses. RESULTS When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birth weight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity. CONCLUSION During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge. KEY POINTS · Telemedicine works well for high-risk neonatal populations.. · Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.. · NICUs should work to prevent food insecurity postdischarge..
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Affiliation(s)
- Diana Montoya-Williams
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | | | | | | | | | - Sara B. DeMauro
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - Andrea F. Duncan
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
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Ali M, Sullivan G. Racial Differences in Expanded Telemedicine Use During COVID-19: A Literature Review. Telemed J E Health 2024; 30:1394-1400. [PMID: 38064549 DOI: 10.1089/tmj.2023.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background: The COVID-19 pandemic prompted the widespread adoption of telemedicine to deliver health care services while minimizing in-person contact. However, concerns persist regarding equitable access to telemedicine, especially for vulnerable populations. This study examines the utilization patterns of telemedicine by race in the United States, considering different modalities, medical specialties, and geographic regions. Methods: A comprehensive review of 26 articles published between January 2020 and August 2022 was conducted to analyze racial disparities in telemedicine use during the pandemic. Data from electronic health records and self-reported race were compiled for analysis. Variations based on geography, clinical care types, telemedicine modalities (audio or video), and study design were explored. Results: The findings indicate the presence of racial disparities in telemedicine utilization, with minority groups exhibiting lower usage rates compared with Whites. The location of outpatient clinics and clinical care types did not significantly influence telemedicine use by race. Among studies comparing telemedicine modalities, African Americans were more likely to choose audio/phone visits over video visits. Studies employing a pre-post design were less likely to identify disparities in telemedicine use by race. Conclusions: This study consistently demonstrates increasing racial disparities in telemedicine use. Future research should focus on identifying contributing factors and developing strategies to address these disparities. Policymakers should consider implementing initiatives promoting equitable access to telemedicine, including financial assistance, improved broadband infrastructure, and digital literacy programs. By addressing these barriers, telemedicine can play a crucial role in reducing health care disparities and improving access to care for all Americans.
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Affiliation(s)
- Mohab Ali
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Greer Sullivan
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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6
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Wilkens J, Thulesius H, Ekman B. From office to digital primary care services: analysing income-related inequalities in utilization. Int J Equity Health 2024; 23:86. [PMID: 38689241 PMCID: PMC11061960 DOI: 10.1186/s12939-024-02184-6] [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: 01/29/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
The use of digital technologies to deliver primary health care has increased over the past decade. While some technologies have been shown to be medically effective and efficient, the effects of digital primary care on the policy goal of equality in the use of such types of care have not been studied using large register data. The aim of this study was to analyse how digital contacts differ from officebased visits by income as an indicator of socioeconomic status. Specifically, we estimated differences in primary care utilization across income, factors of contribution to these inequalities, and applied a needs-based standardisation of utilization to estimate differences in equity.We used a purposively built consultation level dataset with 726 000 Swedish adult patients diagnosed with an infection, including clinical and sociodemographic variables. Applying concentration indexes (CI) and graphical illustrations we measured how the two types of services are distributed relative to income. We estimated how much of the inequalities were attributed to different sociodemographic factors by decomposing the concentration indexes. Standardised utilization for sex, age and comorbidity allowed for the estimation of horizontal inequity indexes for both types of services.Utilization by the two types of care showed large income inequalities. Office-based visits were propoor (CI -0.116), meaning lowincome patients utilized relatively more of these services, while digital contacts were prorich (CI 0.205). However, within the patient group who had at least one digital contact, the utilization was also propoor (CI -0,101), although these patients had higher incomes on average. The standardised utilization showed a smaller prorich digital utilization (CI 0.143), although large differences remained. Decomposing the concentration indexes showed that education level and being born in Sweden were strong attributes of prorich digital service utilization.The prorich utilization effects of digital primary care may risk undermining the policy goals of access and utilization to services regardless of socioeconomic status. As digital health technologies continue to expand, policy makers need to be aware of the risk.
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Affiliation(s)
- Jens Wilkens
- Department of Clinical Sciences, Lund University, Malmö, Sweden, Jan Waldenströms gata 35, 20205.
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden, Jan Waldenströms gata 35, 20205
| | - Björn Ekman
- Department of Clinical Sciences, Lund University, Malmö, Sweden, Jan Waldenströms gata 35, 20205
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Chandrasekaran R. Telemedicine in the Post-Pandemic Period: Understanding Patterns of Use and the Influence of Socioeconomic Demographics, Health Status, and Social Determinants. Telemed J E Health 2024; 30:480-489. [PMID: 37585558 DOI: 10.1089/tmj.2023.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Introduction: The rapid expansion of telemedicine during the COVID-19 pandemic has transformed health care delivery. However, it remains unclear whether telemedicine utilization is equitable across different demographic groups and whether the high levels of adoption during the pandemic have persisted in the post-pandemic period. This study investigates telemedicine use and patterns of use in the initial phases of the post-pandemic period and explores the impact of socioeconomic factors, social determinants of health, and patients' health-related factors on telemedicine utilization. Methods: This study analyzes data from the Health Information National Trends Survey (HINTS) 6, comprising responses from 6,046 U.S. adults collected between March and November 2022. Results: Of 6,046 HINTS respondents, 39.3% (2,517 individuals) reported using telemedicine in the past year. Among telemedicine users, 18.5% used video visits, 12.08% used telephone-based telecare, and 8.72% used both. The main reasons for telehealth visits were minor illnesses (29.67%), chronic condition management (21.4%), annual visits (18.82%), mental and behavioral health concerns (15.72%), and medical emergencies (1.58%). Among non-users, only 17% (578 individuals) were offered telehealth visits, with privacy concerns (16.43%), preference for in-person consultation (84.42%), and difficulty using telemedicine technology (18.96%) being the main reasons for non-use. Logistic regression analysis revealed significant associations of social determinants, socioeconomic demographics, and health factors with telemedicine utilization. Women had a higher likelihood of using telemedicine (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.09-1.78). Older adults showed lower inclination toward telemedicine. Married individuals were more likely to use telemedicine (OR = 1.35, 95% CI = 1.06-1.72), while Whites (OR = 1.52, 95% CI = 1.04-2.22) and Hispanics (OR = 1.80, 95% CI = 1.17-2.75) had higher odds of utilizing telemedicine compared with non-Hispanic African Americans. Lack of reliable transportation (OR = 1.29, 95% CI = 1.01-1.66), frequent provider visits (OR = 1.37, 95% CI = 1.28-1.46), a higher number of chronic conditions (OR = 1.39, 95% CI = 1.22-1.57), and residences in metropolitan locations were also associated with increased telemedicine usage. Greater satisfaction with internet connectivity positively influenced telemedicine utilization. Conclusions: This study highlights the continued preference for in-person visits among U.S. adults in the early post-pandemic period, despite the widespread use of telemedicine. Addressing barriers such as limited access, privacy concerns, technological difficulties, and demographic disparities is crucial for achieving equitable utilization of telemedicine.
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Affiliation(s)
- Ranganathan Chandrasekaran
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Obregon E, Ortiz R, Wallis KE, Morgan S, Montoya-Williams D. Feasibility, Acceptability, and Health Outcomes Associated With Telehealth for Children in Families With Limited English Proficiency. Acad Pediatr 2024; 24:13-22. [PMID: 37385437 PMCID: PMC10753033 DOI: 10.1016/j.acap.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Telehealth use in pediatrics increased during the COVID-19 pandemic and may improve health care access. It may also exacerbate health care disparities among families with limited English proficiency (LEP). OBJECTIVE To systematically review the feasibility, acceptability, and/or associations between telehealth delivery and health outcomes for interventions delivered synchronously in the United States. DATA SOURCES PubMed, Embase, and Scopus. STUDY ELIGIBILITY CRITERIA Original research exploring pediatric health outcomes after telehealth delivery and studies that explored the feasibility and acceptability including surveys and qualitative studies. PARTICIPANTS Patients 0 to 18 years with LEP and/or pediatric caregivers with LEP. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently screened abstracts, conducted full-text review, extracted information using a standardized form, and assessed study quality. A third author resolved disagreements. RESULTS Of 1831 articles identified, 9 were included in the review. Half of the studies explored videoconferencing and the other half studied health care delivered by telephone. Feasibility studies explored telehealth for children with anxiety disorders and mobile phone support for substance abuse treatment among adolescents. Acceptability studies assessed parental medical advice-seeking behaviors and caregivers' general interest in telehealth. Health outcomes studied included follow-up of home parenteral nutrition, developmental screening, and cognitive behavioral therapy. LIMITATIONS The articles were heterogeneous in approach and quality. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Telehealth appears acceptable and feasible among children in families with LEP, with a limited evidence base for specific health outcomes. We provide recommendations both for the implementation of pediatric telehealth and future research. PROSPERO REGISTRATION CRD42020204541.
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Affiliation(s)
- Evelyn Obregon
- Department of Pediatrics (E Obregon), University of Florida, Gainesville; Perinatal Institute (E Obregon), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robin Ortiz
- Department of Pediatrics and Population Health (R Ortiz), Grossman School of Medicine, New York University, New York; Institute for Excellence in Health Equity (R Ortiz), New York University, Langone Health, New York
| | - Kate E Wallis
- Division of Developmental and Behavioral Pediatrics (KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; CHOP PolicyLab (KE Wallis and D Montoya-Williams), The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pa; University of Pennsylvania Perelman School of Medicine (KE Wallis and D Montoya-Williams), Philadelphia
| | - Sherry Morgan
- University of Pennsylvania (S Morgan), Holman Biotech Commons, Robert Wood Johnson Pavilion, Philadelphia
| | - Diana Montoya-Williams
- CHOP PolicyLab (KE Wallis and D Montoya-Williams), The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pa; University of Pennsylvania Perelman School of Medicine (KE Wallis and D Montoya-Williams), Philadelphia; Division of Neonatology (D Montoya-Williams), The Children's Hospital of Philadelphia, Philadelphia, Pa.
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9
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Park JH, Lee MJ, Tsai MH, Shih HJ, Chang J. Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS). Patient Prefer Adherence 2023; 17:3477-3487. [PMID: 38143946 PMCID: PMC10749101 DOI: 10.2147/ppa.s439437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Min Jee Lee
- Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Huan-Ju Shih
- Department of Health Administration and Policy, School of Public Health, George Mason University, Fairfax, VA, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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10
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Cho LD, Rabinowitz G, Goytia C, Andreadis K, Huang HH, Benda NC, Lin JJ, Horowitz C, Kaushal R, Ancker JS, Poeran J. Development of a novel instrument to characterize telemedicine programs in primary care. BMC Health Serv Res 2023; 23:1274. [PMID: 37978511 PMCID: PMC10657014 DOI: 10.1186/s12913-023-10130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine programs. We developed a novel semi - structured survey instrument to systematically describe the characteristics and implementation processes of telemedicine programs in primary care. METHODS In the context of a larger study aiming to describe telemedicine programs in primary care, a survey was developed in 3 iterative steps: 1) literature review to obtain a list of telemedicine features, facilitators, and barriers; 2) application of three evaluation frameworks; and 3) stakeholder engagement through a 2-stage feedback process. During survey refinement, items were tested against the evaluation frameworks while ensuring it could be completed within 20-25 min. Data reduction techniques were applied to explore opportunity for condensed variables/items. RESULTS Sixty initially identified telemedicine features were reduced to 32 items / questions after stakeholder feedback. Per the life cycle framework, respondents are asked to report a month in which their telemedicine program reached a steady state, i.e., "maturation". Subsequent questions on telemedicine features are then stratified by telemedicine services offered at the pandemic onset and the reported point of maturation. Several open - ended questions allow for additional telemedicine experiences to be captured. Data reduction techniques revealed no indication for data reduction. CONCLUSION This 32-item semi-structured survey standardizes the description of primary care telemedicine programs in terms of features as well as maturation process. This tool will facilitate evaluation of and comparisons between telemedicine programs across the United States, particularly those that were deployed at the pandemic onset.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Grace Rabinowitz
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Crispin Goytia
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Katerina Andreadis
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Hsin-Hui Huang
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Jenny J Lin
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 17 E. 102nd Street Box 1087, New York, NY, 10029, USA
| | - Carol Horowitz
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Rm 14122, Nashville, TN, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
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11
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Cengil AB, Eksioglu B, Eksioglu S, Eswaran H, Hayes CJ, Bogulski CA. Using data analytics for telehealth utilization: A case study in Arkansas. J Telemed Telecare 2023:1357633X231160039. [PMID: 36883218 DOI: 10.1177/1357633x231160039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Many patients used telehealth services during the COVID-19 pandemic. In this study, we evaluate how different factors have affected telehealth utilization in recent years. Decision makers at the federal and state levels can use the results of this study to inform their healthcare-related policy decisions. METHODS We implemented data analytics techniques to determine the factors that explain the use of telehealth by developing a case study using data from Arkansas. Specifically, we built a random forest regression model which helps us identify the important factors in telehealth utilization. We evaluated how each factor impacts the number of telehealth patients in Arkansas counties. RESULTS Of the 11 factors evaluated, five are demographic, and six are socioeconomic factors. Socioeconomic factors are relatively easier to influence in the short term. Based on our results, broadband subscription is the most important socioeconomic factor and population density is the most important demographic factor. These two factors were followed by education level, computer use, and disability in terms of their importance as it relates to telehealth use. DISCUSSION Based on studies in the literature, telehealth has the potential to improve healthcare services by improving doctor utilization, reducing direct and indirect waiting times, and reducing costs. Thus, federal and state decision makers can influence the utilization of telehealth in specific locations by focusing on important factors. For example, investments can be made to increase broadband subscriptions, education levels, and computer use in targeted locations.
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Affiliation(s)
- Aysenur Betul Cengil
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Burak Eksioglu
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Sandra Eksioglu
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hari Eswaran
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics/Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Zickuhr L, Albert DA, Herndon C, Imundo LF, Lopker MJ, Marston B, Mian N, O'Rourke K, Torralba KD, Westrich-Robertson T, Venuturupalli RS, Kolfenbach J, Bolster MB. Addressing Competency in Rheumatology Telehealth Care Delivery. Arthritis Care Res (Hoboken) 2022; 75:1213-1219. [PMID: 36121041 DOI: 10.1002/acr.25023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Telehealth is an essential facet of care delivery for patients with rheumatic diseases. The Association of American Medical College's (AAMC) telehealth competencies (TCs) define the skills required for delivering general telehealth care across the range of clinician experience. In this study, the American College of Rheumatology's (ACR) TCs working group aimed to adapt the AAMC TCs to rheumatology, outlining the skills acquisition unique to rheumatology with a focus on knowledge, skills, and behaviors expected of recent rheumatology fellowship graduates. METHODS Through a collaborative process, the working group adapted the AAMC TCs to the training structure and practice of rheumatology. The rheumatology TCs underwent peer review among recipients of the Clinician Scholar Educator Award and attendees at the ACR 2021 Convergence conference. RESULTS The rheumatology TCs define 24 essential skills required for synchronous telehealth care of patients with rheumatic diseases. The working group adapted the AAMC's 20 TCs organized within 6 domains, added 2 skills to the AAMC's domains of patient safety and appropriate use, and data collection and assessment, and created a novel domain of systems-based requirements with 2 competencies. The rheumatology TCs define expected skill levels for recent rheumatology fellowship graduates and experienced rheumatology clinicians. CONCLUSION The rheumatology TCs represent the first adaptation of the AAMC TCs to subspecialty care, expanding the scope to include rheumatology fellowship graduates and additional domains of rheumatology practice. These competencies can guide curricular innovations and measurements of proficiency in telehealth care delivery among rheumatology trainees and experienced clinicians, enhancing the care provided to patients with rheumatic diseases.
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Affiliation(s)
- Lisa Zickuhr
- Washington University in St. Louis, St. Louis, Missouri
| | - Daniel A Albert
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | | | - Lisa F Imundo
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Bethany Marston
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nabeela Mian
- Wilkes-Barre Veterans Affairs Medical Center, Wilkes-Barre, Pennsylvania
| | | | | | | | | | | | - Marcy B Bolster
- Massachusetts General Hospital, Harvard Medical School, Boston
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