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Weakley K, Bryant K. Utilization of Telemedicine for Evaluation of Patients and Distribution of a Scarce Resource During the COVID-19 Pandemic. J Pediatric Infect Dis Soc 2024; 13:368-370. [PMID: 38761121 DOI: 10.1093/jpids/piae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Indexed: 05/20/2024]
Abstract
Telemedicine can be utilized to safely evaluate patients, equitably distribute a scarce resource, and generate wRVUs during pandemics.
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Affiliation(s)
- Kathryn Weakley
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Norton Children's, Louisville, Kentucky, USA
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Kristina Bryant
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Norton Children's, Louisville, Kentucky, USA
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Siciliano B, Ramon S, Gabrielli J, López-López A. [Implementation and use of telemedicine in health care during the outbreak of monkeypox in the health area of Ibiza and Formentera]. Aten Primaria 2024; 56:102742. [PMID: 38432105 PMCID: PMC10915515 DOI: 10.1016/j.aprim.2023.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE The objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area. DESIGN AND SITE A descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care. PARTICIPANTS AND METHODS All patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves. RESULTS AND CONCLUSIONS The adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring.
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Affiliation(s)
- Beatriz Siciliano
- Servei d'Atenció Primària, Àrea de Salut d'Eivissa i Formentera, Illes Balears, España
| | - Susana Ramon
- Servei de Microbiologia i Parasitologia, Hospital Can Misses, Eivissa, Illes Balears, España
| | | | - Aránzazu López-López
- Servei de Microbiologia i Parasitologia, Hospital Can Misses, Eivissa, Illes Balears, España.
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Tanhehco YC, Alsammak M, Chhibber V, Ibeh N, Li Y, Stephens LD, Noland DK, Wu DW, Zantek ND, DeChristopher PJ, Martin MCS, Lu W, Wehrli G. Apheresis practice variation during the COVID-19 pandemic: Results of a survey. J Clin Apher 2024; 39:e22109. [PMID: 38634419 DOI: 10.1002/jca.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare delivery across all specialties including apheresis. To describe the changes in apheresis service practices that occurred during the pandemic, the American Society for Apheresis (ASFA) Apheresis Medicine Attending Physician Subcommittee conducted a survey study. STUDY DESIGN AND METHODS A 32-question survey was designed and distributed to 400 ASFA physician members on September 7, 2022. Attending physicians responded to questions about whether and how apheresis service practices changed during the COVID-19 pandemic compared with the time period prior to the pandemic in terms of: (1) procedure types and volumes, (2) patient consultation workflow, and (3) the use of telemedicine. Descriptive analyses were reported as number and frequency of responses. RESULTS The survey response rate was 13.8% (55/400). Of these respondents, 96.4% (53/55) were attending physicians. The majority of respondents (42/53, 79.2%) indicated that the types of procedures performed during COVID-19 compared to pre-pandemic did not change. Most frequently for apheresis procedure volume, respondents reported: no change in their monthly inpatient volume (21/47, 44.7%) and a decrease in their monthly outpatient volume (28/46, 60.9%). Prior to COVID-19, 75.0% (30/40) of respondents performed consultations at bedside for inpatients and 67.4% (29/43) performed consultations at bedside for outpatients. Bedside consultations decreased in both settings during the pandemic but were still most frequently performed by attending physicians. At the same time, the use of telemedicine increased for 15.4% of survey respondents during COVID-19. CONCLUSION Some, but not all, respondents observed or made changes to their apheresis service during the COVID-19 pandemic. A subset of changes, such as increased utilization of telemedicine, may persist.
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Affiliation(s)
- Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mohamed Alsammak
- Blood Bank/Transfusion Medicine, Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Vishesh Chhibber
- Department of Pathology and Laboratory Medicine, Northwell Health, Manhasset, New York, USA
| | - Nnaemeka Ibeh
- Department of Pathology and Laboratory Medicine, University of Texas Health Houston, Houston, Texas, USA
| | - Yanhua Li
- Transfusion Medicine, UMass Memorial Health and Departments of Medicine and Pathology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Daniel K Noland
- Department of Pathology, University of Texas Southwestern and Children's Health Dallas, Dallas, Texas, USA
| | - Ding Wen Wu
- Department of Pathology and Laboratories, New York University Langone Health, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Phillip J DeChristopher
- Loyola University Health System, Department of Pathology and Laboratory Medicine, Maywood, Illinois, USA
| | | | - Wen Lu
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Rochester, Minnesota, USA
| | - Gay Wehrli
- University Hospitals Samaritan Medical Center and Case Western Reserve University, Ashland, Ohio, USA
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Datta R, Kiwak E, Fried TR, Benjamin A, Iannone L, Krein SL, Carter W, Cohen AB. Diagnostic uncertainty and decision-making in home-based primary care: A qualitative study of antibiotic prescribing. J Am Geriatr Soc 2024; 72:1468-1475. [PMID: 38241465 PMCID: PMC11090732 DOI: 10.1111/jgs.18778] [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: 08/18/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Evaluating infection in home-based primary care is challenging, and these challenges may impact antibiotic prescribing. A refined understanding of antibiotic decision-making in this setting can inform strategies to promote antibiotic stewardship. This study investigated antibiotic decision-making by exploring the perspectives of clinicians in home-based primary care. METHODS Clinicians from the Department of Veterans Affairs Home-Based Primary Care Program were recruited. Semi-structured interviews were conducted from June 2022 through September 2022 using a discussion guide. Transcripts were analyzed using grounded theory. The constant comparative method was used to develop a coding structure and to identify themes. RESULTS Theoretical saturation was reached after 22 clinicians (physicians, n = 7; physician assistants, n = 2, advanced practice registered nurses, n = 13) from 19 programs were interviewed. Mean age was 48.5 ± 9.3 years, 91% were female, and 59% had ≥6 years of experience in home-based primary care. Participants reported uncertainty about the diagnosis of infection due to the characteristics of homebound patients (atypical presentations of disease, presence of multiple chronic conditions, presence of cognitive impairment) and the challenges of delivering medical care in the home (limited access to diagnostic testing, suboptimal quality of microbiological specimens, barriers to establishing remote access to the electronic health record). When faced with diagnostic uncertainty about infection, participants described many factors that influenced the decision to prescribe antibiotics, including those that promoted prescribing (desire to avoid hospitalization, pressure from caregivers, unreliable plans for follow-up) and those that inhibited prescribing (perceptions of antibiotic-associated harms, willingness to trial non-pharmacological interventions first, presence of caregivers who were trusted by clinicians to monitor symptoms). CONCLUSIONS Clinicians face the difficult task of balancing diagnostic uncertainty with many competing considerations during the treatment of infection in home-based primary care. Recognizing these issues provides insight into strategies to promote antibiotic stewardship in home care settings.
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Affiliation(s)
- Rupak Datta
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eliza Kiwak
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Terri R. Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrea Benjamin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynne Iannone
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarah L. Krein
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Warren Carter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew B. Cohen
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Rutstein SE, Muessig KE. Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States. Curr HIV/AIDS Rep 2024; 21:52-61. [PMID: 38517670 DOI: 10.1007/s11904-024-00697-x] [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] [Accepted: 02/24/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Despite highly effective biomedical HIV pre-exposure prophylaxis (PrEP) options, suboptimal PrEP uptake impedes progress towards ending the epidemic in the United States of America (USA). Implementation science bridges what we know works in controlled clinical trial settings to the context and environment in which efficacious tools are intended to be deployed. In this review, we focus on strategies that target PrEP use barriers at the system or structural level, exploring the implications and opportunities in the context of the fragmented USA healthcare system. RECENT FINDINGS Task shifting could increase PrEP prescribers, but effectiveness evidence is scarce in the USA, and generally focused in urban settings. Integration of PrEP within existing healthcare infrastructure concentrates related resources, but demonstration projects rarely present the resource implications of redirecting staff. Changing the site of service via expanded telehealth could improve access to more rural populations, though internet connectivity, technology access, and challenges associated with determining biomedical eligibility remain logistical barriers for some of the highest burden communities in the USA. Finally, a tailored care navigation and coordination approach has emerged as a highly effective component of PrEP service provision, attempting to directly modify the system-level determinants of PrEP use experienced by the individual. We highlight recent advances and evidence surrounding task shifting, integration, service delivery, and tailoring. With the exception of tailored care navigation, evidence is mixed, and the downstream impact and sustainability of task shifting and care integration require further attention. To maximize PrEP outcomes, research will need to continue to examine the interplay between individuals, clinics, and the healthcare system and associated policies within which they operate.
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Affiliation(s)
- Sarah E Rutstein
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
| | - Kathryn E Muessig
- Institute On Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, USA
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Barth SK, Saulters KJ, Balba GP, Monroe AK, Horberg MA, Kumar PN, Greenberg AE, Castel AD. Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC. AIDS Behav 2024; 28:912-923. [PMID: 37872460 PMCID: PMC10923106 DOI: 10.1007/s10461-023-04198-7] [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] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020-December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.
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Affiliation(s)
- Shannon K Barth
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA.
| | - Kacie J Saulters
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
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Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis 2024; 78:e12-e26. [PMID: 38018174 DOI: 10.1093/cid/ciad664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine at San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
| | - Jacinda C Abdul Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California-San Diego, La Jolla, California, USA
| | - Amelia Goff
- Section of Addiction Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica Brown
- Department of Care Management, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Kathleen Fairfield
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Alysse Wurcel
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medicine, Boston, Massachusetts, USA
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Bono RS, Pan Z, Dahman B, Deng Y, Kimmel AD. Urban-rural disparities in geographic accessibility to care for people living with HIV. AIDS Care 2023; 35:1844-1851. [PMID: 36369925 PMCID: PMC10175509 DOI: 10.1080/09540121.2022.2141186] [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: 05/03/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
In the United States, people living with HIV (PLWH) in rural areas fare worse along the HIV care continuum than their urban counterparts; this may be due in part to limited geographic access to care. We estimated drive time to care for PLWH, focusing on urban-rural differences. Adult Medicaid enrollees living with HIV and their usual care clinicians were identified using administrative claims data from 14 states (Medicaid Analytic eXtract, 2009-2012). We used geographic network analysis to calculate one-way drive time from the enrollee's ZIP code tabulation area centroid to their clinician's practice address, then examined urban-rural differences using bivariate statistics. Additional analyses included altering the definition of rurality; examining subsamples based on the state of residence, services received, and clinician specialty; and adjusting for individual and county characteristics. Across n = 49,596 PLWH, median drive time to care was 12.8 min (interquartile range 26.3). Median drive time for rural enrollees (43.6 (82.0)) was nearly four times longer than for urban enrollees (11.9 (20.6) minutes, p < 0.0001), and drive times exceeded one hour for 38% of rural enrollees (versus 12% of urban, p < 0.0001). Urban-rural disparities remained in all additional analyses. Sustained efforts to circumvent limited geographic access to care are critical for rural areas.
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Affiliation(s)
- Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Zhongzhe Pan
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Livorsi DJ, Sherlock SH, Cunningham Goedken C, Pratt S, Goodman DA, Clarke KC, Cho H, Schacht Reisinger H, Perencevich EN. The use of telehealth-supported stewardship activities in acute-care and long-term care settings: An implementation effectiveness trial. Infect Control Hosp Epidemiol 2023; 44:2028-2035. [PMID: 37312262 PMCID: PMC10755161 DOI: 10.1017/ice.2023.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND We assessed the implementation of telehealth-supported stewardship activities in acute-care units and long-term care (LTC) units in Veterans' Administration medical centers (VAMCs). DESIGN Before-and-after, quasi-experimental implementation effectiveness study with a baseline period (2019-2020) and an intervention period (2021). SETTING The study was conducted in 3 VAMCs without onsite infectious disease (ID) support. PARTICIPANTS The study included inpatient providers at participating sites who prescribe antibiotics. INTERVENTION During 2021, an ID physician met virtually 3 times per week with the stewardship pharmacist at each participating VAMC to review patients on antibiotics in acute-care units and LTC units. Real-time feedback on prescribing antibiotics was given to providers. Additional implementation strategies included stakeholder engagement, education, and quality monitoring. METHODS The reach-effectiveness-adoption-implementation-maintenance (RE-AIM) framework was used for program evaluation. The primary outcome of effectiveness was antibiotic days of therapy (DOT) per 1,000 days present aggregated across all 3 sites. An interrupted time-series analysis was performed to compare this rate during the intervention and baseline periods. Electronic surveys, periodic reflections, and semistructured interviews were used to assess other RE-AIM outcomes. RESULTS The telehealth program reviewed 502 unique patients and made 681 recommendations to 24 providers; 77% of recommendations were accepted. After program initiation, antibiotic DOT immediately decreased in the LTC units (-30%; P < .01) without a significant immediate change in the acute-care units (+16%; P = .22); thereafter DOT remained stable in both settings. Providers generally appreciated feedback and collaborative discussions. CONCLUSIONS The implementation of our telehealth program was associated with reductions in antibiotic use in the LTC units but not in the smaller acute-care units. Overall, providers perceived the intervention as acceptable. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use.
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Affiliation(s)
- Daniel J. Livorsi
- Iowa City Veterans’ Administration Health Care System, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Stacey Hockett Sherlock
- Iowa City Veterans’ Administration Health Care System, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | | | - Sandra Pratt
- John J. Pershing Veterans’ Administration Medical Center, Poplar Bluff, Missouri
| | | | - Kim C. Clarke
- Carl Vinson Veterans’ Administration Medical Center, Dublin, Georgia
| | - Hyunkeun Cho
- University of Iowa, Department of Biostatistics, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Iowa City Veterans’ Administration Health Care System, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Eli N. Perencevich
- Iowa City Veterans’ Administration Health Care System, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
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Bolster MB, Kolfenbach J, Poeschla A, Criscione-Schreiber L, Hant F, Ishizawar R, Jonas B, Leverenz D, O'Rourke KS, Wolfe RM, Zickuhr L. Incorporating Telemedicine in Rheumatology Fellowship Training Programs: Needs Assessment, Curricular Intervention, and Evaluation. Arthritis Care Res (Hoboken) 2023; 75:2428-2434. [PMID: 37232060 DOI: 10.1002/acr.25165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/07/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To increase the confidence of rheumatology fellows in training (FITs) in delivering virtual care (VC) and prepare them for independent practice, we developed educational materials addressing gaps in their skills. METHODS We identified gaps in telemedicine skills based on FIT performance in a virtual rheumatology objective structured clinical examination (vROSCE) station on VC delivery using video teleconference technology and survey (survey 1) responses. We created educational materials including videos of "mediocre" and "excellent" VC examples, discussion/reflection questions, and a document summarizing key practices. We measured change in the confidence levels of FITs for delivering VC with a post-intervention survey (survey 2). RESULTS Thirty-seven FITs (19 first-year, 18 second- plus third-year fellows) from 7 rheumatology fellowship training programs participated in a vROSCE and demonstrated gaps in skills mapping to several Rheumatology Telehealth Competency domains. Confidence levels of FITs improved significantly from survey 1 to survey 2 for 22 of 34 (65%) questions. All participating FITs found the educational materials helpful for learning and reflecting on their own VC practice; 18 FITs (64%) qualified usefulness as "moderately" or "a lot." Through surveying, 17 FITs (61%) reported implementing skills from the instructional videos into VC visits. CONCLUSION Continually assessing our learners' needs and creating educational materials addressing gaps in training are requisite. Using a vROSCE station, needs assessments, and targeted learning with videos and discussion-guidance materials enhanced the confidence level of FITs in VC delivery. It is imperative to incorporate VC delivery into fellowship training program curricula to ensure breadth in skills, attitudes, and knowledge of new entrants into the rheumatology workforce.
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Affiliation(s)
| | | | | | | | - Faye Hant
- Medical University of South Carolina, Charleston
| | | | - Beth Jonas
- University of North Carolina at Chapel Hill
| | | | | | - Rachel M Wolfe
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Higgins DM, Riba A, Alderton L, Wendel KA, Scanlon J, Weise J, Gibson N, Obafemi O. Evaluation of the Impact and Outcomes of a Rapid Transition to Telehealth PrEP Delivery at a Sexual Health Clinic During the COVID-19 Pandemic. Sex Transm Dis 2023; 50:816-820. [PMID: 37820240 PMCID: PMC10668045 DOI: 10.1097/olq.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Increasing human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) use is a critical part of ending the HIV epidemic. In response to the COVID-19 pandemic, many PrEP services transitioned to a telehealth model (telePrEP). This report evaluates the effect of COVID-19 and the addition of telePrEP on delivery of PrEP services at the Denver Sexual Health Clinic (DSHC), a regional sexual health clinic in Denver, CO. METHODS Before COVID-19, DSHC PrEP services were offered exclusively in-clinic. In response to the pandemic, after March 15, 2020, most PrEP initiation and follow-up visits were converted to telePrEP. A retrospective analysis of DSHC PrEP visits compared pre-COVID-19 (September 1, 2019 to March 15, 2020) to post-COVID-19 (March 16, 2020 to September 30, 2020) visit volume, demographics, and outcomes. RESULTS The DSHC completed 689 PrEP visits pre-COVID-19 and maintained 96.8% (n = 667) of this volume post-COVID-19. There were no differences in client demographics between pre-COVID-19 (n = 341) and post-COVID-19 PrEP start visits (n = 283) or between post-COVID-19 in-clinic (n = 140) vs telePrEP start visits (n = 143). There were no differences in 3- to 4-month retention rates pre-COVID-19 (n = 17/43) and post-COVID-19 (n = 21/43) ( P = 0.52) or between in-clinic (n = 12/21) and telePrEP clients (n = 9/22) in the post-COVID-19 window ( P = 0.37). Also, there were no significant differences in lab completion rates between in-clinic (n = 140/140) and telePrEP clients (n = 138/143) ( P = 0.06) and prescription fill rates between in-clinic (n = 115/136) and telePrEP clients (n = 116/135) in the post-COVID-19 window ( P = 0.86). CONCLUSIONS Implementation of TelePrEP enabled the DSHC to sustain PrEP services during the COVID-19 pandemic without significant differences in demographics, engagement, or retention in PrEP services.
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Affiliation(s)
- David M. Higgins
- Public Health Institute at Denver Health, Denver, CO
- Department of Preventive Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Adrean Riba
- Public Health Institute at Denver Health, Denver, CO
| | - Lucy Alderton
- Public Health Institute at Denver Health, Denver, CO
| | - Karen A. Wendel
- Public Health Institute at Denver Health, Denver, CO
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Julia Weise
- Public Health Institute at Denver Health, Denver, CO
| | - Nathan Gibson
- Public Health Institute at Denver Health, Denver, CO
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12
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Dulude C, Sutherland S, Vanderhout S, King WJ, Zuijdwijk C, Major N, Audcent T, Howley H, Cloutier P, Buba M, Jain R, Litwinska J, Findlay L, Malic C, Macaulay K, Parker K, Kouri C, Goldbloom EB. A pediatric virtual care evaluation framework and its evolution using consensus methods. BMC Pediatr 2023; 23:402. [PMID: 37592246 PMCID: PMC10433580 DOI: 10.1186/s12887-023-04229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. METHODS We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. RESULTS The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. CONCLUSIONS This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.
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Affiliation(s)
- Catherine Dulude
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Stephanie Sutherland
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Shelley Vanderhout
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, Canada
| | - W James King
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Tobey Audcent
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Heather Howley
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Paula Cloutier
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Melanie Buba
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute Family Leader Program, 401 Smyth Rd, Ottawa, ON, Canada
| | - Raagini Jain
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Justyna Litwinska
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Leanne Findlay
- Children's Hospital of Eastern Ontario Research Institute Family Leader Program, 401 Smyth Rd, Ottawa, ON, Canada
| | - Claudia Malic
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Karen Macaulay
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Kasey Parker
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Christine Kouri
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
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Walia K, Mendelson M, Kang G, Venkatasubramanian R, Sinha R, Vijay S, Veeraraghavan B, Basnyat B, Rodrigues C, Bansal N, Ray P, Mathur P, Gopalakrishnan R, Ohri VC. How can lessons from the COVID-19 pandemic enhance antimicrobial resistance surveillance and stewardship? THE LANCET. INFECTIOUS DISEASES 2023; 23:e301-e309. [PMID: 37290476 DOI: 10.1016/s1473-3099(23)00124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 06/10/2023]
Abstract
COVID-19 demanded urgent and immediate global attention, during which other public health crises such as antimicrobial resistance (AMR) increased silently, undermining patient safety and the life-saving ability of several antimicrobials. In 2019, WHO declared AMR a top ten global public health threat facing humanity, with misuse and overuse of antimicrobials as the main drivers in the development of antimicrobial-resistant pathogens. AMR is steadily on the rise, especially in low-income and middle-income countries across south Asia, South America, and Africa. Extraordinary circumstances often demand an extraordinary response as did the COVID-19 pandemic, underscoring the fragility of health systems across the world and forcing governments and global agencies to think creatively. The key strategies that helped to contain the increasing SARS-CoV-2 infections included a focus on centralised governance with localised implementation, evidence-based risk communication and community engagement, use of technological methods for tracking and accountability, extensive expansion of access to diagnostics, and a global adult vaccination programme. The extensive and indiscriminate use of antimicrobials to treat patients, particularly in the early phase of the pandemic, have adversely affected AMR stewardship practices. However, there were important lessons learnt during the pandemic, which can be leveraged to strengthen surveillance and stewardship, and revitalise efforts to address the AMR crisis.
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Affiliation(s)
- Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India.
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gagandeep Kang
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | - Rina Sinha
- World Health Organization, Country Office for India, New Delhi, India
| | - Sonam Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
| | | | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Camilla Rodrigues
- Department of Microbiology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Nitin Bansal
- Division of Infectious Diseases, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vinod C Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
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14
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Speight CC, Williamson JE, Ebied AM, Medaris LA, McCurdy L, Hammer KL. Impact of Infectious Diseases Consultation in Patients With Candidemia at a Multisite Health Care System With Established Antimicrobial Stewardship and Telemedicine Services. Open Forum Infect Dis 2023; 10:ofad388. [PMID: 37555131 PMCID: PMC10405132 DOI: 10.1093/ofid/ofad388] [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: 05/02/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
Background Infectious diseases consultation improves outcomes in patients with candidemia, although some facilities lack access to consultation. This multisite health care system study compared in-hospital mortality in patients with candidemia across 3 groups-those who received on-site consultation, telemedicine consultation, or no consultation. All patients were reviewed by an antimicrobial stewardship pharmacist. Methods A retrospective observational cohort study was performed of adult hospitalized patients with candidemia from January 2018 to October 2021. The primary outcome was in-hospital mortality. Secondary outcomes included receipt and duration of antifungals, removal of central venous lines if present, ophthalmologic examination, echocardiography, and determination of infection source. Results A total of 265 patients were evaluated: 187 in the on-site consultation group, 49 in the telemedicine consultation group, and 29 in the nonconsultation group. Although in-hospital mortality did not differ significantly between the on-site and nonconsultation groups, it was significantly lower in the telemedicine group when compared with the nonconsultation group (10.2% vs 34.5%, P = .009). Patients who received on-site or telemedicine consultation had significantly more antifungal therapy initiated, appropriate therapy duration, central lines removed, and echocardiography performed, as well as fewer unknown candidemia sources, vs those in the nonconsultation group. Conclusions This is the first study of a multisite health care system providing telemedicine services to evaluate the impact of infectious diseases consultation on candidemia mortality. These findings suggest that when on-site consultation is unavailable, infectious diseases telemedicine consultation and antimicrobial stewardship can improve outcomes and should be considered for all patients with candidemia at resource-limited sites.
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Affiliation(s)
- Carly C Speight
- Department of Pharmacy, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Julie E Williamson
- Antimicrobial Support Network, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Alex M Ebied
- Department of Medical Affairs, Celltrion USA, Jersey City, New Jersey, USA
| | - Leigh Ann Medaris
- Division of Infectious Diseases, Department of Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Lewis McCurdy
- Division of Infectious Diseases, Department of Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Katie L Hammer
- Antimicrobial Support Network, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
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15
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Talal AH, Sofikitou EM, Wang K, Dickerson S, Jaanimägi U, Markatou M. High Satisfaction with Patient-Centered Telemedicine for Hepatitis C Virus Delivered to Substance Users: A Mixed-Methods Study. Telemed J E Health 2023; 29:395-407. [PMID: 35925809 PMCID: PMC10024261 DOI: 10.1089/tmj.2022.0189] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: While telemedicine may increase health care access for vulnerable populations, data are limited on whether people with opioid use disorder (PWOUD) are satisfied with telemedicine. We assessed PWOUD satisfaction with telemedicine and identified factors that increase telemedicine satisfaction. Methods: We conducted a mixed-methods study among hepatitis C virus (HCV)-infected persons enrolled at 12 opioid treatment programs (OTPs) throughout New York State. Participants successfully completed HCV treatment either through telemedicine integrated into OTPs (N = 238) or through offsite referral (N = 106). We evaluated Patient Satisfaction Questionnaire (PSQ) response scores at the initial and final health care encounters and subsequently interviewed telemedicine study participants (N = 25) to assess their experiences with telemedicine. Results: All participants (N = 344) successfully completed HCV treatment. We observed no differences in PSQ scores between telemedicine and in-person encounters (98.3% and 98.7% of telemedicine participants provided PSQ scores of satisfied or highly satisfied at each timepoint, respectively). Study participants indicated that attributes associated with high telemedicine encounter satisfaction included: (1) communicating study information, (2) gaining trust, and (3) delivering patient-centered care. Participants weighted "General Satisfaction" and "Time Spent with Doctor" higher than "Accessibility and Convenience," and female participants were significantly more satisfied than males. Satisfaction with health care delivery among all participants increased significantly comparing timepoints. Conclusions: Participants were highly satisfied with HCV telemedicine encounters equivalent to in-person encounters. Communication augments trust facilitating delivery of patient-centered care through telemedicine. Participants value empathy and trust with providers over accessibility and convenience. In summary, PWOUD are highly satisfied with the facilitated telemedicine model and value empathetic and trusting providers. ClinicalTrials.gov Identifier: NCT02933970.
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Affiliation(s)
- Andrew H. Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, New York, USA
- Address correspondence to: Andrew H. Talal, MD, MPH, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, State University of New York, 875 Ellicott Street, Suite 6090, Buffalo, NY 14203, USA
| | - Elisavet M. Sofikitou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Kejia Wang
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Suzanne Dickerson
- Division of Biobehavioral Health and Clinical Sciences, School of Nursing, University at Buffalo, Buffalo, New York, USA
| | - Urmo Jaanimägi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Marianthi Markatou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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16
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Antibiotic Prescribing in Outpatient Settings: Rural Patients Are More Likely to Receive Fluoroquinolones and Longer Antibiotic Courses. Antibiotics (Basel) 2023; 12:antibiotics12020224. [PMID: 36830137 PMCID: PMC9952143 DOI: 10.3390/antibiotics12020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Suboptimal antibiotic prescribing may be more common in patients living in rural versus urban areas due to various factors such as decreased access to care and diagnostic testing equipment. Prior work demonstrated a rural health disparity of overprescribing antibiotics and longer durations of antibiotic therapy in the United States; however, large-scale evaluations are limited. We evaluated the association of rural residence with suboptimal outpatient antibiotic use in the national Veterans Affairs (VA) system. Outpatient antibiotic dispensing was assessed for the veterans diagnosed with an upper respiratory tract infection (URI), pneumonia (PNA), urinary tract infection (UTI), or skin and soft tissue infection (SSTI) in 2010-2020. Rural-urban status was determined using rural-urban commuting area codes. Suboptimal antibiotic use was defined as (1) outpatient fluoroquinolone dispensing and (2) longer antibiotic courses (>ten days). Geographic variation in suboptimal antibiotic use was mapped. Time trends in suboptimal antibiotic use were assessed with Joinpoint regression. While controlling for confounding, the association of rurality and suboptimal antibiotic use was assessed with generalized linear mixed models with a binary distribution and logit link, accounting for clustering by region and year. Of the 1,405,642 veterans diagnosed with a URI, PNA, UTI, or SSTI and dispensed an outpatient antibiotic, 22.8% were rural-residing. In 2010-2020, in the rural- and urban-residing veterans, the proportion of dispensed fluoroquinolones declined by 9.9% and 10.6% per year, respectively. The rural-residing veterans were more likely to be prescribed fluoroquinolones (19.0% vs. 17.5%; adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI), 1.02-1.04) and longer antibiotic courses (53.8% vs. 48.5%; aOR, 1.19, 95% CI, 1.18-1.20) than the urban-residing veterans. Among a large national cohort of veterans diagnosed with URIs, PNA, UTIs, and SSTIs, fluoroquinolone use and longer antibiotic courses were disproportionally more common among rural- as compared to urban-residing veterans. Outpatient antibiotic prescribing must be improved, particularly for rural-residing patients. There are many possible solutions, of which antibiotic stewardship interventions are but one.
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Nyoni T, Evers EC, Pérez M, Jeffe DB, Fritz SA, Colditz GA, Burnham JP. Perceived barriers and facilitators to the adoption of telemedicine infectious diseases consultations in southeastern Missouri hospitals. J Telemed Telecare 2023:1357633X221149461. [PMID: 36659820 PMCID: PMC10354216 DOI: 10.1177/1357633x221149461] [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: 01/21/2023]
Abstract
INTRODUCTION Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri. METHODS Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants' knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators. RESULTS Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm. DISCUSSION Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach.
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Affiliation(s)
- Thabani Nyoni
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Emily C. Evers
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Maria Pérez
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Donna B. Jeffe
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason P. Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
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Epperson TM, Bennett KK, Kupiec KK, Speigel K, Neely SB, Resman-Targoff BH, Kinney KK, White BP. Impact of a Pharmacist-Managed Outpatient Parenteral Antimicrobial Therapy (OPAT) Service on Cost Savings and Clinical Outcomes at an Academic Medical Center. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e15. [PMID: 36714295 PMCID: PMC9879875 DOI: 10.1017/ash.2022.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
Background Outpatient antimicrobial therapy (OPAT) is managed by a variety of teams, but primarily through an infectious disease clinic. At our medical center, OPAT monitoring is performed telephonically by pharmacists through a collaborative practice agreement under the supervision of an infectious disease physician. The effect of telephonic monitoring of OPAT by pharmacists on patient outcomes is unknown. Methods This retrospective cohort study was conducted between July 2017 and July 2018 at a 350-bed academic medical center and included adult patients discharged home on IV antibiotics or oral linezolid. The experimental group comprised patients discharged with a consultation for the OPAT management program, whereas the control group comprised patients discharged home without a consultation. The primary outcome was 30-day readmission. Results In total, 399 patients were included: 243 patients in the OPAT management program group and 156 patients in the control group. The 30-day readmission rates were similar in each cohort (20% vs 19%; P = .8193); however, the 30-day readmission rates were lower in the OPAT management program for patients discharged on vancomycin (19.4% vs 39.1%; P = .004). Conclusions We did not find a difference in 30-day readmissions between patients receiving pharmacy-driven OPAT management services and those who did not. Patients receiving vancomycin via OPAT had lower 30-day readmissions when included in the pharmacist-driven OPAT management program. Institutions with limited resources may consider reserving OPAT management services for patients receiving antimicrobials that require pharmacokinetic dosing and/or close monitoring.
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Affiliation(s)
| | - Kiya K. Bennett
- Clinical and Administrative Sciences, Department of Pharmacy, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
| | - Katherine K. Kupiec
- Department of Pharmacy, University of Oklahoma Medical Center, Oklahoma City, Oklahoma
| | - Kathy Speigel
- Department of Nursing, University of Oklahoma Medical Center, Oklahoma City, Oklahoma
| | - Stephen B. Neely
- Clinical and Administrative Sciences, Department of Pharmacy, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
| | - Beth H. Resman-Targoff
- Clinical and Administrative Sciences, Department of Pharmacy, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
| | - Karen K. Kinney
- Infectious Diseases Section, Department of Internal Medicine, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Bryan P. White
- Department of Pharmacy, University of Oklahoma Medical Center, Oklahoma City, Oklahoma
- Infectious Diseases Section, Department of Internal Medicine, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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19
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Person AK, Armstrong WS, Evans T, Fangman JJW, Goldstein RH, Haddad M, Jain MK, Keeshin S, Tookes HE, Weddle AL, Feinberg J. Principles for Ending Human Immunodeficiency Virus as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medical Association. Clin Infect Dis 2023; 76:1-9. [PMID: 35965395 DOI: 10.1093/cid/ciac626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023] Open
Abstract
While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation.
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Affiliation(s)
- Anna K Person
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wendy S Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Healthcare System, Infectious Diseases Program, Atlanta, Georgia, USA
| | - Tyler Evans
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John J W Fangman
- Mass General Brigham Community Physicians, Boston, Massachusetts, USA
| | - Robert H Goldstein
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan Haddad
- Center for Key Populations, Community Health Center, Inc, Middletown, Connecticut, USA
| | - Mamta K Jain
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Parkland Health and Hospital System, Dallas, Texas, USA
| | - Susana Keeshin
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrea L Weddle
- HIV Medicine Association of the Infectious Diseases Society of America, Arlington, Virginia, USA
| | - Judith Feinberg
- Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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20
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Chowdhury PP, Beer L, Crim SM, Bosh KA, Desamu-Thorpe RG, Shouse LR. Clinical Outcomes of Adults With Diagnosed HIV Living in Ending the HIV Epidemic Priority Areas, Medical Monitoring Project, 2018. Public Health Rep 2023; 138:107-113. [PMID: 35137642 PMCID: PMC9730174 DOI: 10.1177/00333549221074339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Ending the HIV Epidemic (EHE) initiative prioritizes treatment and prevention efforts in counties where most new HIV diagnoses occur and states with substantial incidence of new HIV diagnoses in rural areas. Understanding the characteristics of adults with HIV living in EHE priority areas, and how these characteristics compare with adults with HIV living in non-EHE priority areas, can inform EHE efforts. METHODS We analyzed data from the 2018 Medical Monitoring Project (MMP) to understand the characteristics of adults with HIV living in 36 of 48 EHE priority counties; San Juan, Puerto Rico; and 1 of 7 EHE priority states. We calculated weighted percentages of sociodemographic characteristics, behaviors, and clinical outcomes of adults with diagnosed HIV living in MMP EHE priority areas and compared them with characteristics of adults who did not live in MMP EHE priority areas using prevalence ratios (PRs) with predicted marginal means. RESULTS Living in an MMP EHE priority area was more common among adults who were non-Hispanic Black or Hispanic, experienced homelessness, or were food insecure compared with adults who were non-Hispanic White (59.3% and 58.4% vs 41.0%), not experiencing homelessness (60.9% vs 51.9%), or not food insecure (59.8% vs 51.0%). Adults who lived in MMP EHE priority areas were significantly less likely to be adherent to their HIV medications (PR = 0.95; 95% CI, 0.91-0.99) and durably virally suppressed (PR = 0.94; 95% CI, 0.91-0.97), and more likely to miss scheduled appointments for HIV care (PR = 1.31; 95% CI, 1.10-1.56) than adults who did not live in MMP EHE priority areas. CONCLUSION To increase viral suppression and reduce HIV transmission, it is essential to strengthen public health efforts to improve medication and appointment adherence in this population.
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Affiliation(s)
- Pranesh P. Chowdhury
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stacy M. Crim
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karin A. Bosh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rodel G. Desamu-Thorpe
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Luke R. Shouse
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Livorsi DJ, Abdel-Massih R, Crnich CJ, Dodds-Ashley ES, Evans CT, Goedken CC, Echevarria KL, Kelly AA, Spires SS, Veillette JJ, Vento TJ, Jump RLP. An Implementation Roadmap for Establishing Remote Infectious Disease Specialist Support for Consultation and Antibiotic Stewardship in Resource-Limited Settings. Open Forum Infect Dis 2022; 9:ofac588. [PMID: 36544860 PMCID: PMC9757681 DOI: 10.1093/ofid/ofac588] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
Infectious Disease (ID)-trained specialists, defined as ID pharmacists and ID physicians, improve hospital care by providing consultations to patients with complicated infections and by leading programs that monitor and improve antibiotic prescribing. However, many hospitals and nursing homes lack access to ID specialists. Telehealth is an effective tool to deliver ID specialist expertise to resource-limited settings. Telehealth services are most useful when they are adapted to meet the needs and resources of the local setting. In this step-by-step guide, we describe how a tailored telehealth program can be implemented to provide remote ID specialist support for direct patient consultation and to support local antibiotic stewardship activities. We outline 3 major phases of putting a telehealth program into effect: pre-implementation, implementation, and sustainment. To increase the likelihood of success, we recommend actively involving local leadership and other stakeholders in all aspects of developing, implementing, measuring, and refining programmatic activities.
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Affiliation(s)
- Daniel J Livorsi
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Rima Abdel-Massih
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Infectious Disease Connect, Inc, Pittsburgh, Pennsylvania, USA
| | - Christopher J Crnich
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | | | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Medical Center, Hines, Illinois, USA
- Preventive Medicine and Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois, USA
| | - Cassie Cunningham Goedken
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Kelly L Echevarria
- Department of Veterans Affairs, Antimicrobial Stewardship Task Force, Washington, DC, USA
| | - Allison A Kelly
- Department of Veterans Affairs, Antimicrobial Stewardship Task Force, Washington, DC, USA
- Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - S Shaefer Spires
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - John J Veillette
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Todd J Vento
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC) at the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Valentine JA, Mena L, Millett G. Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention. Sex Transm Dis 2022; 49:S36-S40. [PMID: 36219706 DOI: 10.1097/olq.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT In the United States, sexually transmitted infections (STIs) are among the most persistent threats to health equity. Increasing access to STI prevention and control services through the provision of Remote Health and Telehealth can improve sexual health outcomes. Telehealth has been shown to increase access to care and even improve health outcomes. The increased flexibility offered by Telehealth services accommodates both patient and provider. Although both Telehealth and Remote Health strategies are important for STI prevention, share common attributes, and, in some circumstances, overlap, this article will focus more specifically on considerations for Telehealth and how it can contribute to increasing health equity by offering an important complement to and, in some cases, substitute for in-person STI services for some populations. Telehealth assists a variety of different populations, including those experiencing STI disparities; however, although the Internet offers a promising resource for many American households and increasing percentages of Americans are using its many resources, not all persons have equal access to the Internet. In addition to tailoring STI programs to accommodate unique patient populations, these programs will likely be faced with adapting services to fit reimbursement and licensing regulations.
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Affiliation(s)
- Jo A Valentine
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Leandro Mena
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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23
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Durojaiye OC, Jibril I, Kritsotakis EI. Effectiveness of telemedicine in outpatient parenteral antimicrobial therapy (Tele-OPAT): A systematic review. J Telemed Telecare 2022:1357633X221131842. [PMID: 36221964 DOI: 10.1177/1357633x221131842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Telemedicine is increasingly used to deliver healthcare in many clinical specialities. However, the adoption of telemedicine in the delivery of outpatient parenteral antimicrobial therapy (OPAT) has been relatively slow and limited. This study aims to collate current evidence for telemedicine in OPAT regarding clinical efficacy, safety, acceptability and cost-effectiveness. METHODS We systematically searched the Cochrane Library, CINAHL, EMCARE, EMBASE and MEDLINE databases through 24 July 2022, for relevant studies published in English. Research articles and conference abstracts were included if they involved any form of telephone or video consultation in delivering parenteral antibiotics in the home or outpatient setting. Study findings were synthesised into three main themes: patient outcomes and safety, patient and provider satisfaction and cost-effectiveness. The mixed methods appraisal tool was used to review the methodological quality of the studies. PROSPERO CRD42022342874. RESULTS The literature search yielded 311 articles, of which 12 (five full-length articles and seven conference abstracts) reporting over 1245 telemedicine interventions were reviewed. The reported outcomes were heterogeneous. Telemedicine was cost-effective and associated with high patient satisfaction and comparable complication rates compared to conventional OPAT. Considering six comparative studies, rehospitalisation risk was lower for telemedicine than conventional OPAT (risk ratio, 0.58; 95% confidence interval, 0.38-0.88; I2 = 31%). DISCUSSION The results of this review demonstrate that telemedicine has a role in delivering safe and cost-effective OPAT care, especially for patients residing in remote and geographically isolated locations. Nevertheless, high-quality studies and publication of existing data and experiences are needed to further validate this model of care delivery.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
- Department of Microbiology, Royal Derby Hospital, Derby, UK
| | - Ihsan Jibril
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, 37778School of Medicine, University of Crete, Heraklion, Greece
- School of Health and Related Research, Faculty of Medicine, Dentistry and Health, 7315University of Sheffield, Sheffield, UK
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24
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Shively NR, Jacobs MW, Moffa MA, Schorr RE, Walsh TL. Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System. Open Forum Infect Dis 2022; 9:ofac458. [PMID: 36168548 PMCID: PMC9511121 DOI: 10.1093/ofid/ofac458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Telehealth-based antimicrobial stewardship programs (TeleASPs) have led to reduced broad-spectrum antimicrobial utilization. Data on factors associated with acceptance of stewardship recommendations are limited. Methods A TeleASP, facilitated by remote infectious disease physicians and local pharmacists, was implemented in 2 community hospitals from February 2018 through July 2020. Variables potentially affecting acceptance of TeleASP recommendations were tracked. Odds ratios of acceptance were determined utilizing multiple logistic regression. Results During the 30-month period, 4863 (91.2%) of the total 5333 recommendations were accepted. Factors associated with a higher odds of acceptance in multivariable analysis were recommendations for antimicrobial dose/frequency adjustment (odds ratio [OR], 2.63; 95% CI, 1.6–4.3) and order for labs/tests (OR, 3.30; 95% CI, 2.1–5.2), while recommendations for antimicrobial de-escalation (OR, 0.75; 95% CI, 0.60–0.95) and antimicrobial discontinuation (OR, 0.57; 95% CI, 0.42–0.76) were associated with lower odds of acceptance. Female physicians were more likely to accept recommendations compared with males (93.1% vs 90.3% acceptance; OR, 1.65; 95% CI, 1.3–2.2). Compared with physicians with <3 years of experience, who had the highest acceptance rate (96.3%), physicians with ≥21 years of experience had the lowest (87.1%; OR, 0.26; 95% CI, 0.15–0.45). Conclusions TeleASP recommendations were accepted at a high rate. Acceptance rates were higher among female physicians, and recommendations to stop or de-escalate antimicrobials led to lower acceptance. Recommendations made to the most experienced physicians were the least accepted, which may be an important factor for stewardship programs to consider in education and intervention efforts.
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Affiliation(s)
- Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
| | - Max W Jacobs
- Department of Medicine, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
| | - Matthew A Moffa
- Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
| | - Rebecca E Schorr
- Care Analytics, Highmark Health , Pittsburgh, Pennsylvania , USA
| | - Thomas L Walsh
- Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
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25
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Payvandi L, Correa ET, Hatoun J, O'Donnell H, Vernacchio L. Trends in Telehealth Antibiotic Prescribing for Children Through the COVID-19 Pandemic. Pediatrics 2022; 150:188355. [PMID: 35765129 DOI: 10.1542/peds.2022-056209] [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: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Telehealth visits increased significantly during the coronavirus disease 2019 pandemic without consensus on the appropriate scope of telehealth antibiotic prescribing within pediatric primary care. We describe telehealth antibiotic prescribing patterns within our statewide pediatric primary care network during the coronavirus disease 2019 pandemic. METHODS In a retrospective observational study of a large statewide pediatric primary care network, we identified and analyzed telehealth and in-person encounters with oral antibiotics prescribed from March 2020 to July 2021. We focused on the top 5 general diagnosis groupings using International Classification of Disease 10 codes. RESULTS Of the 55 926 encounters with an oral antibiotic prescribed, 12.5% were conducted via telehealth and 87.5% in person. The proportion of telehealth antibiotic encounters varied significantly according to diagnosis category (P <.001): ear (30.8%), skin and subcutaneous (21.8%), respiratory (18.8%), genitourinary (6.3%), and Lyme disease infections (3.8%). The proportion of telehealth antibiotic encounters for all diagnosis categories peaked in spring of 2020. The greatest proportion of telehealth antibiotic prescribing during the most recent 4weeks of the analysis were Lyme disease infections (11.7%) and for skin and subcutaneous tissue infections (3.1%). CONCLUSIONS Telehealth continues to be used to prescribe antibiotics even after the initial stage of the pandemic. Clinicians and patients would benefit from clearer guidelines about the appropriate use of antibiotics prescribed during telehealth encounters.
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Affiliation(s)
| | | | - Jonathan Hatoun
- Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Heather O'Donnell
- Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Brookline, Massachusetts
| | - Louis Vernacchio
- Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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26
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Gupta N, Bariola JR, Mellors JW, Abdel-Massih RC. In-Person vs Tele-Infectious Disease (Tele-ID) Care: Is One Better? Open Forum Infect Dis 2022; 9:ofac410. [PMID: 36046699 PMCID: PMC9423376 DOI: 10.1093/ofid/ofac410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
We compared outcomes at 3 community hospitals before and after switching from in-person to a Tele-ID group from an academic medical center. Compared to in-person, Tele-ID received significantly more consultations with similar outcomes for length of hospital stay, transfers, readmission, and mortality. Tele-ID is a suitable alternative for community settings.
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Affiliation(s)
- Nupur Gupta
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
| | - J Ryan Bariola
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
| | - Rima C Abdel-Massih
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
- Infectious Disease Connect, Inc , Pittsburgh, PA , USA
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27
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Lam PW, Schwartz IS, Medford RJ. Use of virtual care by infectious disease specialists in Canada: A national survey. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e106. [PMID: 36483399 PMCID: PMC9726522 DOI: 10.1017/ash.2022.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the type and extent of virtual care use among infectious disease specialists in Canada, with a focus on the clinical factors that influence the decision to provide virtual versus in-person care. METHODS Infectious disease physicians practicing in Canada were invited to complete a survey regarding their experiences with virtual care. The survey included 14 vignettes depicting new outpatient and post-hospital-discharge referrals. Participants were asked to select which (if any) virtual care modalities they would feel comfortable using and to specify a reason if they did not feel comfortable providing care virtually. Machine learning and natural language processing techniques were used to identify themes. RESULTS In total, 57 infectious disease physicians completed the survey. Respondents reported devoting 36.5% (SD, 18.4%) of their infectious disease practice to outpatient care, with 44.2% (SD, 23.2%) of it being delivered virtually. Respondents were more comfortable providing virtual care to post-hospital-discharge referrals who had been seen by an infectious disease physician compared to new outpatient referrals. When respondents were not comfortable with using any virtual care modality, the following common themes emerged: the need for physical examination, the importance of establishing a therapeutic relationship, the need for additional in-person tests or diagnostics, and patient counselling. CONCLUSION This study provides a glimpse into the current state of virtual care use in Canada and some of the major themes that affect decision making for virtual versus in-person care.
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Affiliation(s)
- Philip W. Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, TorontoOntario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard J. Medford
- Division of Infectious Diseases & Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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28
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Meyer JP, Price CR, Ye Y, Qin Y, Tracey D, Demidont AC, Melbourne K, Altice FL. A PrEP Demonstration Project Using eHealth and Community Outreach to Justice-Involved Cisgender Women and Their Risk Networks. AIDS Behav 2022; 26:3807-3817. [PMID: 35672552 DOI: 10.1007/s10461-022-03709-2] [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] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Women involved in criminal justice systems (WICJ) are a key population at risk for HIV, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. This project was designed to evaluate the feasibility and acceptability of delivering PrEP via eHealth to WICJ and members of their risk network (RN). We recruited HIV-negative cisgender WICJ index participants (n = 38) and risk network (RN) members (n = 67) using modified respondent-driven sampling. TDF/FTC was initiated for PrEP in participants meeting clinical criteria and dispensed through eHealth using a community-based, low barrier-to-care outreach model. Key steps in the PrEP care continuum were measured over 12 months. Enrolled participants (n = 105) had high current and lifetime justice-involvement and were predominantly cisgender women and non-Hispanic white with a mean age of 40.9y (SD 9.6). Despite most having primary care providers and medical insurance, PrEP awareness was low, and participants experienced high levels of medical, psychiatric, substance use, social, and economic need. Fifty-two participants (50%) were PrEP-eligible, of whom 24 (46%) initiated PrEP. TDF/FTC was safe and well-tolerated throughout follow-up and 13 individuals chose to remain on PrEP following study conclusion. In this novel PrEP demonstration project for WICJ and RN members, despite high medical, psychiatric, and social comorbidity, PrEP was positively received and effectively delivered using a community outreach model via eHealth.Registered on clinicaltrials.gov under trial registration number NCT03293290.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States.
| | - Carolina R Price
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - Yiwen Ye
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States
| | - Yilu Qin
- Primary Care Program, Yale New Haven Health, HIV Training Track, New Haven, CT, United States
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - A C Demidont
- Gilead Sciences, Inc, Foster City, CA, United States
| | | | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
- Yale School of Public Health, Epidemiology of Microbial Diseases, New Haven, CT, United States
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29
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Experiences with Telemedicine for HIV Care During the COVID-19 Pandemic: A Mixed-Methods Study. AIDS Behav 2022; 26:2099-2111. [PMID: 35064390 PMCID: PMC8782707 DOI: 10.1007/s10461-021-03556-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/14/2022]
Abstract
To characterize perspectives and experiences with telemedicine during the COVID-19 pandemic, we conducted a mixed-methods study in two HIV clinics in the US Northeast. Among surveyed patients with HIV (PWH) who had a telemedicine appointment (n = 205), 42.4% perceived telemedicine visits as useful during the pandemic. PWH and clinical staff identified benefits of telemedicine: (1) ability to engage and re-engage patients in care; (2) perceived patient-centeredness and flexibility; (3) opportunity to engage family and multidisciplinary care team members; and (4) opportunity to enhance telemedicine use proficiency through practice and support. Identified barriers included: (1) technical challenges; (2) privacy concerns; (3) loss of routine clinical experiences and interactions; (4) limited objective patient remote monitoring; and (5) reimbursement concerns. Efforts to optimize telemedicine for HIV care should consider strategies to improve technology support for PWH, flexible options to access care, additional platforms to allow patient remote monitoring, and appropriate billing and reimbursement methods.
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30
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Baim-Lance A, Angulo M, Chiasson MA, Lekas HM, Schenkel R, Villarreal J, Cantos A, Kerr C, Nagaraja A, Yin MT, Gordon P. Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State. BMC Health Serv Res 2022; 22:609. [PMID: 35524251 PMCID: PMC9073813 DOI: 10.1186/s12913-022-08010-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/28/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Older persons living with HIV (PLWH) need routine healthcare to manage HIV and other comorbidities. This mixed methods study investigated digital equity, constituted as access, use and quality, of HIV and specialty telehealth services for PLWH > 50 years during the initial wave of the COVID-19 pandemic when services transitioned to remote care. METHODS A survey of closed and open-ended questions was administered to 80 English (N = 63) and Spanish (N = 17) speaking PLWH receiving HIV care at an Academic Medical Center (N = 50) or a Federally Qualified Health Center (N = 30) in New York State. Quantitative analyses examined characteristics predicting telehealth use and visit quality. Qualitative analyses utilized thematic coding to reveal common experiences. Results were integrated to deepen the interpretation. RESULTS Telehealth access and use were shaped by multiple related and unstable factors including devices and connectivity, technology literacy, and comfort including privacy concerns. Participants demonstrated their substantial effort to achieve the visit. The majority of patients with a telehealth visit perceived it as worse than an in-person visit by describing it as less interpersonal, and resulting in poorer outcomes, particularly participants with less formal education. Technology was not only a barrier to access, but also influenced perceptions of quality. CONCLUSIONS In the COVID-19 pandemic initial wave, barriers to using telehealth were unequally distributed to those with more significant access and use challenges. Beyond these barriers, examining the components of equity indicate further challenges replicating in-person care using telehealth formats for older PLWH. Work remains to establish telehealth as both equitable and desirable for this population.
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Affiliation(s)
- Abigail Baim-Lance
- Geriatric Research Education and Clinical Center (GRECC), James J Peters VA Medical Center, 130 W. Kingsbridge Rd, 4A-17, Bronx, VA, 10468, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Matthew Angulo
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mary Ann Chiasson
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Helen-Maria Lekas
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Grossman School of Medicine, New York University, New York, NY, USA
| | - Rachel Schenkel
- Department of Family Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Jason Villarreal
- Comprehensive Health Program, New York-Presbyterian Hospital, New York, NY, USA
| | - Anyelina Cantos
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Michael T Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
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31
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Korycinski S, Metcalf D, Keteyian C. Effectiveness of a telephone-based nursing intervention to reduce hospital utilization by COVID-19 patients. Public Health Nurs 2022; 39:940-948. [PMID: 35334128 PMCID: PMC9115443 DOI: 10.1111/phn.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Determine the effectiveness of a COVID-19 remote monitoring and management program in reducing preventable hospital utilization. DESIGN A retrospective cohort study utilizing data from electronic health records. SAMPLE Two hundred ninety-three patients who tested positive for COVID-19 at a drive-through testing site in Michigan. [Correction added on 11 April 2022, after first online publication: In the preceding sentence, "Two hundred and ninety-third" has been corrected to "Two hundred ninety-three" in this version.] The intervention group, consisting of 139 patients, was compared to a control group of 154 patients. MEASUREMENTS The primary outcome was the 30-day probability of hospital utilization. The covariates included in the analysis were age, gender, tobacco use, body mass index (BMI), race, and ethnicity. INTERVENTION A nurse-led, telephone-based active management protocol for COVID-19 patients who were isolating at home. RESULTS The intervention group had a non-statistically significant 42% reduction in risk of hospital utilization within 30 days of a positive COVID-19 test when compared to the control group (HR = 0.578, p-value .111, HR 95% CI [0.29, 1.13]). CONCLUSIONS A nurse-led remote monitoring and management program for COVID-19 reduced the probability of 30-day hospital utilization. Although the findings were not statistically significant, the program yielded practical significance by reducing hospital utilization, in-person interaction, and the risk of infection for healthcare workers.
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Affiliation(s)
- Samantha Korycinski
- Preventive Medicine Residency ProgramUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - David Metcalf
- Research StatisticianResearch and Support SystemsHenry Ford Allegiance HealthJacksonMichiganUSA
| | - Courtland Keteyian
- President/CEOJackson Health NetworkJacksonMichiganUSA,Vice PresidentPopulation HealthHenry Ford Allegiance HealthJacksonMichiganUSA,Medical DirectorOccupational HealthHenry Ford Allegiance HealthJacksonMichiganUSA
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32
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Infectious diseases and primary care telemedicine in France. Infect Dis Now 2022; 52:236-238. [PMID: 35331975 PMCID: PMC9584825 DOI: 10.1016/j.idnow.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
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33
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Stosic MD, Duane JN, Durieux BN, Sando M, Robicheaux E, Podolski M, Sanders JJ, Ericson JD, Blanch-Hartigan D. Patient Preference for Telehealth Background Shapes Impressions of Physicians and Information Recall: A Randomized Experiment. Telemed J E Health 2022; 28:1541-1546. [PMID: 35271378 DOI: 10.1089/tmj.2021.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Telehealth is increasing rapidly as a health care delivery platform, but we lack empirical evidence regarding how telehealth environments can affect patient experiences. The present research determined how physician's telehealth backgrounds affect various patient outcomes. Methods: Participants viewed a 30-s video of a physician with one of six different virtual backgrounds and reported various socioemotional and cognitive responses to the mock telehealth experience. Results: Although the telehealth background manipulation did not impact participants' socioemotional or cognitive responses, participants' subjective perceptions of the telehealth backgrounds were related to important clinical outcomes, such as their ability to remember critical information from the appointment and overall satisfaction with the experience. Discussion: Telehealth environments may result in tradeoffs between patient experience, subjective impressions of clinicians, and information recall. Conclusions: A physician's telehealth background can have measurable impact on patients' telehealth experiences, suggesting a need for careful background selection and design.
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Affiliation(s)
- Morgan D Stosic
- Department of Psychology, University of Maine, Orono, Maine, USA
| | - Ja-Nae Duane
- Department of Information and Process Management, Bentley University, Waltham, Massachusetts, USA
| | - Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Madelyn Sando
- Department of Information Design & Corporate Communication, Bentley University, Waltham, Massachusetts, USA
| | | | - Maxim Podolski
- Department of Economics, Bentley University, Waltham, Massachusetts, USA
| | - Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Family Medicine, Palliative Care, McGill University, Montreal, Québec, Canada
| | - Jonathan D Ericson
- Department of Information Design & Corporate Communication, Bentley University, Waltham, Massachusetts, USA
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On the use of telemedicine in the context of COVID-19: legal aspects and a systematic review of technology. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC7954684 DOI: 10.1007/s42600-021-00133-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose The aim of this study was to carry out a systematic review of telemedicine technology and to discuss the role of legislation in the application of telemedicine technology within the scope of COVID-19. Methods The search for papers was conducted in the databases Cochrane Central, MEDLINE, and Embase. The keywords considered for this systematic review were (coronavirus OR “2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19” OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*))) AND ((telemedicine OR telehealth OR “remote assessment” OR telemonitoring)). The review process was carried out by six independent reviewers, using the PRISMA-P method. Results As a result, a total of 34 papers were selected, which addressed the study of telemedicine technologies used in times of endemics, epidemics, and pandemics, focusing on COVID-19. Conclusion Telemedicine allows for care in remote areas and at a lower cost to the patient and, in the current situation, it can reduce the number of contagions as well as the occupation of beds in health facilities. Telemedicine may suffer from limitations, mainly due to current legislation, but in this pandemic era of COVID-19, several countries around the world have made their laws more flexible to allow more widespread use of telemedicine.
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Pierce J, Stevens MP. The Emerging Role of Telehealth in Antimicrobial Stewardship: A Systematic Review and Perspective. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2021; 13:175-191. [PMID: 34975344 PMCID: PMC8713008 DOI: 10.1007/s40506-021-00256-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Purpose of Review The purpose of this article is to critically evaluate the available literature on telehealth and antimicrobial stewardship. Recent Findings There is limited evidence regarding the role of telehealth within the discipline of antimicrobial stewardship. A review of the available literature suggests remote antimicrobial stewardship programs conducted via telehealth can decrease antimicrobial consumption. A direct comparison between traditional antimicrobial stewardship programs and remote antimicrobial stewardship programs is lacking. Summary Telehealth is a promising tool for expanding antimicrobial stewardship, especially in small rural or community hospitals. Trust, team, and technology, the three Ts of remote antimicrobial stewardship derived from themes within the available literature, can serve as a framework for developing a remote antimicrobial stewardship program.
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Affiliation(s)
- Jacob Pierce
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University School of Medicine, 1000 E Marshall St., Richmond, VA 23298 USA
| | - Michael P Stevens
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University School of Medicine, 1000 E Marshall St., Richmond, VA 23298 USA
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Linz W, Andrzejewski C, Hofmann JC. Apheresis medicine in the era of advanced telehealth technologies: An American Society for Apheresis position paper part II: Principles of apheresis medical practice in a 21st century electronic medical practice environment. J Clin Apher 2021; 37:122-126. [PMID: 34837406 DOI: 10.1002/jca.21951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Walter Linz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - Chester Andrzejewski
- Transfusion and Apheresis Medicine Services, Department of Pathology, Baystate Medical Center, Baystate Health, Springfield, Massachusetts, USA
| | - Jan C Hofmann
- Department of Laboratory Medicine, UCSF School of Medicine, San Francisco, California, USA
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Recent Updates in Antimicrobial Stewardship in Outpatient Parenteral Antimicrobial Therapy. Curr Infect Dis Rep 2021; 23:24. [PMID: 34776793 PMCID: PMC8577634 DOI: 10.1007/s11908-021-00766-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/11/2022]
Abstract
Purpose of Review Antimicrobial stewardship within acute care is common and has been expanding to outpatient areas. Some inpatient antimicrobial stewardship tactics apply to outpatient parenteral antimicrobial therapy (OPAT) and complex outpatient antimicrobial therapy (COpAT) management, but differences do exist. Recent Findings OPAT/COpAT is a growing area of practice and research with its own unique considerations for antimicrobial stewardship. Potential ideas for antimicrobial stewardship in the OPAT/COpAT setting include redesigning the regimen to COpAT instead of OPAT, ensuring the use of the shortest effective duration of antimicrobial therapy; using antimicrobials dosed less frequently, such as long-acting glycopeptides; optimizing antimicrobial susceptibility testing reporting for common OPAT/COpAT drugs; and establishing routine laboratory and safety monitoring. Future consensus is needed to determine validated OPAT program metrics and outcomes. Summary As more focus is placed on outpatient antimicrobial stewardship, clinicians practicing in OPAT should publish more data regarding OPAT program methods and outcomes as they relate to antimicrobial stewardship. These can involve patient clinical outcomes, OPAT readmission rates, OPAT therapy completion, and central line-related complications.
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Rivera CG, Mehta M, Ryan KL, Stevens RW, Tucker KJ, Mahoney MV. Role of infectious diseases pharmacists in outpatient intravenous and complex oral antimicrobial therapy: Society of Infectious Diseases Pharmacists insights. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Meera Mehta
- Department of Pharmacy West Virginia University Medicine Morgantown West Virginia USA
| | - Keenan Levy Ryan
- Department of Pharmacy University of New Mexico Hospital Albuquerque New Mexico USA
| | | | - Kendall Jamaal Tucker
- Oregon Health & Science University Portland Oregon USA
- College of Pharmacy Oregon State University Corvallis Oregon USA
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Badowski ME, Bente JA, Davis EM, Isaacs D, Lewis L, Martello JL, Pitlick M, Almodóvar AS, Stadler S, Sutton Burke E, Belk M, Tovey A, Kane‐Gill SL. Telehealth and technological applications in
patient‐centered
care: Implications for pharmacy learners and clinical pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Diana Isaacs
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Lindi Lewis
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | - Madeline Belk
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Amber Tovey
- American College of Clinical Pharmacy Lenexa Kansas USA
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Andrzejewski C, McCreary EK, Khadem T, Abdel‐Massih RC, Bariola JR. Tele‐antimicrobial
stewardship programs: A review of the literature and the role of the pharmacist. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Erin K. McCreary
- Infectious Disease Connect, Incorporated Pittsburgh Pennsylvania USA
- Division of Infectious Diseases, Department of Medicine UPMC Pittsburgh Pennsylvania USA
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Tina Khadem
- Infectious Disease Connect, Incorporated Pittsburgh Pennsylvania USA
- Division of Infectious Diseases, Department of Medicine UPMC Pittsburgh Pennsylvania USA
- UPMC Community Hospital Antimicrobial Stewardship Efforts Pittsburgh Pennsylvania USA
| | - Rima C. Abdel‐Massih
- Infectious Disease Connect, Incorporated Pittsburgh Pennsylvania USA
- Division of Infectious Diseases, Department of Medicine UPMC Pittsburgh Pennsylvania USA
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - J. Ryan Bariola
- Infectious Disease Connect, Incorporated Pittsburgh Pennsylvania USA
- Division of Infectious Diseases, Department of Medicine UPMC Pittsburgh Pennsylvania USA
- UPMC Community Hospital Antimicrobial Stewardship Efforts Pittsburgh Pennsylvania USA
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Casariego-Vales E, Blanco-López R, Rosón-Calvo B, Suárez-Gil R, Santos-Guerra F, Dobao-Feijoo MJ, Ares-Rico R, Bal-Alvaredo M. Efficacy of Telemedicine and Telemonitoring in At-Home Monitoring of Patients with COVID-19. J Clin Med 2021; 10:jcm10132893. [PMID: 34209725 PMCID: PMC8268946 DOI: 10.3390/jcm10132893] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023] Open
Abstract
Aim: this work aims to assess if telemedicine and telemonitoring are clinically useful and safe for at-home monitoring of Coronavirus disease 2019 (COVID-19) patients. Methods: This is a retrospective cohort study of all patients diagnosed with COVID-19 in Galicia (Northwestern Spain) between 26 December 2020 and 15 February 2021. The structured, proactive monitoring via telemonitoring (TELEA) of patients considered to be high-risk in the Lugo, A Mariña, and Monforte Healthcare Area (ASLAM) was evaluated compared to other models in the remaining healthcare areas of Galicia. Results: Of the 47,053 COVID-19 patients, 4384 (9.3%) were in ASLAM. Of them, 1187 (27.1%) were monitored via TELEA, and the rest (3197 in ASLAM and 42,669 in the rest of Galicia) were monitored via other methods. Patients monitored in ASLAM via TELEA were older, consulted in the emergency department less frequently (p = 0.05), were hospitalized less frequently (p < 0.01), had shorter hospital stays (p < 0.0001), and had a lower mortality rate in their first hospitalization (p = 0.03). No at-home life-threatening emergencies were recorded. Conclusions: these data suggest that, for COVID-19 patients, a care model involving proactive at-home monitoring with telemedicine and telemonitoring is associated with reduced pressure on hospital services and a lower mortality rate.
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Affiliation(s)
- Emilio Casariego-Vales
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.S.-G.); (M.B.-A.)
- Unidad Administrativa 3B, Lucus Augusti University Hospital, C/Dr. U. Romero, 1, 27003 Lugo, Spain
- Correspondence:
| | - Rosa Blanco-López
- Day Hospital Nursing, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.B.-L.); (M.J.D.-F.)
| | - Benigno Rosón-Calvo
- Subdirectorate General, Galician Health Service, Ministry of Health, Santiago de Compostela, 15703 A Coruña, Spain; (B.R.-C.); (F.S.-G.)
| | - Roi Suárez-Gil
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.S.-G.); (M.B.-A.)
| | - Fernando Santos-Guerra
- Subdirectorate General, Galician Health Service, Ministry of Health, Santiago de Compostela, 15703 A Coruña, Spain; (B.R.-C.); (F.S.-G.)
| | - María José Dobao-Feijoo
- Day Hospital Nursing, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.B.-L.); (M.J.D.-F.)
| | - Ramón Ares-Rico
- Management, Lugo Healthcare Area, A Mariña and Monforte de Lemos, Lucus Augusti University Hospital, 27003 Lugo, Spain;
| | - Mercedes Bal-Alvaredo
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.S.-G.); (M.B.-A.)
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Cairns KA, Avent M, Buono E, Cheah R, Devchand M, Khumra S, Rawlins M, Roberts JA, Xenos K, Munro C. Standard of practice in infectious diseases for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kelly A. Cairns
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department Alfred Health Melbourne Australia
| | - Minyon Avent
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Queensland State‐Wide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR The University of Queensland Brisbane Australia
| | - Evette Buono
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Clinical Excellence Commission Sydney Australia
- National Centre for Antimicrobial Stewardship Doherty Institute Melbourne Australia
| | - Ron Cheah
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- National Centre for Antimicrobial Stewardship Doherty Institute Melbourne Australia
- Pharmacy Department Monash Health Clayton Australia
| | - Misha Devchand
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Austin Health Heidelberg Australia
| | - Sharmila Khumra
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Austin Health Heidelberg Australia
| | - Matthew Rawlins
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Department of Pharmacy Fiona Stanley Hospital Murdoch Australia
| | - Jason A. Roberts
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- The University of Queensland Centre for Clinical Research Faculty of Medicine & Centre for Translational Anti‐infective Pharmacodynamics School of Pharmacy The University of Queensland Brisbane Australia
- Royal Brisbane and Women’s Hospital Brisbane Australia
- Nîmes University Hospital University of Montpellier Montpellier France
| | - Kristin Xenos
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Australian Commission on Safety and Quality in Health Care Sydney Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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Klatt ME, Schulz LT, Fleischman D, Fox BC, Burke S, Grinder D, Rose WE, Lepak AJ, Andes DR. Implementation of telehealth antimicrobial stewardship through partnership of an academic medical center and a community hospital. Am J Health Syst Pharm 2021; 78:2256-2264. [PMID: 34153104 DOI: 10.1093/ajhp/zxab263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Small community hospitals often lack the human, financial, and technological resources necessary to implement and maintain successful antimicrobial stewardship programs now required by national regulatory and accrediting bodies. Creative solutions are needed to address this problem. SUMMARY A 3-stage, quasi-experimental study including patients receiving antibiotics for pneumonia, skin and soft tissue infections, and urinary tract infections at a community hospital in Wisconsin from June 2013 to December 2015 was conducted. Remote telehealth prospective audit and feedback, guideline and order set management, and staff education targeting pharmacists, nurses, and physicians were provided during the 7-month intervention phase; these services were then removed for the postintervention period. Antimicrobial utilization (days of therapy [DOT] per 1,000 patient-days), hospital length of stay, and readmission and 30-day mortality rates were assessed to determine the impact of telehealth services on these outcomes. During the preintervention (baseline), intervention, and postintervention periods, 1,037 patients received antibiotics for the targeted infectious disease conditions. Patient demographics and rates of infectious disease conditions were similar among the different periods. Telehealth antimicrobial stewardship reduced broad-spectrum antibiotic use, including use of imipenem (from 83 to 31 DOT, P < 0.001), levofloxacin (from 123 to 99 DOT, P < 0.001), and vancomycin (from 104 to 85 DOT, P < 0.001), compared to utilization during the baseline period; mean (SD) length of stay also decreased (from 4.6 [2.8] days to 4.2 [2.6] days, P = 0.02). After nonrenewal of telehealth stewardship, vancomycin and piperacillin/tazobactam usage returned to or exceeded baseline levels. CONCLUSION The partnership between an academic medical center and a small community hospital improved antimicrobial utilization and clinical outcomes. Successful telehealth antimicrobial stewardship models should be explored further as a means to provide optimal patient care.
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Affiliation(s)
| | | | | | - Barry C Fox
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Stuart Burke
- Department of Pharmacy, UW Health, Madison, WI, USA
| | - Dave Grinder
- Department of Pharmacy, Monroe Clinic, Monroe, WI, USA
| | - Warren E Rose
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander J Lepak
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David R Andes
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Safaeinili N, Vilendrer S, Williamson E, Zhao Z, Brown-Johnson C, Asch SM, Shieh L. Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study. JMIR Form Res 2021; 5:e26452. [PMID: 34033576 PMCID: PMC8211098 DOI: 10.2196/26452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33%), attending physicians (5/15, 33%), and resident physicians (5/15, 33%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient–clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team.
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Affiliation(s)
- Nadia Safaeinili
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Stacie Vilendrer
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Emma Williamson
- Department of Engineering, Stanford University, Stanford, CA, United States
| | - Zicheng Zhao
- Department of Comparative Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Cati Brown-Johnson
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Steven M Asch
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States.,Center for Innovation to Implementation, Veterans Affairs, Palo Alto, CA, United States
| | - Lisa Shieh
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
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Vento TJ, Veillette JJ, Gelman SS, Adams A, Jones P, Repko K, Stenehjem EA. Implementation of an Infectious Diseases Telehealth Consultation and Antibiotic Stewardship Program for 16 Small Community Hospitals. Open Forum Infect Dis 2021; 8:ofab168. [PMID: 34141816 PMCID: PMC8205263 DOI: 10.1093/ofid/ofab168] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Telehealth improves access to infectious diseases (ID) and antibiotic stewardship (AS) services in small community hospitals (SCHs), but the optimal model has not been defined. We describe implementation and impact of an integrated ID telehealth (IDt) service for 16 SCHs in the Intermountain Healthcare system. METHODS The Intermountain IDt service included a 24-hour advice line, eConsults, telemedicine consultations (TCs), daily AS surveillance, long-term AS program (ASP) support by an IDt pharmacist, and a monthly telementoring webinar. We evaluated program measures from November 2016 through April 2018. RESULTS A total of 2487 IDt physician interactions with SCHs were recorded: 859 phone calls (35% of interactions), 761 eConsults (30%), and 867 TCs (35%). Of 1628 eConsults and TCs, 1400 (86%) were SCH provider requests, while 228 (14%) were IDt pharmacist generated. Six SCHs accounted for >95% of interactions. Median consultation times for each initial telehealth interaction type were 5 (interquartile range [IQR], 5-10) minutes for phone calls, 20 (IQR, 15-25) minutes for eConsults, and 50 (IQR, 35-60) minutes for TCs. Thirty-two percent of consults led to in-person ID clinic follow-up. Bacteremia was the most common reason for consultation (764/2487 [31%]) and Staphylococcus aureus the most common organism identified. ASPs were established at 16 facilities. Daily AS surveillance led to 2229 SCH pharmacist and 1305 IDt pharmacist recommendations. Eight projects were completed with IDt pharmacist support, leading to significant reductions in meropenem, vancomycin, and fluoroquinolone use. CONCLUSIONS An integrated IDt model led to collaborative ID/ASP interventions and improvements in antibiotic use at 16 SCHs. These findings provide insight into clinical and logistical considerations for IDt program implementation.
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Affiliation(s)
- Todd J Vento
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
| | - John J Veillette
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Stephanie S Gelman
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
| | - Angie Adams
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
| | - Peter Jones
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
| | - Katherine Repko
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
| | - Edward A Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Office of Patient Experience, Intermountain Healthcare, Salt Lake City, Utah, USA
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Bono RS, Dahman B, Sabik LM, Yerkes LE, Deng Y, Belgrave FZ, Nixon DE, Rhodes AG, Kimmel AD. Human Immunodeficiency Virus-Experienced Clinician Workforce Capacity: Urban-Rural Disparities in the Southern United States. Clin Infect Dis 2021; 72:1615-1622. [PMID: 32211757 DOI: 10.1093/cid/ciaa300] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-experienced clinicians are critical for positive outcomes along the HIV care continuum. However, access to HIV-experienced clinicians may be limited, particularly in nonmetropolitan areas, where HIV is increasing. We examined HIV clinician workforce capacity, focusing on HIV experience and urban-rural differences, in the Southern United States. METHODS We used Medicaid claims and clinician characteristics (Medicaid Analytic eXtract [MAX] and MAX Provider Characteristics, 2009-2011), county-level rurality (National Center for Health Statistics, 2013), and diagnosed HIV cases (AIDSVu, 2014) to assess HIV clinician capacity in 14 states. We assumed that clinicians accepting Medicaid approximated the region's HIV workforce, since three-quarters of clinicians accept Medicaid insurance. HIV-experienced clinicians were defined as those providing care to ≥ 10 Medicaid enrollees over 3 years. We assessed HIV workforce capacity with county-level clinician-to-population ratios, using Wilcoxon-Mann-Whitney tests to compare urban-rural differences. RESULTS We identified 5012 clinicians providing routine HIV management, of whom 28% were HIV-experienced. HIV-experienced clinicians were more likely to specialize in infectious diseases (48% vs 6%, P < .001) and practice in urban areas (96% vs 83%, P < .001) compared to non-HIV-experienced clinicians. The median clinician-to-population ratio for all HIV clinicians was 13.3 (interquartile range, 38.0), with no significant urban-rural differences. When considering HIV experience, 81% of counties had no HIV-experienced clinicians, and rural counties generally had fewer HIV-experienced clinicians per 1000 diagnosed HIV cases (P < .001). CONCLUSIONS Significant urban-rural disparities exist in HIV-experienced workforce capacity for communities in the Southern United States. Policies to improve equity in access to HIV-experienced clinical care for both urban and rural communities are urgently needed.
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Affiliation(s)
- Rose S Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren E Yerkes
- Division of Population Health Data, Virginia Department of Health, Richmond, Virginia, USA.,Division of Disease Prevention, Virginia Department of Health, Richmond, Virginia, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faye Z Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Daniel E Nixon
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anne G Rhodes
- Division of Disease Prevention, Virginia Department of Health, Richmond, Virginia, USA
| | - April D Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
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Meredith J, Onsrud J, Davidson L, Medaris LA, Kowalkowski M, Fischer K, Priem J, Leonard M, McCurdy L. Successful Use of Telemedicine Infectious Diseases Consultation With an Antimicrobial Stewardship-Led Staphylococcus aureus Bacteremia Care Bundle. Open Forum Infect Dis 2021; 8:ofab229. [PMID: 34189171 PMCID: PMC8231364 DOI: 10.1093/ofid/ofab229] [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] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background Telemedicine (TM) programs can be implemented to deliver specialty care through virtual platforms and overcome geographic/resource constraints. Few data exist to describe outcomes associated with TM-based infectious diseases (ID) management. The purpose of this study was to compare outcomes associated with TM and onsite standard-of-care (SOC) ID consultation after implementation of an antimicrobial stewardship (AMS)-led Staphylococcus aureus bacteremia (SAB) bundle. Methods A retrospective cohort study was conducted on the effects of a SAB bundle comparing ID consult delivery (SOC or TM) at 10 US hospitals within Atrium Health in adult patients admitted from September 2016 through December 2017. The type of ID consult provided was based on the admitting hospital; no hospital had both modalities. Bundle components included the following: (1) ID consult, (2) appropriate antibiotics, (3) repeat blood cultures until clearance, (4) echocardiogram obtainment, and (5) appropriate antibiotic duration. The AMS facilitated bundle initiation and compliance. The primary outcome was bundle adherence between groups. Differences in clinical outcomes were also assessed. Results We evaluated 738 patients with SAB (576 with SOC, 162 with TM ID). No differences were observed in overall bundle adherence (SOC 86% vs TM 89%, P = .33). In addition, no significant differences resulted between groups for hospital mortality, 30-day SAB-related readmission, persistent bacteremia, and culture clearance. Groups did not differ in 30-day mortality when controlling for demographics, bacteremia source, and physiological measures with multivariable logistic regression. Conclusions Our findings provide evidence to support effective use of TM ID consultation and AMS-led care bundles for SAB management in resource-limited settings.
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Affiliation(s)
- Jacqueline Meredith
- Antimicrobial Support Network, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer Onsrud
- Antimicrobial Support Network, Atrium Health, Charlotte, North Carolina, USA
| | - Lisa Davidson
- Department of Internal Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina, USA
| | - Leigh Ann Medaris
- Department of Internal Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina, USA
| | - Marc Kowalkowski
- Centers for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Kristin Fischer
- Antimicrobial Support Network, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer Priem
- Centers for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Michael Leonard
- Department of Internal Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina, USA
| | - Lewis McCurdy
- Department of Internal Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina, USA
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Shively NR, Moffa MA, Paul KT, Wodusky EJ, Schipani BA, Cuccaro SL, Harmanos MS, Cratty MS, Chamovitz BN, Walsh TL. Impact of a Telehealth-Based Antimicrobial Stewardship Program in a Community Hospital Health System. Clin Infect Dis 2021; 71:539-545. [PMID: 31504367 DOI: 10.1093/cid/ciz878] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Data on antimicrobial stewardship programs (ASPs) facilitated via telehealth in the community hospital setting are limited. METHODS A telehealth-based ASP was implemented in 2 community hospitals (285 and 176 beds). Local pharmacists without residency or prior antimicrobial stewardship training were trained to conduct prospective audit and feedback. For approximately 60 minutes 3 times weekly at the 285-bed hospital and 2 times weekly at the 176-bed hospital, infectious diseases (ID) physicians remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft tissue infections with local pharmacists. Recommendations for ASP interventions made by ID physicians were relayed to primary teams and tracked by local pharmacists. Antimicrobial utilization was collected in days of therapy (DOT) per 1000 patient-days (PD) for a 12-month baseline and 6-month intervention period, and analyzed with segmented linear regression analysis. Local ID consultations were tracked and antimicrobial cost savings were estimated. RESULTS During the 6-month intervention period, 1419 recommendations were made, of which 1262 (88.9%) were accepted. Compared to the baseline period, broad-spectrum antibiotic utilization decreased by 24.4% (342.1 vs 258.7 DOT/1000 PD; P < .001) during the intervention period. ID consultations increased by 40.2% (15.4 consultations per 1000 PD vs 21.5 consultations per 1000 PD; P = .001). Estimated annualized savings on antimicrobial expenditures were $142 629.83. CONCLUSIONS An intense ASP model, facilitated in the community hospital setting via telehealth, led to reduced broad-spectrum antimicrobial utilization, increased ID consultations, and reduced antimicrobial expenditures.
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Affiliation(s)
- Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Matthew A Moffa
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Kathleen T Paul
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Eric J Wodusky
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Beth Ann Schipani
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Susan L Cuccaro
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Mark S Harmanos
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Michael S Cratty
- Department of Medicine, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Bruce N Chamovitz
- Division of Infectious Diseases, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Thomas L Walsh
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Avent ML, Walker D, Yarwood T, Malacova E, Brown C, Kariyawasam N, Ashley S, Daveson K. Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth. Int J Antimicrob Agents 2021; 57:106346. [PMID: 33882332 DOI: 10.1016/j.ijantimicag.2021.106346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/15/2021] [Accepted: 04/10/2021] [Indexed: 01/09/2023]
Abstract
A significant portion of healthcare takes place in small hospitals, and many are located in rural and regional areas. Facilities in these regions frequently do not have adequate resources to implement an onsite antimicrobial stewardship programme and there are limited data relating to their implementation and effectiveness. We present an innovative model of providing a specialist telehealth antimicrobial stewardship service utilising a centralised service (Queensland Statewide Antimicrobial Stewardship Program) to a rural Hospital and Health Service. Results of a 2-year post-implementation follow-up showed an improvement in adherence to guidelines [33.7% (95% CI 27.0-40.4%) vs. 54.1% (95% CI 48.7-59.5%)] and appropriateness of antimicrobial prescribing [49.0% (95% CI 42.2-55.9%) vs. 67.5% (95% CI 62.7-72.4%) (P < 0.001). This finding was sustained after adjustment for hospitals, with improvement occurring sequentially across the years for adherence to guidelines [adjusted odds ratio (aOR) = 2.44, 95% CI 1.70-3.51] and appropriateness of prescribing (aOR = 2.48, 95% CI 1.70-3.61). There was a decrease in mean total antibiotic use (DDDs/1000 patient-days) between the years 2016 (52.82, 95% CI 44.09-61.54) and 2018 (39.74, 95% CI 32.76-46.73), however this did not reach statistical significance. Additionally, there was a decrease in mean hospital length of stay (days) from 2016 (3.74, 95% CI 3.08-4.41) to 2018 (2.55, 95% CI 1.98-3.12), although this was not statistically significant. New telehealth-based models of antimicrobial stewardship can be effective in improving prescribing in rural areas. Programmes similar to ours should be considered for rural facilities.
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Affiliation(s)
- M L Avent
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia.
| | - D Walker
- Central West Hospital and Health Service, Longreach, Queensland, Australia
| | - T Yarwood
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia; Rural Clinical School, Faculty of Medicine, University of Queensland, Cairns, Queensland, Australia; Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - E Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - C Brown
- Central West Hospital and Health Service, Longreach, Queensland, Australia
| | - N Kariyawasam
- Central West Hospital and Health Service, Longreach, Queensland, Australia
| | - S Ashley
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia
| | - K Daveson
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia
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Barsoumian AE, Roth AL, Solberg SL, Hanhurst AS, Funari TS, Crouch H, Florez C, Murray CK. Antimicrobial Stewardship Challenges in the Deployed Setting. Mil Med 2021; 185:e818-e824. [PMID: 31786601 DOI: 10.1093/milmed/usz412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Up to 34% of combat trauma injuries are complicated by infection with multidrug-resistant organisms. Overutilization of antibiotics has been linked to increased multidrug-resistant organisms in combat-injured patients. Antimicrobial stewardship efforts at deployed medical treatment facilities have been intermittently reported; however; a comprehensive assessment of antimicrobial stewardship practices has not been performed. MATERIALS AND METHODS A survey tool was modified to include detailed questions on antimicrobial stewardship practices at medical treatment facilities. A Joint Service, multidisciplinary team conducted on-site assessments and interviews to assess the status of antimicrobial stewardship best practices, with particular emphasis on antibiotic prophylaxis in combat injured, in the U.S. Central Command operational theaters. Limitations to implementing stewardship to the national standards were explored thematically. RESULTS Nine Role 1, 2, and 3 medical facilities representing the range of care were assessed on-site. A total of 67% of the sites reported a formal antimicrobial stewardship program and 56% of the sites had an assigned head of antimicrobial stewardship. No military personnel in theater received training on antimicrobial stewardship and laboratory assets were limited. Personnel at these sites largely had access to Joint Trauma System guidelines describing antimicrobial prophylaxis for combat injured (89%), yet infrequently received feedback on their implementation and adherence to these guidelines (11%). CONCLUSIONS Antimicrobial stewardship programs in theater are in the early stages of development in theater. Areas identified for improvement are access to expertise, development of a focus on high-impact lines of effort, laboratory support, and the culture of antimicrobial prescribing. Risks can be mitigated through theater level formalization of efforts, expert mentoring through telehealth, and a focus on implementation and adherence and feedback to national guidelines.
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Affiliation(s)
- Alice E Barsoumian
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234
| | - Amanda L Roth
- U.S. Army Medical Materiel Development Activity, 1430 Veterans Drive, Fort Detrick, MD 21702
| | - Steffanie L Solberg
- United States Air Forces Central Command, Command Surgeon Cell, 524 Shaw Drive, Suite B-15, Shaw Air Force Base, SC 29152
| | - Ashley S Hanhurst
- Main Operating Room, Department of Surgical Services, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Tamara S Funari
- U.S. Central Command HQ, Surgeon Division, 7115 South Boundary Blvd., MacDill AFB, FL 33621
| | - Helen Crouch
- Infection Prevention and Control, Quality and Safety Center, U.S. Army Medical Command Headquarters, 2748 Worth Rd. STE 26, JBSA Ft Sam Houston, TX 78234
| | - Christopher Florez
- United States Air Force Infection Prevention Consultant to the Surgeon General, 3488 Garden Avenue, JBSA Fort Sam Houston, TX 78234
| | - Clinton K Murray
- 1st Area Medical Laboratory, 6745 Plum Point Drive, Aberdeen Proving Ground, MD 21005
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