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Choi J, Kim G, Choi S, Chang JE. A Year After Implementation of the Telehealth Waiver: Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:255-266. [PMID: 37938810 DOI: 10.1097/phh.0000000000001845] [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: 11/10/2023]
Abstract
OBJECTIVE Telehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare's temporary telehealth waiver. DESIGN, SETTING, AND PARTICIPANT A cross-sectional, phone survey with a national representative sample of Medicare recipients. We obtained a final study sample from the Winter 2021 COVID-19 Supplement of Medicare Current Beneficiary Survey dataset (N = 10 586). We examined associations for being offered and having had telehealth visits or any video telehealth visits during the pandemic since November 1, 2020. MAIN OUTCOME MEASURES Our primary outcomes were being offered any telehealth, being offered any video telehealth, having had any telehealth visit, and having had any video telehealth. RESULTS Although dual eligibility was not significantly associated with being offered or having had any telehealth services during the pandemic, those who were dual eligible were more likely to have had video telehealth visits (adjusted odds ratio = 1.39, 95% confidence interval 1.04-1.86, P = .03) compared with those with non-dual eligibility. Recipients with disability eligibility, technology access, and severe chronic conditions were more likely to have been offered or have had telehealth. At the same time, those who lived in the nonmetropolitan area were less likely to have been offered or have had telehealth, including video telehealth. CONCLUSIONS Our findings suggest that the federal waivers to expand telehealth services were successful in continuing care for vulnerable Medicare recipients. The providers' specific outreach and intervention efforts to offer telehealth visits are crucial for dual-eligible recipients. To increase video telehealth uptake, technology access and services to rural areas should be prioritized.
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Affiliation(s)
- Jasmin Choi
- Departments of Social and Behavioral Sciences (Ms J. Choi) and Public Health Policy and Management (Dr Chang), School of Global Public Health, New York University, New York, New York; Robert F. Wagner Graduate School of Public Service, New York University, New York, New York (Dr Kim); and Department of Population Health, Grossman School of Medicine, New York University, New York, New York (Dr S. Choi)
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Bogulski CA, Pro G, Acharya M, Ali MM, Brown CC, Hayes CJ, Eswaran H. The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims. J Telemed Telecare 2024:1357633X241226741. [PMID: 38314738 DOI: 10.1177/1357633x241226741] [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: 02/07/2024]
Abstract
INTRODUCTION Telehealth services have the potential to increase healthcare access among underserved populations, such as rural residents and racial/ethnic minority groups. The COVID-19 public health emergency led to unprecedented growth in telehealth utilization, but evidence suggests the growth has not been equitable across all patient populations. This study aimed to explore whether telehealth utilization and expansion changed equitably from 2019 to 2020 among sub-groups of Medicare beneficiaries. METHODS We conducted an analysis of telehealth utilization among a 20% random sample of 2019-2020 Medicare beneficiaries on a national level. We fit multivariable logistic regression models and calculated average marginal effects (AME) to assess the association between demographic and clinical characteristics on telehealth utilization. RESULTS We found telehealth utilization was less likely among non-Hispanic Black/African-American (2019: adjusted odds ratio [aOR] = 0.77, AME = -0.15; 2020: aOR = 0.85, AME = -3.50) and Hispanic (2019: aOR = 0.79, AME = -0.13; 2020: aOR = 0.87, AME = -2.89) beneficiaries, relative to non-Hispanic White beneficiaries in both 2019 and 2020, with larger disparities in 2020. Rural beneficiaries were more likely to utilize telehealth than urban beneficiaries in 2019 (aOR = 2.62, AME = 0.84), but less likely in 2020 (aOR = 0.57, AME = -14.47). In both years, dually eligible Medicare/Medicaid beneficiaries were more likely than non-dually eligible beneficiaries to utilize telehealth (2019: aOR = 4.75, AME = 0.84; 2020: aOR = 1.34, AME = 2.25). However, the effects of dual eligibility and rurality changed in both models as the number of chronic conditions increased. DISCUSSION We found evidence of increasing disparities in telehealth utilization among several Medicare beneficiary sub-groups in 2020 relative to 2019, including individuals of minority race/ethnicity, rural residents, and dually eligible beneficiaries, with disparities increasing among individuals with more chronic conditions. Although telehealth has the potential to address health inequities, our findings suggest that many of the patients in greatest need of healthcare are least likely to utilize telehealth services.
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Affiliation(s)
- Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - George Pro
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahip Acharya
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clare C Brown
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Hari Eswaran
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Park JH, Lee MJ, Tsai MH, Shih HJ, Chang J. Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS). Patient Prefer Adherence 2023; 17:3477-3487. [PMID: 38143946 PMCID: PMC10749101 DOI: 10.2147/ppa.s439437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Min Jee Lee
- Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Huan-Ju Shih
- Department of Health Administration and Policy, School of Public Health, George Mason University, Fairfax, VA, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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Masters MC, Rivera J, Calamari M, Wright K, Janulis P, Rusie L, Bannon J, Milne P, Galvin SR, Molina EG, Hirschhorn LR, Palella FJ, Kumar R, Brown C, Hawkins C. Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic. J Acquir Immune Defic Syndr 2023; 94:46-52. [PMID: 37368925 PMCID: PMC10526734 DOI: 10.1097/qai.0000000000003238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/08/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, telemedicine was adopted to ensure continuity of HIV care. We examined how introducing televisits affected technical quality of care for people with HIV (PWH) during this time. METHODS PWH receiving HIV care at Howard Brown Health Centers and Northwestern University in Chicago, Illinois were included. HIV care quality indicators were calculated using data extracted from electronic medical records during 4 timepoints every 6 months from March, March 1, 2020 to September 1, 2021. Generalized linear mixed models estimated differences in indicators across timepoints within each site while controlling for multiple observations of individuals. Generalized linear mixed models were also used to compare differences in outcomes among PWH who attended all versus a combination of in-person and televisits versus no televisits across the study time periods. RESULTS 6447 PWH were included in the analysis. Compared with prepandemic levels, there were significant declines in care utilization and processes of care measures. Measures of HIV virologic suppression, blood pressure control, and HbA1C <7% (in both people with and without diabetes) were stable with no significant differences noted across the study timepoints. Similar trends were observed across all age, race, and sex subgroups. In multivariable models, televisits were not associated with decreased HIV viral suppression. CONCLUSIONS During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and processes of care decreased compared with prepandemic levels. Among PWH who remained in care, televisits were not associated with worse virologic, blood pressure, and glycemic control in PWH.
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Affiliation(s)
| | | | - Mia Calamari
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Patrick Janulis
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jacqueline Bannon
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patrick Milne
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shannon R. Galvin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Claudia Hawkins
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Cao YJ, Chen D, Smith M. Use telehealth as needed: telehealth substitutes in-person primary care and associates with the changes in unplanned events and follow-up visits. BMC Health Serv Res 2023; 23:426. [PMID: 37138327 PMCID: PMC10154749 DOI: 10.1186/s12913-023-09445-0] [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] [Received: 08/11/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Telehealth rapidly expanded since the outbreak of the COVID-19 pandemic. This study aims to understand how telehealth can substitute in-person services by 1) estimating the changes in non-COVID emergency department (ED) visits, hospitalizations, and care costs among US Medicare beneficiaries by visit modality (telehealth vs. in-person) during the COVID-19 pandemic relative to the previous year; 2) comparing the follow-up time and patterns between telehealth and in-person care. METHODS A retrospective and longitudinal study design using US Medicare patients 65 years or older from an Accountable Care Organization (ACO). The study period was April-December 2020, and the baseline period was March 2019 - February 2020. The sample included 16,222 patients, 338,872 patient-month records and 134,375 outpatient encounters. Patients were categorized as non-users, telehealth only, in-person care only and users of both types. Outcomes included the number of unplanned events and costs per month at the patient level; number of days until the next visit and whether the next visit happened within 3-, 7-, 14- and 30-days at the encounter level. All analyses were adjusted for patient characteristics and seasonal trends. RESULTS Beneficiaries who used only telehealth or in-person care had comparable baseline health conditions but were healthier than those who used both types of services. During the study period, the telehealth only group had significantly fewer ED visits/hospitalizations and lower Medicare payments than the baseline (ED 13.2, 95% CI [11.6, 14.7] vs. 24.6 per 1,000 patients per month and hospitalization 8.1 [6.7, 9.4] vs. 12.7); the in-person only group had significantly fewer ED visits (21.9 [20.3, 23.5] vs. 26.1) and lower Medicare payments, but not hospitalizations; the both-types group had significantly more hospitalizations (23.0 [21.4, 24.6] vs. 17.8). Telehealth was not significantly different from in-person encounters in number of days until the next visit (33.4 vs. 31.2 days) or the probabilities of 3- and 7-day follow-up visits (9.2 vs. 9.3% and 21.8 vs.23.5%). CONCLUSIONS Patients and providers treated telehealth and in-person visits as substitutes and used either depending on medical needs and availability. Telehealth did not lead to sooner or more follow-up visits than in-person services.
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Affiliation(s)
- Ying Jessica Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 760B WARF Office Building, Madison, WI, 53726, USA.
| | - Dandi Chen
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 760B WARF Office Building, Madison, WI, 53726, USA
| | - Maureen Smith
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 760B WARF Office Building, Madison, WI, 53726, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 610 N Whitney Way, Ste 200, Madison, WI, 53705, USA
- Health Innovation Program, University of Wisconsin-Madison, 800 University Bay, Madison, WI, 53726, USA
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Chang MH, Moonesinghe R, Truman BI. Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic-United States, 2020. Healthcare (Basel) 2023; 11:healthcare11081126. [PMID: 37107960 PMCID: PMC10137947 DOI: 10.3390/healthcare11081126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Access and use of health care services are essential to health and well-being for people with HIV and HIV-related comorbidities. Health care use during the COVID-19 pandemic among Medicare beneficiaries (MBs) with concurrent HIV and depression has not been investigated. We used 2020 Medicare data to assess the percentage of MBs with claims for HIV and depression who also received hospitalization, outpatient diagnostic services, drug treatment, and outpatient procedures. We assessed person-level association between service receipt and HIV and depression, adjusting for known risk factors. MBs with claims for HIV and depression were more likely than those with neither claim to have claims for short-stay hospitalization, long-stay hospitalization, outpatient diagnostic services, prescription drugs, or outpatient procedures, supplies, and products. Non-White beneficiaries were more likely than White beneficiaries to be hospitalized but were less likely to receive drug treatment, outpatient diagnostic services, or outpatient procedures, supplies, and products during the pandemic. Significant disparities in health care use by race/ethnicity existed among MBs. Policymakers and practitioners can use these findings to implement public health policies and programs that reduce disparities in health care access and optimize use among vulnerable populations during a public health emergency.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, Atlanta, GA 30345, USA
| | - Benedict I Truman
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Roblin DW, Goodrich GK, Davis TL, Gander JC, McCracken CE, Weinfield NS, Ritzwoller DP. Management of Neck or Back Pain in Ambulatory Care: Did Visit Mode or the COVID-19 Pandemic Affect Provider Practice or Patient Adherence? Med Care 2023; 61:S30-S38. [PMID: 36893416 PMCID: PMC9994575 DOI: 10.1097/mlr.0000000000001833] [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: 03/11/2023]
Abstract
BACKGROUND/OBJECTIVE In recent years, 2 circumstances have changed provider-patient interactions in ambulatory care: (1) the replacement of virtual for in-person visits and (2) the COVID-19 pandemic. We studied the potential impact of each event on provider practice and patient adherence by comparing the frequency of the association of provider orders, and patient fulfillment of those orders, by visit mode and pandemic period, for incident neck or back pain (NBP) visits in ambulatory care. METHODS Data were extracted from the electronic health records of 3 Kaiser Permanente regions (Colorado, Georgia, and Mid-Atlantic States) from January 2017 to June 2021. Incident NBP visits were defined from ICD-10 coded as primary or first listed diagnoses on adult, family medicine, or urgent care visits separated by at least 180 days. Visit modes were classified as virtual or in-person. Periods were classified as prepandemic (before April 2020 or the beginning of the national emergency) or recovery (after June 2020). Percentages of provider orders for, and patient fulfillment of orders, were measured for 5 service classes and compared on: virtual versus in-person visits, and prepandemic versus recovery periods. Comparisons were balanced on patient case-mix using inverse probability of treatment weighting. RESULTS Ancillary services in all 5 categories at each of the 3 Kaiser Permanente regions were substantially ordered less frequently on virtual compared with in-person visits in both the prepandemic and recovery periods (both P ≤ 0.001). Conditional on an order, patient fulfillment within 30 days was high (typically ≥70%) and not likely meaningfully different between visit modes or pandemic periods. CONCLUSIONS Ancillary services for incident NBP visits were ordered less frequently during virtual than in-person visits in both prepandemic and recovery periods. Patient fulfillment of orders was high, and not significantly different by mode or period.
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Affiliation(s)
- Douglas W. Roblin
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD
| | | | | | | | | | - Nancy S. Weinfield
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD
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Ekwegh T, Cobb S, Adinkrah EK, Vargas R, Kibe LW, Sanchez H, Waller J, Ameli H, Bazargan M. Factors Associated with Telehealth Utilization among Older African Americans in South Los Angeles during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2675. [PMID: 36768041 PMCID: PMC9915549 DOI: 10.3390/ijerph20032675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic transformed healthcare delivery with the expansive use of telemedicine. However, health disparities may result from lower adoption of telehealth among African Americans. This study examined how under-resourced, older African Americans with chronic illnesses use telehealth, including related sociodemographic and COVID-19 factors. METHODS Using a cross-sectional design, 150 middle-aged and older African Americans were recruited from faith-based centers from March 2021 to August 2022. Data collected included sociodemographics, comorbidities, technological device ownership, internet usage, and attitudes toward COVID-19 disease and vaccination. Descriptive statistics and multivariable regression models were conducted to identify factors associated with telehealth use. RESULTS Of the 150 participants, 32% had not used telehealth since the COVID-19 pandemic, with 75% reporting no home internet access and 38% having no cellular/internet network on their mobile device. Age, access to a cellular network on a mobile device, and wireless internet at home were significantly associated with the utilization of telehealth care. Higher anxiety and stress with an increased perceived threat of COVID-19 and positive attitudes toward COVID-19 vaccination were associated with telehealth utilization. DISCUSSION Access and integration of telehealth services were highlighted as challenges for this population of African Americans. To reduce disparities, expansion of subsidized wireless internet access in marginalized communities is necessitated. Education outreach and training by healthcare systems and community health workers to improve uptake of telehealth currently and post-COVID-19 should be considered.
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Affiliation(s)
- Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing (MMDSON), Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing (MMDSON), Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Roberto Vargas
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Lucy W. Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Humberto Sanchez
- Office of Research, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Joe Waller
- Office of Research, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Hoorolnesa Ameli
- Department of Emergency Medicine, Mellie’s Bank Hospital, Tehran 1135933763, Iran
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90059, USA
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Green S, Hartzfeld D, Terry AB, Fissell K, Friedman S, Paolino N, Principe K, Sandbach J, Trzupek K, Winheld S, Malinowski J. An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling. J Genet Couns 2023; 32:4-17. [PMID: 36054686 DOI: 10.1002/jgc4.1627] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022]
Abstract
There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available.
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Affiliation(s)
- Sarah Green
- Institute for Digital Health and Innovation, High Risk Pregnancy Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deborah Hartzfeld
- Department of Veterans Affairs, Genomic Medicine Service, Salt Lake City, Utah, USA
| | - Alissa Bovee Terry
- New York Mid-Atlantic-Caribbean Regional Genetics Network, Binghamton, New York, USA
| | | | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, Florida, USA
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Datta P, Eiland L, Samson K, Donovan A, Anzalone AJ, McAdam-Marx C. Telemedicine and health access inequalities during the COVID-19 pandemic. J Glob Health 2022; 12:05051. [PMID: 36462207 PMCID: PMC9718446 DOI: 10.7189/jogh.12.05051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background During the COVID-19 pandemic, health systems rapidly introduced in-home telehealth to maintain access to care. Evidence is evolving regarding telehealth's impact on health disparities. Our objective was to evaluate associations between socioeconomic factors and rurality with access to ambulatory care and telehealth use during the COVID-19 pandemic. Methods We conducted a retrospective study at an academic medical centre in midwestern United States. We included established and new patients who received care during a one-year COVID-19 period vs pre-COVID-19 baseline cohorts. The primary outcome was the occurrence of in-person or telehealth visits during the pandemic. Multivariable analyses identified factors associated with having a health care provider visit during the COVID-19 vs pre-COVID-19 period, as well as having at least one telehealth visit during the COVID-19 period. Results All patient visit types were lower during the COVID-19 vs the pre-COVID-19 period. During the COVID-19 period, 125 855 of 255 742 established patients and 53 973 new patients had at least one health care provider visit, with 41.1% of established and 23.5% of new patients having at least one telehealth visit. Controlling for demographic and clinical characteristics, established patients had 30% lower odds of having any health care provider visit during COVID-19 vs pre-COVID-19 (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.698-0.71) period. Factors associated with lower odds of having a telehealth visit during COVID-19 period for established patients included older age, self-pay or other insurance vs commercial insurance, Black or Asian vs White race and non-English preferred languages. Female patients, patients with Medicare or Medicaid coverage, and those living in lower income zip codes were more likely to have a telehealth visit. Living in a zip code with higher average internet access was associated with telehealth use but living in a rural zip code was not. Factors affecting telehealth visit during the COVID-19 period for new patients were similar, although new patients living in more rural areas had a higher odds of telehealth use. Conclusion Healthcare inequities existed during the COVID-19 pandemic, despite the availability of in-home telehealth. Patient-level solutions targeted at improving digital literacy, interpretive services, as well as increasing access to stable high-speed internet are needed to promote equitable health care access.
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Affiliation(s)
- Proleta Datta
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Leslie Eiland
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Anthony Donovan
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Alfred Jerrod Anzalone
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Carrie McAdam-Marx
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
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Habel MA, Sullivan P, Hall C, Aral S. Remote Health: Optimizing the Delivery of Sexual Health Care. Sex Transm Dis 2022; 49:S1-S6. [PMID: 35312660 PMCID: PMC10197151 DOI: 10.1097/olq.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa A Habel
- From the Centers for Disease Control and Prevention, Division of STD Prevention
| | | | | | - Sevgi Aral
- From the Centers for Disease Control and Prevention, Division of STD Prevention
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Wallace S, Spencer J, Birk D, Chen L. Using the Move Your Way Campaign to Promote Physical Activity in American Adults and to Advocate for the Enactment of the Promoting Physical Activity for Americans Act. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2120122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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LaManna JB, Eckhoff DO, Duncan J. Applying Nurse Practitioner Student Reflections in Design of Telehealth Curricula. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Qu H, Ruoting Wei T, Islam S, Barnes G, Schmidt K, Knight J, Patel N. Patient factors associated with the offering of telehealth appointments from primary care physicians among Medicare Beneficiaries: Results from a national survey. Int J Med Inform 2022; 165:104822. [PMID: 35738162 DOI: 10.1016/j.ijmedinf.2022.104822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study assessed patient factors associated with self-reported telehealth offerings from their primary care physicians (PCPs) among Medicare beneficiaries during the COVID-19 pandemic, and compared potential telehealth accessibility of telehealth appointments from PCP by US census region before and during the COVID-19 pandemic. METHODS Data were from the Medicare Current Beneficiary Survey (MCBS) 2021 Winter COVID-19 Supplement. We conducted a multivariable logistic regression to examine patient-level factors associated with telehealth offerings. RESULTS Overall, 78% Medicare beneficiaries reported that they had access to telehealth appointments from their PCPs during the COVID-19 pandemic. Majority beneficiary respondents reported to have Internet access (82.1%) and own at least one type of computer device (81.5%). Respondents with Internet access (Adjusted Odds Ratio (AOR) = 1.66, 95% Confidence Interval (CI): 1.38, 2.00; p < 0.0001) and owning a device (AOR = 1.43, 95 %CI: 1.19, 1.72; p < 0.0001) were more likely to report PCP telehealth offerings controlling for patient characteristic variables in the model. Respondents who were female (AOR = 1.16, 95 %CI: 1.02, 1.31; p = 0.020), age group of 65-74 years (AOR = 1.29, 95 %CI: 1.07, 1.56; p = 0.008), income ≥$25,000 (AOR = 1.36, 95 %CI: 1.18 1.56; p < 0.0001), metropolitan residence (AOR = 1.96, 95 %CI: 1.72, 2.24; p < 0.0001), and with a history of weakened immune system (AOR = 1.46, 95 %CI: 1.18, 1.80; p < 0.0001) or diabetes (AOR = 1.20, 95 %CI: 1.06, 1.37; p = 0.005) were more likely to report PCP telehealth offerings compared to their counterparts. Non-Hispanic Black (AOR = 0.70, 95 %CI: 0.58, 0.85; p < 0.0001) (compared to Non-Hispanic-White) and beneficiaries living in the South (compared to those living in the Northwest, Midwest, and West) were less likely to report PCP telehealth offerings. DISCUSSION Key findings suggested health disparities existed in telehealth offerings from PCPs in terms of Internet access, device owning, age, race/ethnicity, income, residential locations, and census regions. Policy makers should consider these health disparities and provide targeted incentives and/or interventions when expanding and encouraging utilization of telehealth among Medicare beneficiaries.
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Affiliation(s)
- Haiyan Qu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States.
| | - Tina Ruoting Wei
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States
| | - Shafiqul Islam
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States
| | - Garry Barnes
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States
| | - Kimberly Schmidt
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States
| | - Joshua Knight
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States
| | - Nihar Patel
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States
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