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Wishart AV, Hamouda RK, Elsaady E, Aslam MR, Perala A, Khan S. The Adoption and Impact of Telemedicine on Health Equity: A Narrative Review From the Jamaican Context. Cureus 2024; 16:e69650. [PMID: 39301454 PMCID: PMC11412623 DOI: 10.7759/cureus.69650] [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: 08/04/2024] [Accepted: 09/18/2024] [Indexed: 09/22/2024] Open
Abstract
Telemedicine rose to popularity during the coronavirus disease 2019 (COVID-19) pandemic but is yet to be fully developed. Hence, this study explores the current status of telehealth in Jamaica, looking at its benefits, challenges with its implementation, the regulatory landscape, and solutions to using this technology. Due to the limited research on this topic, a majority of the sources utilized were gray literature with qualitative and quantitative studies. This review seeks to transform policy and practice, promoting telemedicine as a feasible solution for improving Jamaica's healthcare quality and access. By comparing telemedicine in Jamaica to a more developed nation like the United States, the review highlights not only benefits but also major challenges, including healthcare disparities due to the digital divide, less advanced technology, privacy breaches, and significant financing required for telemedicine infrastructure, among other barriers to its integration. The analysis advocates for improvement in various areas, such as cybersecurity measures, advanced training for healthcare professionals, further investments in technological infrastructure, refinement of regulatory frameworks and policies, and incorporation of community-based initiatives. This investigation further highlights the need for additional research to gain insights and a broader perspective.
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Affiliation(s)
- Annetta V Wishart
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ranim K Hamouda
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Entesar Elsaady
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Muhammad Rizwan Aslam
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Alekya Perala
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Alnasser Y, Proaño A, Loock C, Chuo J, Gilman RH. Telemedicine and Pediatric Care in Rural and Remote Areas of Middle-and-Low-Income Countries: Narrative Review. J Epidemiol Glob Health 2024; 14:779-786. [PMID: 38478166 PMCID: PMC11442723 DOI: 10.1007/s44197-024-00214-8] [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: 11/04/2023] [Accepted: 02/24/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC. METHODOLOGY A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC. RESULTS Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency. CONCLUSION Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care.
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Affiliation(s)
- Yossef Alnasser
- Milken Institute of Public Health, George Washington University, Washington, DC, USA.
- Pediatric Department, King Saud University, Riyadh, Saudi Arabia.
- Pediatric Department, BronxCare Health System, Bronx, NY, USA.
| | - Alvaro Proaño
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christine Loock
- British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John Chuo
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert H Gilman
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hayden EM, Grabowski BG, Kishen EB, Zachrison KS, White BA. The Value of an Emergency Medicine Virtual Observation Unit. Ann Emerg Med 2024; 84:261-269. [PMID: 38530672 DOI: 10.1016/j.annemergmed.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 03/28/2024]
Abstract
STUDY OBJECTIVE We implemented a virtual observation unit in which emergency department (ED) patients receive observation-level care at home. Our primary aim was to compare this new care model to in-person observation care in terms of brick-and-mortar ED length of stay (inclusive of ED observation unit time) as well as secondarily on inpatient admission and 72-hour return visits (overall and with admission). METHODS In a retrospective analysis of electronic health record data on ED observation patients from January 1, 2022 to December 29, 2022 from an academic urban ED, we used propensity matching to compare virtual to in-person observation patients on outcomes of interest. Patients were matched 1:1 based on age, sex, Charlson Comorbidity Index, and reason for observation. We also conducted real-time review of all virtual observation cases for potential safety concerns. RESULTS Of 8,218 observation stays, 361 virtual observation patients were matched with 361 in-person observation patients. Virtual observation patients experienced lower median brick-and-mortar ED + EDOU LOS [14.6 (IQR 10.2, 18.9) versus 33.3 (IQR 28.1, 38.1) hours] and lower inpatient admission rates (10.2% [SD 5.0] versus 24.7% [SD 11.3]). The 72-hour return rate was higher for virtual observation patients (3.6% [SD 3.0] versus 2.5% [SD 3.0]). Among those with return visits, the rate of inpatient admission was higher among virtual observation patients (53.8% [SD 3.2] versus 11.1% [13.0]). There were no significant patient safety events recorded. CONCLUSION Virtual observation unit patients used fewer hours in ED and ED observation relative to on-site observation patients. This new care delivery model warrants further study because it has the potential to positively impact ED capacity.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
| | - Beth G Grabowski
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Ekta B Kishen
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Staloff J, Gunnink E, Rojas J, Wong ES, Nelson K, Reddy A. Identifying Patterns of Primary Care In-Person and Telemedicine Use in the Veterans Health Administration: A Latent Class Analysis. J Gen Intern Med 2024; 39:2241-2248. [PMID: 38619738 PMCID: PMC11347524 DOI: 10.1007/s11606-024-08751-5] [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: 11/28/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic. OBJECTIVE Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available. DESIGN A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification. PARTICIPANTS A random national sample consisting of 564,580 primary care empaneled veterans in June 2021. MAIN MEASURES Latent class membership. KEY RESULTS We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p < .05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p < .05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05). CONCLUSIONS Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video.
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Affiliation(s)
- Jonathan Staloff
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
- Department of Family Medicine, University of Washington, Seattle, WA, USA.
| | - Eric Gunnink
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jorge Rojas
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Karin Nelson
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ashok Reddy
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Muscat DM, Cvejic E, Smith J, Thompson R, Chang E, Tracy M, Zadro J, Linder R, McCaffery K. Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse. BMJ Qual Saf 2024:bmjqs-2024-017411. [PMID: 39174336 DOI: 10.1136/bmjqs-2024-017411] [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: 04/18/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals' health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care. METHODS Preplanned analysis of randomised trial data comparing: the Choosing Wisely questions, a SDM video, both interventions or control (no intervention). Randomisation was stratified by participant health literacy ('adequate' vs 'limited'), as assessed by the Newest Vital Sign. MAIN OUTCOME MEASURES Self-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM. PARTICIPANTS 1439 Australian adults, recruited online. RESULTS The effects of the Choosing Wisely questions and SDM video did not differ based on participants' health literacy for most primary or secondary outcomes (all two-way and three-way interactions p>0.05). Compared with individuals with 'adequate' health literacy, those with 'limited' health literacy had lower knowledge of SDM rights (82.1% vs 89.0%; 95% CI: 3.9% to 9.8%, p<0.001) and less positive attitudes towards SDM (48.3% vs 58.1%; 95% CI: 4.7% to 15.0%, p=0.0002). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; 95% CI: 0.33 to 0.72, p<0.001) and generated fewer questions to ask a healthcare provider which aligned with the Choosing Wisely questions (χ2 (1)=73.79, p<.001). On average, 67.7% of participants with 'limited' health literacy indicated that they would use video interventions again compared with 55.7% of individuals with 'adequate' health literacy. CONCLUSION Adults with limited health literacy continue to have lower scores on decision-making outcomes in the context of low value care. Ongoing work is needed to develop and test different intervention formats that support people with lower health literacy to engage in question asking and SDM.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Edward Chang
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marguerite Tracy
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Zadro
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Linder
- NPS MedicineWise, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Jerjes W, Harding D. Telemedicine in the post-COVID era: balancing accessibility, equity, and sustainability in primary healthcare. Front Digit Health 2024; 6:1432871. [PMID: 39233772 PMCID: PMC11371753 DOI: 10.3389/fdgth.2024.1432871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
- Waseem Jerjes
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, United Kingdom
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Daniel Harding
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, United Kingdom
- Faculty of Medicine, Imperial College London, London, United Kingdom
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Badr J, Motulsky A, Denis JL. Digital health technologies and inequalities: A scoping review of potential impacts and policy recommendations. Health Policy 2024; 146:105122. [PMID: 38986333 DOI: 10.1016/j.healthpol.2024.105122] [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: 10/19/2023] [Revised: 05/17/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024]
Abstract
Digital health technologies hold promises for reducing health care costs, enhancing access to care, and addressing labor shortages. However, they risk exacerbating inequalities by disproportionately benefitting a subset of the population. Use of digital technologies accelerated during the Covid-19 pandemic. Our scoping review aimed to describe how inequalities related to their use were conceptually assessed during and after the pandemic and understand how digital strategies and policies might support digital equity. We used the PRISMA Extension for scoping reviews, identifying 2055 papers through an initial search of 3 databases in 2021 and complementary search in 2022, of which 41 were retained. Analysis was guided by the eHealth equity framework. Results showed that digital inequalities were reported in the U.S. and other high-income countries and were mainly assessed through differences in access and use according to individual sociodemographic characteristics. Health disparities related to technology use and the interaction between context and technology implementation were more rarely documented. Policy recommendations stressed the adoption of an equity lens in strategy development and multilayered and intersectoral collaboration to align interventions with the needs of specific subgroups. Finally, findings suggested that evaluations of health and wellbeing distribution related to the use of digital technologies should inform digital strategies and health policies.
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Affiliation(s)
- Janine Badr
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada.
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada
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8
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Srichan C, Danvirutai P, Boonsim N, Namvong A, Surawanitkun C, Ritsongmuang C, Siritaratiwat A, Anutrakulchai S. Non-Invasive Sensors Integration for NCDs with AIoT Based Telemedicine System. SENSORS (BASEL, SWITZERLAND) 2024; 24:4431. [PMID: 39065830 PMCID: PMC11281239 DOI: 10.3390/s24144431] [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: 05/27/2024] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
Thailand's hospitals face overcrowding, particularly with non-communicable disease (NCD) patients, due to a doctor shortage and an aging population. Most literature showed implementation merely on web or mobile application to teleconsult with physicians. Instead, in this work, we developed and implemented a telemedicine health kiosk system embedded with non-invasive biosensors and time-series predictors to improve NCD indicators over an eight-month period. Two cohorts were randomly selected: a control group with usual care and a telemedicine-using group. The telemedicine-using group showed significant improvements in average fasting blood glucose (148 to 130 mg/dL) and systolic blood pressure (152 to 138 mmHg). Data mining with the Apriori algorithm revealed correlations between diseases, occupations, and environmental factors, informing public health policies. Communication between kiosks and servers used LoRa, 5G, and IEEE802.11, which are selected based on the distance and signal availability. The results support telemedicine kiosks as effective for NCD management, significantly improving key NCD indicators, average blood glucose, and blood pressure.
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Affiliation(s)
- Chavis Srichan
- Faculty of Engineering, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Pobporn Danvirutai
- Chronic Kidney Disease Prevention in Northeast Thailand, Khon Kaen University, Khon Kaen 40002, Thailand; (P.D.); (S.A.)
| | - Noppakun Boonsim
- Faculty of Interdisciplinary Studies, Khon Kaen University, Nong Khai Campus, Nong Khai 43000, Thailand; (N.B.); (A.N.); (C.S.)
| | - Ariya Namvong
- Faculty of Interdisciplinary Studies, Khon Kaen University, Nong Khai Campus, Nong Khai 43000, Thailand; (N.B.); (A.N.); (C.S.)
- Center of Multidisciplinary Innovation Network Talent (MINT Center), Department of Technology and Engineering, Faculty of Interdisciplinary Studies, Khon Kaen University, Nong Khai Campus, Nong Khai 43000, Thailand
| | - Chayada Surawanitkun
- Faculty of Interdisciplinary Studies, Khon Kaen University, Nong Khai Campus, Nong Khai 43000, Thailand; (N.B.); (A.N.); (C.S.)
- Center of Multidisciplinary Innovation Network Talent (MINT Center), Department of Technology and Engineering, Faculty of Interdisciplinary Studies, Khon Kaen University, Nong Khai Campus, Nong Khai 43000, Thailand
| | | | | | - Sirirat Anutrakulchai
- Chronic Kidney Disease Prevention in Northeast Thailand, Khon Kaen University, Khon Kaen 40002, Thailand; (P.D.); (S.A.)
- Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Alarcón Belmonte I, Sánchez Collado R, Yuguero O, Acezat Oliva J, Martínez-Millana A, Saperas Pérez C. [Digital literacy as a key element in the digital transformation of health organizations]. Aten Primaria 2024; 56:102880. [PMID: 38377712 PMCID: PMC10884755 DOI: 10.1016/j.aprim.2024.102880] [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: 11/10/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/22/2024] Open
Abstract
In the last years, the digital transformation, has become a reality influencing organizational processes and advancing services for users. This transformation must align with WHO guidelines, addressing the needs of individuals globally and acknowledging Social Determinants of Health and emerging Digital Determinants of Health and the digital divide thas has been created. To accomplish this, the appropriate legislation and infrastructures are required. Correspondingly technology enables enhanced self-care and increased participation in decision-making across various levels, consequently, addressing the digital divide must not be an exception, and needs to include citizens, communities, entities, and professionals to work on how to diminish it and solve it. As a result of this national and supranational campaigns should formulate unified plans and strategies, that include training requirements and establishing programs for both professionals and users, highlighting the significance of incorporating digital knowledge on both groups.
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Affiliation(s)
- Iris Alarcón Belmonte
- Servicio de Atención Primaria Dreta-Muntanya, Gerencia de Atención Primaria de Barcelona, Institut Català de la Salut, Barcelona, España; Grupo de Trabajo Salud Digital, Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España
| | - Rou Sánchez Collado
- Grupo de Trabajo Salud Digital, Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España; Centro de Atención Primaria (CAP) Garrotxa, Olot Nord, Institut Català de la Salut, Barcelona, España
| | - Oriol Yuguero
- Grupo de Trabajo Salud Digital, Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España; Grupo de investigación eHealth Center, Universitat Oberta de Catalunya (UOC), Barcelona, España; ErLAB, Investigación en Urgencias y Emergencias, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España
| | - Jordi Acezat Oliva
- Servicio de Atención Primaria Dreta-Muntanya, Gerencia de Atención Primaria de Barcelona, Institut Català de la Salut, Barcelona, España; Grupo de Trabajo Salud Digital, Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España; Equipo Integral de Atención a la Complejidad Casernes, Gerencia de Atención Primaria de Barcelona, Institut Català de la Salut, Barcelona, España
| | - Antonio Martínez-Millana
- Grupo de Trabajo Salud Digital, Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España; Instituto de Tecnologías de la Información y las Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, España
| | - Carme Saperas Pérez
- Grupo de Trabajo Salud Digital, Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España; Centro de Atención Primaria (CAP) Plana Lledó Mollet del Vallès, Institut Català de la Salut Metropolitana Nord, Barcelona, España.
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10
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Hayden EM, Nentwich LM, Jung OS, Zheng H, White BA. Patient Perceptions of Emergency Department Observation Care at Home. Telemed J E Health 2024; 30:1874-1879. [PMID: 38597956 DOI: 10.1089/tmj.2023.0705] [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: 04/11/2024] Open
Abstract
Introduction: The Virtual Observation Unit (VOU) utilizes telehealth and community paramedicine to provide observation-level care in patients' homes. Patients' experience of this novel program has not been reported. Methods: A phone-based patient experience survey was administered to the patients who were admitted to the VOU at an urban, academic Emergency Department in the Northeast United States. The survey asked about patient's perception of the program's quality of care (0 = worst care possible, 10 = best care possible). t Tests with a Bonferroni adjustment assessed for differences between patient demographic groups. Results: The survey response rate was 40% (124/307). Overall mean scores for perceived quality of care were very high (9.51 ± 1.19). There were no significant differences in patient's perception of quality of care between demographic cohorts of age, gender, race, or ethnicity. Conclusions: Patient experience with a novel VOU program was very positive and did not differ significantly by demographic cohort. Further research is warranted.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren M Nentwich
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia S Jung
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, California, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Beauchemin J, Krueger D, Yates T, Ding X. Effects of a Brief, Solution-Focused, Digital Intervention on Social Wellness Among College Students: A Pilot Study. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:349-362. [PMID: 37982300 DOI: 10.1080/26408066.2023.2284918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE Current trends among college students include compromised mental health and wellness which have been exacerbated due to COVID-19. This pilot study examined the effectiveness of a brief, digital intervention focused on social wellness among college students on wellness-related outcomes including perceived wellness, life satisfaction, and happiness. MATERIALS AND METHODS A longitudinal, explanatory mixed-methods design was utilized. Quantitative data were collected from a total of 133 participants using questionnaires at baseline and one-week post-intervention. RM-ANOVA and post-hoc pairwise comparisons were employed to assess quantitative data. Qualitative data collection was obtained via semi-structured interviews at six weeks post-intervention and evaluated using Applied Thematic Analysis. A sub-sample (n = 23) from the participant pool (N = 133) completed the interviews. RESULTS Results indicated intervention effectiveness as participants experienced significant positive change in perceived wellness, the primary outcome variable. Significant relationships were detected between wellness outcomes and goal attainment (e.g. I am confident in my ability to complete my goals) items. Qualitative analysis revealed themes related to accessibility and convenience of the intervention, increased self-awareness, and increased intentionality of participants. DISCUSSION This study demonstrates the utility of a brief, digital intervention on wellness-related outcomes. Benefits were shown of a preventative, self-directed and solution-focused approach in enhancing wellness among college students. CONCLUSION From a social work perspective, employing a salutogenic approach to support college students' wellbeing aligns with the field's core values. Specifically, this social wellness-focused intervention encourages self-determination, dignity and worth of the person, and emphasizes the importance of human relationships.
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Affiliation(s)
| | - Danya Krueger
- School of Social Work, University of North Carolina, Chapel Hill, North Corolina, US
| | - Taylor Yates
- School of Social Work, University of North Carolina, Wilmington, North Corolina, US
| | - Xiao Ding
- School of Social Work, University of Texas, Austin, Texas, US
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Wong D, Cross IH, Ramers CB, Imtiaz F, Scott JD, Dezan AM, Armistad AJ, Manteuffel ME, Wagner D, Hunt RC, England WL, Kwong MW, Dizon RA, Lamers V, Plotkin I, Jolly BT, Jones W, Daly DD, Yeager M, Riley JA, Krupinski EA, Solomon AP, Wibberly KH, Struminger BB. Large-Scale Telemedicine Implementation for Outpatient Clinicians: Results From a Pandemic-Adapted Learning Collaborative. J Ambul Care Manage 2024; 47:51-63. [PMID: 38441558 DOI: 10.1097/jac.0000000000000491] [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: 03/07/2024]
Abstract
Learning collaboratives are seldom used outside of health care quality improvement. We describe a condensed, 10-week learning collaborative ("Telemedicine Hack") that facilitated telemedicine implementation for outpatient clinicians early in the COVID-19 pandemic. Live attendance averaged 1688 participants per session. Of 1005 baseline survey respondents, 57% were clinicians with one-third identifying as from a racial/ethnic minoritized group. Practice characteristics included primary care (71%), rural settings (51%), and community health centers (28%). Of three surveys, a high of 438 (81%) of 540 clinicians had billed ≥1 video-based telemedicine visit. Our learning collaborative "sprint" is a promising model for scaling knowledge during emergencies and addressing health inequities.
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Affiliation(s)
- David Wong
- Author Affiliations: Healthcare Resilience Working Group, U.S. National COVID-19 Response, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, District of Columbia (Drs Wong, Cross, Manteuffel, Hunt, England, and Jolly, and Ms Imtiaz, and Mr Jones, Mr Daly, Ms Yeager, and Ms Riley); Commissioned Corps of the U.S. Public Health Service (Drs Wong, Cross, and Manteuffel, Mr Daly, and Ms Riley); Laura Rodriguez Research Institute - Family Health Centers of San Diego, San Diego, California (Dr Ramers); ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, New Mexico (Drs Ramers and Struminger, Ms Dezan, and Ms Armistad); Deloitte Consulting, LLP, Arlington, Virginia (Ms Imtiaz and Ms Yeager); Digital Health, University of Washington, Seattle, Washington (Dr Scott); Yes And Leadership, LLC, Alexandria, Virginia (Mr Wagner); Center for Connected Health Policy, Sacramento, California (Ms Kwong and Mr Dizon); Public Health Foundation, Washington, District of Columbia (Ms Lamers and Mr Plotkin); Telehealth Consultant, Aveshka, Inc., Vienna, Virginia (Dr Jolly); Southwest Telehealth Resource Center, Tucson, Arizona (Dr Krupinski); Northeast Telehealth Resource Center, Augusta, Maine (Mr Solomon); Mid-Atlantic Telehealth Resource Center, Charlottesville, Virginia (Dr Wibberly)
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Whitehead DC, Li KY, Hayden E, Jaffe T, Karam A, Zachrison KS. Evaluating the Quality of Virtual Urgent Care: Barriers, Motivations, and Implementation of Quality Measures. J Gen Intern Med 2024; 39:731-738. [PMID: 38302813 PMCID: PMC11043309 DOI: 10.1007/s11606-024-08636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Experts estimate virtual urgent care programs could replace approximately 20% of current emergency department visits. In the absence of widespread quality guidance to programs or quality reporting from these programs, little is known about the state of virtual urgent care quality monitoring initiatives. OBJECTIVE We sought to characterize ongoing quality monitoring initiatives among virtual urgent care programs. APPROACH Semi-structured interviews of virtual health and health system leaders were conducted using a pilot-tested interview guide to assess quality metrics captured related to care effectiveness and equity as well as programs' motivations for and barriers to quality measurement. We classified quality metrics according to the National Quality Forum Telehealth Measurement Framework. We developed a codebook from interview transcripts for qualitative analysis to classify motivations for and barriers to quality measurement. KEY RESULTS We contacted 13 individuals, and ultimately interviewed eight (response rate, 61.5%), representing eight unique virtual urgent care programs at primarily academic (6/8) and urban institutions (5/8). Most programs used quality metrics related to clinical and operational effectiveness (7/8). Only one program reported measuring a metric related to equity. Limited resources were most commonly cited by participants (6/8) as a barrier to quality monitoring. CONCLUSIONS We identified variation in quality measurement use and content by virtual urgent care programs. With the rapid growth in this approach to care delivery, more work is needed to identify optimal quality metrics. A standardized approach to quality measurement will be key to identifying variation in care and help focus quality improvement by virtual urgent care programs.
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Affiliation(s)
- David C Whitehead
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | | | - Emily Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Todd Jaffe
- University of Pennsylvania, Philadelphia, PA, USA
| | - Alessandra Karam
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Chary A, Hernandez N, Rivera AP, Ramont V, Obi T, Santangelo I, Ritchie C, Singh H, Hayden E, Naik AD, Liu S, Kennedy M. Perceptions of Acute Care Telemedicine Among Caregivers for Persons Living with Dementia: A Qualitative Study. J Appl Gerontol 2024; 43:69-77. [PMID: 37682526 PMCID: PMC10693729 DOI: 10.1177/07334648231198018] [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: 09/09/2023] Open
Abstract
Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication and digital literacy challenges. People from racial/ethnic minority groups reported lower comfort with the virtual format. In both sites, participants expressed uncertainty about illness severity that could preclude using telemedicine for acute complaints. Overall, respondents deemed acute care telemedicine acceptable, but caregivers describe specific roles as crucial intermediaries to facilitate virtual care.
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Affiliation(s)
- Anita Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Norvin Hernandez
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Vivian Ramont
- University of Texas School of Public Health, UT Health Science Center, Houston, TX, USA
| | - Tracey Obi
- University of Texas School of Public Health, UT Health Science Center, Houston, TX, USA
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Emily Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- University of Texas School of Public Health, UT Health Science Center, Houston, TX, USA
- Consortium on Aging, University of Texas Health Science Center, Houston, TX, USA
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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15
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Chagpar AB. Change. Am J Surg 2023; 226:756-759. [PMID: 37328327 DOI: 10.1016/j.amjsurg.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, United States.
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16
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Antonacci G, Benevento E, Bonavitacola S, Cannavacciuolo L, Foglia E, Fusi G, Garagiola E, Ponsiglione C, Stefanini A. Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS. BMC Health Serv Res 2023; 23:1115. [PMID: 37853448 PMCID: PMC10585875 DOI: 10.1186/s12913-023-10100-x] [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: 11/29/2022] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. METHODS An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. RESULTS Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. CONCLUSIONS Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK.
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK.
| | - Elisabetta Benevento
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
| | | | | | - Emanuela Foglia
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Giulia Fusi
- LIUC- Cattaneo University, Castellanza, VA, Italy
| | - Elisabetta Garagiola
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Cristina Ponsiglione
- Department of Industrial Engineering, University of Naples Federico II, Naples, Italy
| | - Alessandro Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
- School of Economics and Business, Kaunas University of Technology, Kaunas, Lithuania
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Le R, Mendez I, Ponce SA, Green A, El-Toukhy S, Nápoles AM, Strassle PD. Telehealth access, willingness, and barriers during the COVID-19 pandemic among a nationally representative diverse sample of U.S. adults with and without chronic health conditions. J Telemed Telecare 2023:1357633X231199522. [PMID: 37709268 PMCID: PMC10937324 DOI: 10.1177/1357633x231199522] [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: 09/16/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, telehealth services represented a critical tool in maintaining continuity and access to care for adults in the USA. However, despite improvements in access and utilization during the pandemic, disparities in telehealth utilization have persisted. It is unclear what role access and willingness to use telehealth play in telehealth disparities. METHODS We used data from the nationally representative COVID-19's Unequal Racial Burden (CURB) survey, an online survey conducted between December 2020 and February 2021, n = 5500. Multivariable Poisson regression was used to estimate the prevalence of perceived telehealth access and willingness to use telehealth services among adults with and without chronic conditions. RESULTS Overall, 60.1% of adults with and 38.7% of adults without chronic conditions reported having access to telehealth. After adjustment, adults with chronic conditions were more likely to report telehealth access (adjusted prevalence ratio [aPR] = 1.35, 95% confidence interval [CI] = 1.21-1.50). Most adults with and without chronic conditions reported being willing to use telehealth services (85.1% and 79.8%, respectively), and no significant differences in willingness were observed across chronic condition status (aPR = 1.03, 95% CI = 0.95-1.13). Perceived telehealth access appeared to be a predictor of telehealth willingness in both groups (chronic conditions: aPR = 1.22, 95% CI = 0.97-1.54; no chronic conditions: aPR = 1.37, 95% CI = 1.22-1.54). The prevalence of perceived barriers to telehealth was low, with the majority reporting no barriers (chronic conditions = 51.4%; no chronic conditions = 61.4%). DISCUSSION Perceived access to telehealth was associated with telehealth willingness. Investing in approaches that increase telehealth accessibility and awareness is needed to improve access to telehealth for adults with and without chronic conditions.
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Affiliation(s)
- Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Alexis Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Allison WE, Choi AN, Kawasaki K, Desai A, Melhado TV. Accessing Care During the COVID-19 Pandemic Using Telemedicine: Perspectives From People With HIV. Health Promot Pract 2023; 24:982-989. [PMID: 37440447 PMCID: PMC10345820 DOI: 10.1177/15248399231169925] [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: 07/15/2023]
Abstract
The COVID-19 pandemic has resulted in a steep increase in telemedicine implementation and use. Data are lacking on telemedicine use in marginalized and underserved groups including people with HIV (PWH). The Ryan White HIV/AIDS Program (RWHAP) is the largest single provider of HIV care in the United States (U.S.) and the southern part of the country remains the epicenter of the HIV epidemic. This study recruited PWH from RWHAP clinics across South Texas. To ascertain their perspectives on utilizing telemedicine for HIV care during the COVID-19 pandemic, a survey instrument derived from validated instruments was used. Descriptive statistics were used for client characteristics, quality of telemedicine care, and COVID-19 impact. Wilcoxon Rank Sum and Kruskal-Wallis tests were assessed associations of telemedicine care quality and COVID-19 impact between client groups. Among 246 eligible PWH, 122 clients completed the survey with a response rate of 50%. Clients were predominantly Hispanic males. Significant differences in perception of telemedicine care and the impact of COVID-19 by gender, age, language, and race/ethnicity were observed. Older PWHIV used telemedicine more than younger clients (p = .01). English speakers indicated more impact of the COVID-19 pandemic on daily life than Spanish speakers (p = .02). Worry about the pandemic was most evident among non-Hispanic Black and Hispanic PWH (p = .03). Overall, telemedicine was found to be a favorable and acceptable mechanism of HIV care delivery by PWH in a Southern state during the COVID-19 pandemic.
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Affiliation(s)
- Waridibo E. Allison
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Aro N. Choi
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Keito Kawasaki
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anmol Desai
- The University of Texas at Austin, Austin, TX, USA
| | - Trisha V. Melhado
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Ko JS, El-Toukhy S, Quintero SM, Wilkerson MJ, Nápoles AM, Stewart AL, Strassle PD. Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities. J Rural Health 2023; 39:617-624. [PMID: 37042413 PMCID: PMC10330004 DOI: 10.1111/jrh.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
PURPOSE Although telehealth access and utilization have increased during the pandemic, rural and low-income disparities persist. We sought to assess whether access or willingness to use telehealth differed between rural and non-rural and low-income and non-low-income adults and measure the prevalence of perceived barriers. METHODS We conducted a cross-sectional study using COVID-19's Unequal Racial Burden (CURB) online survey (December 17, 2020-February 17, 2021), which included 2 nationally representative cohorts of rural and low-income Black/African American, Latino, and White adults. Non-rural and non-low-income participants from the main, nationally representative sample were matched for rural versus non-rural and low-income versus non-low-income comparisons. We measured perceived telehealth access, willingness to use telehealth, and perceived telehealth barriers. FINDINGS Rural (38.6% vs 44.9%) and low-income adults (42.0% vs 47.4%) were less likely to report telehealth access, compared to non-rural and non-low-income counterparts. After adjustment, rural adults were still less likely to report telehealth access (adjusted prevalence ratio [aPR] = 0.89, 95% CI = 0.79-0.99); no differences were seen between low-income and non-low-income adults (aPR = 1.02, 95% CI = 0.88-1.17). The majority of adults reported willingness to use telehealth (rural = 78.4%; low-income = 79.0%), with no differences between rural and non-rural (aPR = 0.99, 95% CI = 0.92-1.08) or low-income versus non-low-income (aPR = 1.01, 95% CI = 0.91-1.13). No racial/ethnic differences were observed in willingness to use telehealth. The prevalence of perceived telehealth barriers was low, with the majority reporting no barriers (rural = 57.4%; low-income = 56.9%). CONCLUSIONS Lack of access (and awareness of access) is likely a primary driver of disparities in rural telehealth use. Race/ethnicity was not associated with telehealth willingness, suggesting that equal utilization is possible once granted access.
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Affiliation(s)
- Jamie S Ko
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Stephanie M. Quintero
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Miciah J. Wilkerson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, San Francisco, CA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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van Munster M, Printz MR, Crighton E, Mestre TA, Pedrosa DJ. Impact of the COVID-19 pandemic on perceived access and quality of care in German people with parkinsonism. Front Public Health 2023; 11:1091737. [PMID: 37124823 PMCID: PMC10140578 DOI: 10.3389/fpubh.2023.1091737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/27/2023] [Indexed: 05/02/2023] Open
Abstract
Due to the heterogeneous clinical presentation, people with Parkinsonism (PwP) develop individual healthcare needs as their disease progresses. However, because of limited health resources during the COVID-19 pandemic, many patients were put at risk of inadequate care. All this occurred in the context of inequitable healthcare provision within societies, especially for such vulnerable populations. This study aimed to investigate factors influencing satisfaction and unmet need for healthcare among PwP during the COVID-19 pandemic in Germany. Analyses relied on an anonymous online survey with a 49-item questionnaire. We aimed at describing access to health services before and during the early stages of the pandemic. To this end, a generalized linear model was used to derive significant predictors and a stepwise regression to subsummarize the main factors of perceived inadequate care. In total, 551 questionnaires showed that satisfaction with Parkinsonism-related care decreased significantly during the pandemic (p < 0.001). In particular, factors such as lower educational level, lower perceived expertise of healthcare providers, less confidence in remote care, difficulties in obtaining healthcare, and restricted access to care before the pandemic but also lower densities of neurologists at residence and less ability to overcome barriers were indicative of higher odds to perceive unmet needs (p < 0.05). The results unveil obstacles contributing to reduced access to healthcare during the COVID-19 pandemic for PwP. These findings enable considerations for improved provision of healthcare services to PwP.
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Affiliation(s)
- Marlena van Munster
- Department of Neurology, Philipps University Marburg, Baldingerstraße, Marburg, Germany
- Department of International Health, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, Netherlands
| | - Marcel R. Printz
- Department of Neurology, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Eric Crighton
- Department of Geography, Environment and Geomatics, University of Ottawa, University Private, Ottawa, ON, Canada
| | - Tiago A. Mestre
- Parkinson’s Disease and Movement Disorders Clinic, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - David J. Pedrosa
- Department of Neurology, Philipps University Marburg, Baldingerstraße, Marburg, Germany
- Centre of Mind, Brain and Behaviour, Philipps University Marburg, Hans Meerwein Straße, Marburg, Germany
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Clarke J, Beaney T, Alboksmaty A, Flott K, Ashrafian H, Fowler A, Benger JR, Aylin P, Elkin S, Neves AL, Darzi A. Factors associated with enrolment into a national COVID-19 pulse oximetry remote monitoring programme in England: a retrospective observational study. Lancet Digit Health 2023; 5:e194-e205. [PMID: 36963909 PMCID: PMC10032661 DOI: 10.1016/s2589-7500(23)00001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/31/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023]
Abstract
BACKGROUND Hypoxaemia is an important predictor of severity in individuals with COVID-19 and can present without symptoms. The COVID Oximetry @home (CO@h) programme was implemented across England in November, 2020, providing pulse oximeters to higher-risk people with COVID-19 to enable early detection of deterioration and the need for escalation of care. We aimed to describe the clinical and demographic characteristics of individuals enrolled onto the programme and to assess whether there were any inequalities in enrolment. METHODS This retrospective observational study was based on data from a cohort of people resident in England recorded as having a positive COVID-19 test between Oct 1, 2020, and May 3, 2021. The proportion of participants enrolled onto the CO@h programmes in the 7 days before and 28 days after a positive COVID-19 test was calculated for each clinical commissioning group (CCG) in England. Two-level hierarchical multivariable logistic regression with random intercepts for each CCG was run to identify factors predictive of being enrolled onto the CO@h programme. FINDINGS CO@h programme sites were reported by NHS England as becoming operational between Nov 21 and Dec 31, 2020. 1 227 405 people resident in 72 CCGs had a positive COVID-19 test between the date of programme implementation and May 3, 2021, of whom 19 932 (1·6%) were enrolled onto the CO@h programme. Of those enrolled, 14 441 (72·5%) were aged 50 years or older or were identified as clinically extremely vulnerable (ie, having a high-risk medical condition). Higher odds of enrolment onto the CO@h programme were found in older individuals (adjusted odds ratio 2·21 [95% CI 2·19-2·23], p<0·001, for those aged 50-64 years; 3·48 [3·33-3·63], p<0·001, for those aged 65-79 years; and 2·50 [2·34-2·68], p<0·001, for those aged ≥80 years), in individuals of non-White ethnicity (1·35 [1·28-1·43], p<0·001, for Asian individuals; 1·13 [1·04-1·22], p=0·005, for Black individuals; and 1·17 [1·03-1·32], p=0·015, for those of mixed ethnicity), in those who were overweight (1·31 [1·26-1·37], p<0·001) or obese (1·69 [1·63-1·77], p<0·001), or in those identified as clinically extremely vulnerable (1·58 [1·51-1·65], p<0·001), and lower odds were reported in those from the least socioeconomically deprived areas compared with those from the most socioeconomically deprived areas (0·75 [0·69-0·81]; p<0·001). INTERPRETATION Nationally, uptake of the CO@h programme was low, with clinical judgment used to determine eligibility. Preferential enrolment onto the pulse oximetry monitoring programme was observed in people known to be at the highest risk of developing severe COVID-19. FUNDING NHS England, National Institute for Health Research, and The Wellcome Trust.
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Affiliation(s)
- Jonathan Clarke
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK; Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK.
| | - Thomas Beaney
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ahmed Alboksmaty
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Paul Aylin
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah Elkin
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
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22
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Golovaty I, Ritchie ND, Tuomilehto J, Mohan V, Ali MK, Gregg EW, Bergman M, Moin T. Two decades of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change. Diabetes Res Clin Pract 2023; 198:110195. [PMID: 36470316 PMCID: PMC10079599 DOI: 10.1016/j.diabres.2022.110195] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention. This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual's risk, readiness, barriers, and digital competency.
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Affiliation(s)
- Ilya Golovaty
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. University of Colorado College of Nursing, Aurora, CO, USA
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III. Madrid, Spain
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Chairman, Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
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23
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Zhou R, Gu Y, Zhang B, Kong T, Zhang W, Li J, Shi J. Digital Therapeutics: Emerging New Therapy for Nonalcoholic Fatty Liver Disease. Clin Transl Gastroenterol 2023; 14:e00575. [PMID: 36854062 PMCID: PMC10132718 DOI: 10.14309/ctg.0000000000000575] [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: 10/18/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
The increased prevalence of nonalcoholic fatty liver disease (NAFLD) worldwide is particularly worrisome, as no medication has been approved to treat the disease. Lifestyle modifications aimed at promoting weight loss and weight maintenance remain the current first-line treatment for NAFLD. However, due to the lack of standard and scientific guidance and out-of-hospital supervision, long-term outcomes of lifestyle interventions for patients with NAFLD are often unsatisfactory. In addition, the COVID-19 pandemic aggravated this dilemma. At the same time, digital therapeutics (DTx) are expected to be a new method for the convenient management and treatment of patients with NAFLD and are attracting a great deal of attention. DTx, which provide evidence-based medicine through software programs for remote intervention in preventing, treating, or managing diseases, overcome the drawbacks of traditional treatment. The efficacy of the approach has already been demonstrated for some chronic diseases, but DTx have not been fully developed for NAFLD. This study reviews the concepts, clinical value, and practical applications related to DTx, with an emphasis on recommendations based on unmet needs for NAFLD. A better understanding of the current state will help clinicians and researchers develop high-quality, standardized, and efficient DTx products, with the aim of optimizing the prognosis of patients with NAFLD.
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Affiliation(s)
- Run Zhou
- College of Nursing, Hangzhou Normal University, Zhejiang, China;
| | - Yunpeng Gu
- School of Public Health, Hangzhou Normal University, Zhejiang, China;
| | - Binbin Zhang
- Department of Translational Medicine Platform, The Affiliated Hospital of Hangzhou Normal University, Zhejiang, China;
- Zhejiang University of Traditional Chinese Medicine, Zhejiang, China;
| | - Tingting Kong
- College of Nursing, Hangzhou Normal University, Zhejiang, China;
| | - Wei Zhang
- School of Public Health, Hangzhou Normal University, Zhejiang, China;
| | - Jie Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China;
- Institute of Viruses and Infectious Diseases, Nanjing University, Jiangsu, China;
| | - Junping Shi
- College of Clinical Medicine, Hangzhou Normal University, Zhejiang, China;
- The Department of Hepatology, the Affiliated Hospital & Institute of Hepatology and Metabolic Disease, Hangzhou Normal University, Zhejiang, China
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24
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Callison K, Anderson A, Shao Y, LaVeist TA, Walker B. Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic. Med Care 2023; 61:S70-S76. [PMID: 36893421 PMCID: PMC9994576 DOI: 10.1097/mlr.0000000000001795] [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 The COVID-19 pandemic led to an increased reliance on telemedicine. Whether this exacerbated existing disparities within vulnerable populations is not yet known. OBJECTIVES Characterize changes in outpatient telemedicine evaluation and management (E&M) services for Louisiana Medicaid beneficiaries by race, ethnicity, and rurality during the COVID-19 pandemic. RESEARCH DESIGN Interrupted time series regression models estimated pre-COVID-19 trends and changes in E&M service use at the April and July 2020 peaks in COVID-19 infections in Louisiana and in December 2020 after those peaks had subsided. SUBJECTS Louisiana Medicaid beneficiaries continuously enrolled between January 2018 and December 2020 who were not also enrolled in Medicare. MEASURES Monthly outpatient E&M claims per 1000 beneficiaries. RESULTS Prepandemic differences in service use between non-Hispanic White and non-Hispanic Black beneficiaries narrowed by 34% through December 2020 (95% CI: 17.6%-50.6%), while differences between non-Hispanic White and Hispanic beneficiaries increased by 10.5% (95% CI: 0.1%-20.7%). Non-Hispanic White beneficiaries used telemedicine at higher rates than non-Hispanic Black (difference=24.9 claims per 1000 beneficiaries, 95% CI: 22.3-27.4) and Hispanic beneficiaries (difference=42.3 claims per 1000 beneficiaries, 95% CI: 39.1-45.5) during the first wave of COVID-19 infections in Louisiana. Telemedicine use increased slightly for rural beneficiaries compared with urban beneficiaries (difference=5.3 claims per 1000 beneficiaries, 95% CI: 4.0-6.6). CONCLUSIONS The COVID-19 pandemic narrowed gaps in outpatient E&M service use between non-Hispanic White and non-Hispanic Black Louisiana Medicaid beneficiaries, though gaps in telemedicine use emerged. Hispanic beneficiaries experienced large reductions in service use and relatively small increases in telemedicine use.
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25
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Access to What for Whom? How Care Delivery Innovations Impact Health Equity. J Gen Intern Med 2023; 38:1282-1287. [PMID: 36627525 PMCID: PMC9831366 DOI: 10.1007/s11606-022-07987-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Abstract
Achieving health equity (where every person has the opportunity to attain their full health potential) requires the removal of obstacles to health, including barriers to high-quality medical care. Innovations in service delivery can inadvertently maintain, worsen, or introduce inequities. As such, implementation of innovations must be accompanied by a dual commitment to evaluate impact on marginalized groups and to restructure systems that obstruct people from health and healthcare. Understanding the impact innovations have on access to high-quality care is central to this effort. In this Perspective, we join conceptual models of healthcare access and quality with health equity frameworks to conceptualize healthcare receipt as a series of interactions between people and systems unfolding over time. This synthesized model is applied to illustrate the effects of telemedicine on patient, population, and system outcomes. Telemedicine may improve or worsen health equity by altering access to care and by altering quality of care once it is accessed. Teasing out these varied effects is complex and requires considering multilevel influences on the outcome of a care-seeking episode. This synthesized model can be used to inform research, practice, and policy surrounding the equity implications of care delivery innovations more broadly.
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26
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Campanozzi LL, Gibelli F, Bailo P, Nittari G, Sirignano A, Ricci G. The role of digital literacy in achieving health equity in the third millennium society: A literature review. Front Public Health 2023; 11:1109323. [PMID: 36891330 PMCID: PMC9986277 DOI: 10.3389/fpubh.2023.1109323] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Healthcare in the third millennium is largely delivered through systems involving the use of the technological devices and services, foremost among them telemedicine. For the adequate delivery of digital medicine services, however, it is necessary for users to be digitally literate, that is, able to consciously make use of technology. In order to understand how relevant digital literacy is in determining the effectiveness of e-Health services, we performed a traditional literature review on 3 major databases by combining the terms "Digital Literacy" and "Computer Literacy" with the terms "Telemedicine" and "Telehealth". Starting from an initial library of 1,077 papers, we selected 38 articles. At the outcome of the search, we found that digital literacy is a pivotal element in conditioning the effectiveness of telemedicine and digital medicine services in general, however, with some limitations.
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Affiliation(s)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
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27
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The Role of Telemedicine in Follow-Up for Cardiovascular Hospitalizations. JACC ADVANCES 2022; 1:100154. [PMID: 36620530 PMCID: PMC9802536 DOI: 10.1016/j.jacadv.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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28
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Moorhead JB, Herbert BM, Abebe KZ, Harrington C, Miller E, Lindau ST, Magnani JW, Johnson AE. Internet access and cardiovascular death in the United States. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 21:100200. [PMID: 37077665 PMCID: PMC10112670 DOI: 10.1016/j.ahjo.2022.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 04/21/2023]
Abstract
As high-speed internet becomes increasingly important as a resource for cardiovascular disease (CVD) prevention and management services, gaps in digital infrastructure may have detrimental impact on health outcomes. Using national census and CDC data from 2018 we evaluated state-level rates of household internet access and age-adjusted cardiac mortality. After adjusting for state level demographic variables, and rates of education, income, and health insurance, internet access rates were inversely associated with age adjusted CVD mortality, showing that the potential for internet access to affect CVD management deserves further study.
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Affiliation(s)
| | - Brandon M. Herbert
- University of Pittsburgh, School of Public Health, United States of America
| | - Kaleab Z. Abebe
- University of Pittsburgh, School of Medicine, United States of America
- University of Pittsburgh, Department of Medicine, Division of General Internal Medicine, United States of America
| | - Christina Harrington
- Carnegie Mellon University, Human-Computer Interaction Institute, United States of America
| | - Elizabeth Miller
- University of Pittsburgh, School of Medicine, United States of America
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, United States of America
| | - Stacy T. Lindau
- The University of Chicago, Departments of Ob/Gyn and Medicine-Geriatrics and Palliative Medicine, United States of America
| | - Jared W. Magnani
- University of Pittsburgh, School of Medicine, United States of America
- University of Pittsburgh, Department of Medicine, Division of Cardiology, United States of America
| | - Amber E. Johnson
- University of Pittsburgh, School of Medicine, United States of America
- University of Pittsburgh, Department of Medicine, Division of Cardiology, United States of America
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29
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Balakrishnan AS, Nguyen HG, Shinohara K, Carroll PR, Odisho AY. Patient engagement in a mobile health intervention to improve preparedness for prostate biopsy. Urol Oncol 2022; 40:407.e1-407.e7. [DOI: 10.1016/j.urolonc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
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30
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Kong-Wong C, Weiss MA, Shumway M, Schleyer A, Aas E, Rhodes M, Scott JD. Lessons Learned: Building a Comprehensive Telehealth Quality Program. Am J Med Qual 2022; 37:456-463. [PMID: 35799323 DOI: 10.1097/jmq.0000000000000071] [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: 11/26/2022]
Abstract
The UW Medicine Telehealth Services team developed a comprehensive telehealth Quality Improvement (QI) program founded upon 5 QI pillars: incident reporting, patient experience surveys, patient complaints, peer review, and targeted QI projects. The authors outline the foundation of this QI program, early trends from peer review, patient experience surveys, and telehealth utilization by demographic group. Telehealth quality should be scrutinized with the same rigor applied to in-person care. All health systems should establish a telehealth QI program.
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Affiliation(s)
- Crystal Kong-Wong
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
- UW Medicine Digital Health, Seattle, WA
| | | | | | - Anneliese Schleyer
- Department of Medicine, University of Washington, School of Medicine, Seattle, WA
- UW Medicine, Office of the Chief Medical Officer, Seattle, WA
| | - Erin Aas
- Harborview Medical Center Quality Improvement, Seattle, WA
| | - Marcia Rhodes
- UW Medicine, Office of the Chief Medical Officer, Seattle, WA
| | - John D Scott
- UW Medicine Digital Health, Seattle, WA
- Department of Medicine, Division of Allergy, and Infectious Disease, University of Washington School of Medicine, Seattle, WA
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31
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Spain D, Stewart GR, Mason D, Milner V, Fairhurst B, Robinson J, Gillan N, Ensum I, Stark E, Happe F. Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals. JMIR Ment Health 2022; 9:e37901. [PMID: 35857358 PMCID: PMC9302612 DOI: 10.2196/37901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. OBJECTIVE This study explored health professionals' experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. METHODS A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. RESULTS Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals' experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. CONCLUSIONS A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.
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Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- The National Psychology Clinic, London, United Kingdom
| | - Gavin R Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Victoria Milner
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- The National Psychology Clinic, London, United Kingdom
| | - Bryony Fairhurst
- The National Psychology Clinic, London, United Kingdom
- Berrywood Hospital, Northampton Healthcare National Health Service Foundation Trust, Northampton, United Kingdom
| | - Janine Robinson
- Cambridge Lifespan Autism Spectrum Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Nicola Gillan
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership National Health Service Trust, Bristol, United Kingdom
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership National Health Service Trust, Bristol, United Kingdom
| | | | - Francesca Happe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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32
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Gallegos-Rejas VM, Thomas EE, Kelly JT, Smith AC. A multi-stakeholder approach is needed to reduce the digital divide and encourage equitable access to telehealth. J Telemed Telecare 2022; 29:73-78. [PMID: 35733379 DOI: 10.1177/1357633x221107995] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the COVID-19 pandemic onset, there has been exponential growth in the uptake of telehealth, globally. However, evidence suggests that people living in lower socioeconomic areas, cultural and linguistically diverse communities, people with disabilities, and with low health literacy are less likely to receive telehealth services. These population groups have disproportionately higher health needs and face additional barriers to healthcare access. Barriers that reduce access to telehealth further exacerbate existing gaps in care delivery. To improve equity of access to telehealth, we need to reduce the digital divide through a multi-stakeholder approach. This article proposes practical steps to reduce the digital divide and encourage equitable access to telehealth. Enabling more equitable access to telehealth requires improvements in digital health literacy, workforce training in clinical telehealth, co-design of new telehealth-enabled models of care, change management, advocacy for culturally appropriate services, and sustainable funding models.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,Centre for Innovative Medical Technology, 6174University of Southern Denmark, Odense, Denmark
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33
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Woodcock E, Sen A, Weiner J. Automated patient self-scheduling: case study. J Am Med Inform Assoc 2022; 29:1637-1641. [PMID: 35652165 DOI: 10.1093/jamia/ocac087] [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: 02/27/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022] Open
Abstract
This case study assesses the uptake, user characteristics, and outcomes of automated self-scheduling in a community-based physician group affiliated with an academic health system. We analyzed 1 995 909 appointments booked between January 1, 2019, and June 30, 2021 at more than 30 practice sites. Over the study period, uptake of self-scheduling increased from 4% to 15% of kept appointments. Younger, commercially insured patients were more likely to be users. Missed appointments were lower and cancelations were higher for self-scheduled patients. An examination of characteristics, benefits, and usage of automated self-scheduling provides insight to those organizations contemplating the implementation or expansion of similar consumer-facing digital self-scheduling platforms.
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Affiliation(s)
- Elizabeth Woodcock
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aditi Sen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan Weiner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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34
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Ramasawmy M, Poole L, Thorlu-Bangura Z, Chauhan A, Murali M, Jagpal P, Bijral M, Prashar J, G-Medhin A, Murray E, Stevenson F, Blandford A, Potts HWW, Khunti K, Hanif W, Gill P, Sajid M, Patel K, Sood H, Bhala N, Modha S, Mistry M, Patel V, Ali SN, Ala A, Banerjee A. Frameworks for implementation, uptake and use of digital health interventions in ethnic minority populations: a scoping review using cardiometabolic disease as a case study. (Preprint). JMIR Cardio 2022; 6:e37360. [PMID: 35969455 PMCID: PMC9412726 DOI: 10.2196/37360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies.
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Affiliation(s)
- Mel Ramasawmy
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Lydia Poole
- Institute of Health Informatics, University College London, London, United Kingdom
| | | | - Aneesha Chauhan
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mayur Murali
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Parbir Jagpal
- School of Pharmacy, University of Birmingham, Birmingham, United Kingdom
| | - Mehar Bijral
- University College London Medical School, University College London, London, United Kingdom
| | - Jai Prashar
- University College London Medical School, University College London, London, United Kingdom
| | - Abigail G-Medhin
- Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom
| | - Fiona Stevenson
- eHealth Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom
| | - Ann Blandford
- University College London Interaction Centre, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Wasim Hanif
- Department of Diabetes and Institute of Translational Medicine, University Hospital Birmingham, Birmingham, United Kingdom
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Madiha Sajid
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Kiran Patel
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Harpreet Sood
- Health Education England, London, United Kingdom
- Hurley Group Practice, London, United Kingdom
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shivali Modha
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Manoj Mistry
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Vinod Patel
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sarah N Ali
- Department of Diabetes and Endocrinology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Aftab Ala
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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Telehealth Interventions to Improve Diabetes Management Among Black and Hispanic Patients: a Systematic Review and Meta-Analysis. J Racial Ethn Health Disparities 2022; 9:2375-2386. [PMID: 35000144 PMCID: PMC8742712 DOI: 10.1007/s40615-021-01174-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous systematic reviews have found that telehealth is an effective strategy for implementing interventions to improve glycemic control and other clinical outcomes for diabetes patients. However, these reviews have not meaningfully focused on Black and Hispanic patients-partly because of the lack of adequate representation of people from racial and ethnic minority groups in clinical trials. It is unclear whether telehealth interventions are effective at improving glycemic control among Black and Hispanic patients given the disproportionate number of barriers they face accessing health care. OBJECTIVES A systematic review and meta-analysis of randomized control trials that used telehealth interventions for improving glycemic control among Black and Hispanic diabetes patients. METHODS We reviewed PubMed, Embase, Web of Science, CINAHL, PsycINFO, and clinicalTrials.gov from inception to March 2021. We used a narrative summary approach to describe key study characteristics and graded the quality of studies using two reviewers. The pooled net change in HbA1c values was estimated across studies using a random-effects model. RESULTS We identified 10 studies that met our inclusion and exclusion criteria. Nine studies were included in the meta-analysis. Only one study was rated as having low bias. Telehealth interventions were primarily delivered by telephone calls, text messages, web-based portals, and virtual visits. Most interventions involved delivering diabetes self-management education. Telehealth intervention pooled across studies with a mix of Black and Hispanic participants (> 50% sample) was associated with a - 0.465 ([CI: - 0.648 to - 0.282], p = 0.000) reduction in HbA1c. CONCLUSIONS Our findings suggest telehealth interventions are effective at improving glycemic control among Black and Hispanic diabetes patients.
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Chang MH, Moonesinghe R, Truman BI. Telehealth Availability and Usage Among Medicare Beneficiaries During the COVID-19 Pandemic, October and November 2020. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:77-85. [PMID: 34654021 PMCID: PMC11323286 DOI: 10.1097/phh.0000000000001448] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT During the COVID-19 pandemic, demand for telehealth services increased to reduce disease exposure for patients and providers and to meet preexisting demand for physician services in health resource shortage areas. OBJECTIVE To estimate self-reported telehealth availability, equipment for accessing telehealth, and telehealth usage among Medicare beneficiaries during the COVID-19 pandemic. DESIGN We used data from the 2020 Medicare Current Beneficiary Survey (MCBS) COVID-19 Fall Supplement Public Use File to estimate the weighted percentages of beneficiaries who had (a) access to telehealth before or during COVID-19; (b) equipment for accessing telehealth; and (c) telehealth visits during COVID-19. We used logistic regression to examine sociodemographic factors associated with telehealth usage. PARTICIPANTS Beneficiaries who participated in the MCBS COVID-19 Fall Supplements. RESULTS During October and November 2020, telehealth appointments offered by providers were available to 63.8% (95% confidence interval [CI], 61.8-65.9) of Medicare beneficiaries who had accessed medical care by telephone or video. Among those, only 18.0% (95% CI, 16.1-19.9) had been offered telehealth before the pandemic. The majority of beneficiaries (92.2%; 95% CI, 91.2-93.1) had 1 or more types of equipment available for accessing telehealth, but only 44.9% (95% CI, 43.0-46.9) had had a telehealth visit since July 1, 2020. Older adults, minorities, those with a lower income, and non-English speakers had less availability of telehealth equipment. Patient characteristics were significantly (P < .05) associated with telehealth use, including age, sex, race/ethnicity, and equipment availability. CONCLUSION Telehealth availability for Medicare beneficiaries increased substantially during the COVID-19 pandemic. Even with the improvement in telehealth offerings and use hastened by the pandemic, gaps in access and use still exist. Effectiveness and implementation research can find ways to close gaps in telehealth services between vulnerable and underrepresented populations and counterparts.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (Ms Chang and Dr Truman), and Office of Genomics and Precision Public Health (Dr Moonesinghe), Centers for Disease Control and Prevention, Atlanta, Georgia
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Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Chagpar AB. Sociodemographic factors affecting telemedicine access: A population-based analysis. Surgery 2021; 171:793-798. [PMID: 34848076 PMCID: PMC8872675 DOI: 10.1016/j.surg.2021.08.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/14/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
Background The coronavirus disease 2019 pandemic prompted a surge in telemedicine, with the presumption that patients had computer and internet access. We sought to determine, in a population-based sample, how many Americans were using computers and the internet before the pandemic, and whether disparities existed in this. Methods The National Health Interview Survey is conducted annually by the Centers for Disease Control and Prevention and is representative of the entire United States civilian non-institutionalized population. In 2018, questions were fielded regarding computer and web utilization. We evaluated sociodemographic factors associated with this. Results Twenty-five thousand and forty-nine people, representing 245,842,992 in the population, responded to these questions. Of the responses, 19% stated they used a computer “never or almost never,” 18% stated they did not use the internet, and 25% did not use email. Over the previous 12 months, 55% of responders stated they had looked up health information on the internet, 11% had filled a prescription online, 16% had scheduled a medical appointment on the internet, and 17% had communicated with a healthcare provider by email. Internet usage varied by region, age, race, education, family income, and insurance status, but not by gender. Conclusion As telemedicine becomes more prevalent, sociodemographic factors limiting computer and internet use may disadvantage certain segments of the population.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, CT.
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The Use of Telemedicine in Nursing Homes: A Mixed-Method Study to Identify Critical Factors When Connecting with a General Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111148. [PMID: 34769665 PMCID: PMC8583601 DOI: 10.3390/ijerph182111148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/21/2022]
Abstract
Evaluating the use and impact of telemedicine in nursing homes is necessary to promote improvements in the quality of this practice. Even though challenges and opportunities of telemedicine are increasingly becoming well documented for geriatrics (such as improving access to healthcare, patient management, and education while reducing costs), there is still limited knowledge on how to better implement it in an inter-organizational context, especially when considering nursing homes. In this regard, this study aimed first to describe the telemedicine activity of nursing homes when cooperating with a general hospital; and then understand the behavioral differences amongst nursing homes while identifying critical factors when implementing a telemedicine project. We conducted a sequential, explanatory mixed-method study using quantitative then qualitative methods to better understand the results. Three years of teleconsultation data of twenty-six nursing homes (15 rural and 11 urban) conducting teleconsultations with a general hospital (Troyes Hospital, France) were included for the quantitative analysis, and eleven telemedicine project managers for the qualitative analysis. Between April 2018 and April 2021, 590 teleconsultations were conducted: 45% (n = 265) were conducted for general practice, 29% (n = 172) for wound care, 11% (n = 62) for diabetes management, 8% (n = 47) with gerontologist and 6% (n = 38) for dermatology. Rural nursing homes conducted more teleconsultations overall than urban ones (RR: 2.484; 95% CI: 1.083 to 5.518; p = 0.03) and included more teleconsultations for general practice (RR: 16.305; 95% CI: 3.505 to 73.523; p = 0.001). Our qualitative study showed that three critical factors are required for the implementation of a telemedicine project in nursing homes: (1) the motivation to perform teleconsultations (in other words, improving access to care and cooperation between professionals); (2) building a relevant telemedicine medical offer based on patients' and treating physicians' needs; and (3) it's specific organization in terms of time and space. Our study showed different uses of teleconsultations according to the rural or urban localization of nursing homes and that telemedicine projects should be designed to consider this aspect. Triggered by the COVID-19 pandemic, telemedicine projects in nursing homes are increasing, and observing the three critical factors presented above could be necessary to limit the failure of such projects.
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Davoodi NM, Chen K, Zou M, Li M, Jiménez F, Wetle TF, Goldberg EM. Emergency physician perspectives on using telehealth with older adults during COVID-19: A qualitative study. J Am Coll Emerg Physicians Open 2021; 2:e12577. [PMID: 34693401 PMCID: PMC8516338 DOI: 10.1002/emp2.12577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Emergency medicine physicians have played a pivotal role throughout the coronavirus disease 19 (COVID-19) pandemic through in-person and remote management and treatment. Our primary objectives were to understand emergency medicine physicians' experiences using telehealth throughout the pandemic, any facilitators/barriers to successful usage, lessons learned during implementation, and successful/abandoned strategies used to engage with older adults. METHODS Using a semi-structured interview guide, we conducted 30-min interviews. We used purposeful sampling to recruit emergency medicine physicians from all United States regions, rural-urban settings, and academic and community practices, who reported caring for patients 65 years or older in-person or virtually during the pandemic. Interviews were audio-recorded, transcribed, double-coded, and analyzed for emergent themes using framework analysis. RESULTS A total of 15 in-depth interviews were completed from September to November 2020. Physicians had a median age of 37 years, 7 were women, and 9 had experience with telehealth before the pandemic. We identified several themes: (1) there were various motivations for telehealth use; (2) telehealth was used primarily to supplement, not replace in-person care; (3) most platforms were easy to use; (4) patients and caregivers had high acceptability of telemedicine; and (5) older adults with sensory and cognitive impairments often relied on caregivers. Emergency medicine physicians played a critical role during primary care office closures during the first wave-dispelling misinformation about COVID-19, triaging patients to testing and treatment, and providing care that would otherwise have been deferred. CONCLUSIONS Our data show that telemedicine gained acceptability among emergency medicine physicians and provided options to patients who may have otherwise deferred care. These findings can inform future healthcare delivery for acute care needs or pandemic responses.
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Affiliation(s)
| | - Kevin Chen
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Maria Zou
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Melinda Li
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Frances Jiménez
- School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Terrie Fox Wetle
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Center for Gerontology and Healthcare ResearchBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Elizabeth M. Goldberg
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Emergency MedicineThe Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Thom B, Benedict C, Friedman DN, Watson SE, Zeitler MS, Chino F. Economic distress, financial toxicity, and medical cost-coping in young adult cancer survivors during the COVID-19 pandemic: Findings from an online sample. Cancer 2021; 127:4481-4491. [PMID: 34351638 PMCID: PMC8426858 DOI: 10.1002/cncr.33823] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Background Young adult (YA) cancer survivors are at risk for financial toxicity during and after cancer treatment. Financial toxicity has been associated with medical‐related cost‐coping behaviors such as skipping or delaying treatment. The coronavirus disease 2019 (COVID‐19) pandemic has resulted in dire economic consequences that may worsen financial hardship among young survivors. Methods This was a cross‐sectional survey; data collection occurred online. A convenience sample was recruited through YA cancer advocacy groups and social media. Negative economic events associated with the COVID‐19 pandemic (eg, income loss, increased debt, and decreased job security) and medical‐related cost‐coping were documented. A validated measure assessed cancer‐related financial toxicity. Results Participants (N = 212) had a mean age of 35.3 years at survey completion and a mean age of 27.4 years at diagnosis. Financial toxicity (mean, 14.0; SD, 9.33) was high. Two‐thirds of the sample experienced at least 1 negative economic event during COVID‐19, and 71% engaged in at least 1 medical cost‐coping behavior. Cost‐coping and pandemic‐related negative economic events were significantly correlated with cancer‐related financial toxicity. In multivariable analyses, pandemic‐related negative economic events and financial toxicity were associated with cost‐coping. Conclusions Acute negative economic events associated with the COVID‐19 pandemic may exacerbate cancer‐related financial toxicity and overall financial hardship among YAs and lead to cost‐coping behaviors that can compromise survivorship care and health outcomes. Multilevel, systematic interventions are needed to address the financial needs of YA survivors after the global pandemic. This study illustrates how the acute negative economic events associated with the coronavirus disease 2019 pandemic may have exacerbated existing cancer‐related financial toxicity and general financial hardship among young adult cancer survivors. These negative economic events and financial toxicity are associated with cost‐coping behaviors that can compromise survivorship care and health outcomes.
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Affiliation(s)
- Bridgette Thom
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Benedict
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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