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Qin J, Chan CW, Dong J, Homma S, Ye S. Telemedicine is associated with reduced socioeconomic disparities in outpatient clinic no-show rates. J Telemed Telecare 2024; 30:1507-1515. [PMID: 36974422 DOI: 10.1177/1357633x231154945] [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: 03/29/2023]
Abstract
INTRODUCTION The global pandemic caused by coronavirus (COVID-19) sped up the adoption of telemedicine. We aimed to assess whether factors associated with no-show differed between in-person and telemedicine visits. The focus is on understanding how social economic factors affect patient no-show for the two modalities of visits. METHODS We utilized electronic health records data for outpatient internal medicine visits at a large urban academic medical center, from February 1, 2020 to December 31, 2020. A mixed-effect logistic regression was used. We performed stratified analysis for each modality of visit and a combined analysis with interaction terms between exposure variables and visit modality. RESULTS A total of 111,725 visits for 72,603 patients were identified. Patient demographics (age, gender, race, income, partner), lead days, and primary insurance were significantly different between the two visit modalities. Our multivariable regression analyses showed that the impact of sociodemographic factors, such as Medicaid insurance (OR 1.23, p < 0.01 for in-person; OR 1.03, p = 0.57 for telemedicine; p < 0.01 for interaction), Medicare insurance (OR 1.11, p = 0.04 for in-person; OR 0.95, p = 0.32 for telemedicine; p = 0.03 for interaction) and Black race (OR 1.36, p < 0.01 for in-person; OR 1.20, p < 0.01 for telemedicine; p = 0.03 for interaction), on increased odds of no-show was less for telemedicine visits than for in-person visits. In addition, inclement weather and younger age had less impact on no-show for telemedicine visits. DISCUSSION Our findings indicated that if adopted successfully, telemedicine had the potential to reduce no-show rate for vulnerable patient groups and reduce the disparity between patients from different socioeconomic backgrounds.
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Affiliation(s)
- Jimmy Qin
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Carri W Chan
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Jing Dong
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Siqin Ye
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
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Tong JY, Hartkorn AR, Sataloff R. Otolaryngology residency program websites in a socially distanced application cycle. EAR, NOSE & THROAT JOURNAL 2024; 103:NP514-NP519. [PMID: 34983198 DOI: 10.1177/01455613211064005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To provide an updated evaluation of otolaryngology residency program websites during a socially distanced application cycle. Criteria were selected to evaluate for level of comprehensiveness, new content accommodating a virtual interview cycle, and stated commitment to diversity and inclusion. STUDY DESIGN Review of otolaryngology residency program websites. SETTING Online websites between December 2020 and January 2021. METHODS Otolaryngology residency program websites were evaluated for selected criteria. Programs were categorized by geographic location, size, and Doximity rankings. Differences between groups were analyzed using Student's t-test and analysis of variance with a significance level of P < .05. RESULTS 118 otolaryngology residency program websites contained a mean (SD) of 16.3 (4.7) of 31 criteria (52.6%). Fewer than one third included virtual/video tours of facilities or the surrounding area. Only 33% had a stated commitment to diversity and inclusion. There was no difference in number of criteria included when categorized by geographic location (P = .22). Larger programs (17.9 vs 14.5, P < .001) and programs ranked in the top 50 by Doximity (17.7 vs 15.2, P = .003) included a significantly greater number of criteria. CONCLUSION While the comprehensiveness of otolaryngology residency program websites has improved, considerable room for improvement remains. Programs should strive to maintain updated websites that highlight training opportunities, program culture, and commitment to diversity and inclusion. Programs also should consider prioritizing the development of new online resources that may be especially useful to applicants during a virtual interview cycle.
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Affiliation(s)
- Jane Y Tong
- Department of otolaryngology-head and neck surgery, University of Maryland, Baltimore, Maryland
| | - Alyssa R Hartkorn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Robert Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
- Lankenau Institute for Medical Research, Philadelphia, PA, USA
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Gornik AE, Northrup RA, Kalb LG, Jacobson LA, Lieb RW, Peterson RK, Wexler D, Ludwig NN, Ng R, Pritchard AE. To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic. Clin Neuropsychol 2024; 38:279-301. [PMID: 37291078 DOI: 10.1080/13854046.2023.2219421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.
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Affiliation(s)
- Allison E Gornik
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rachel A Northrup
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Luther G Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rebecca W Lieb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Danielle Wexler
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rowena Ng
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Alison E Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
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Lee MGY, Russo JJ, Ward J, Wilson WM, Grigg LE. Impact of Telehealth on Failure to Attend Rates and Patient Re-Engagement in Adult Congenital Heart Disease Clinic. Heart Lung Circ 2023; 32:1354-1360. [PMID: 37821262 DOI: 10.1016/j.hlc.2023.08.010] [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: 02/02/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic paved the way for telehealth consultations. We aimed to determine the impact of telehealth on rates of failure to attend (FTA) in adult congenital heart disease (ACHD) clinics and whether telehealth could re-engage patients with previous FTA face-to-face appointments. METHODS This was a retrospective audit of a tertiary ACHD clinic over a 12-month pre-telehealth (26 March 2019-17 March 2020) and 12-month post-telehealth implementation period (24 March 2020-16 March 2021). Patients with one or more FTAs during the 24-month study period were included. Our ACHD clinic is run three times per month. Patients with ACHD are offered lifelong follow-up and reviewed annually on average. Re-engagement was defined as two or more consecutive face-to-face FTAs immediately before the telehealth period with subsequent attendance of their telehealth appointment. RESULTS A total of 359 patients with a total of 623 FTAs were included. Complexity of congenital heart disease was moderate in 56% (202/359) and severe in 19% (69/359) of patients. Overall FTA rate was 18% (623/3,452). FTA rate was significantly lower in the post-telehealth period (15%, 257/1,664) compared with the pre-telehealth period (20%, 366/1,788) (p<0.00001). At study conclusion, 1% of patients had died (5/359). Of the 354 remaining patients, 42% (150/354) were considered lost to follow-up (two or more FTAs including telehealth), 37% (132/354) missed only one clinic appointment, and 20% (72/354) previously considered lost to follow-up had re-engaged in the telehealth period. CONCLUSIONS Rates of FTA in a tertiary ACHD clinic significantly reduced after the introduction of telehealth consultation. A fifth of patients considered lost to follow-up were re-engaged with telehealth. Additional strategies to further reduce FTA should be explored.
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Affiliation(s)
- Melissa G Y Lee
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia; Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Jeremy J Russo
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Juliet Ward
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - William M Wilson
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
| | - Leeanne E Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
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Discepolo K, Melvin P, Ghazarians M, Tennermann N, Ward VL. Socioeconomic and Clinical Demography of Dental Missed Care Opportunities. JDR Clin Trans Res 2023; 8:356-366. [PMID: 35722931 DOI: 10.1177/23800844221104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Missed care opportunities (MCOs) contribute to poor health outcomes, and pediatric dental patients are particularly vulnerable; identifying associated patient characteristics will help inform development of targeted interventional programs. OBJECTIVE To assess socioeconomic and demographic disparities associated with MCOs among children in an urban pediatric hospital's dental clinic. MCOs lead to a lack of continuous care and increased emergent needs, so understanding MCOs is required to achieve equitable pediatric dental health. METHODS A retrospective 2-y (2019-2020) cohort of MCOs in children 1 to 17 y old, with scheduled dental visits. MCOs were defined as appointments not attended or canceled and not rescheduled prior to initial scheduled visit. Multivariable mixed-effects logistic regression models with patient-level clustering assessed the associations of demographics, neighborhood-level socioeconomic factors (using social vulnerability index [SVI]), and clinic characteristics with MCOs. RESULTS Of 30,095 visits, 30.9% were MCOs. Multivariable logistic regression estimated increased likelihood of MCOs in Black/non-Hispanic (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09-1.32) and Hispanic (OR, 1.18; 95% CI, 1.06-1.31) patients, patients with public insurance (OR, 1.25; 95% CI, 1.15-1.36) or no insurance (OR, 1.46; 95% CI, 1.15-1.85), patients with complex chronic conditions (OR, 1.11; 95% CI, 1.03-1.19), visits scheduled during the COVID-19 pandemic (OR, 9.48; 95% CI, 8.89-10.11), appointments with wait days over 21 d (OR, 4.07; 95% CI, 3.49-4.74), and children from neighborhoods of high social vulnerability (75th percentile SVI) (OR, 1.08; 95% CI, 1.01-1.16). CONCLUSIONS Children with highest dental MCOs were from neighborhoods with high SVI, had public insurance, and were from marginalized populations. MCOs contribute to inequities in overall health; hence, interventions that address barriers related to characteristics associated with pediatric dental MCOs are needed. KNOWLEDGE TRANSFER STATEMENT Missed care opportunities contribute to poor health outcomes; identifying associated patient characteristics will help inform development of targeted interventional programs. Providing these findings to stakeholders will better impart understanding access barriers and drive research and program development. Dissemination of this information in the form of altering appointment practices will better accommodate specific patient population needs.
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Affiliation(s)
- K Discepolo
- Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | - P Melvin
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - M Ghazarians
- Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | - N Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - V L Ward
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Cutchin GM, Shelly S, Petty B, van Leer E, Tripp RM, Klein AM, Gillespie AI. A Comparison of Voice Therapy Attendance Rates Between In-Person and Telepractice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1154-1164. [PMID: 36958015 DOI: 10.1044/2022_ajslp-22-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE This study sought to investigate whether a significant difference exists in attendance, cancellations, and no-shows between in-person therapy and telepractice. The authors hypothesized that telepractice no-show and cancellation rates would be less than in-person no-show and cancellation rates. METHOD This retrospective study manually reviewed and analyzed attendance, no-show, and cancellation data over a 3-month span of in-person-only visits (September 2019-November 2019) and a 3-month span of telepractice visits (September 2020-November 2020) conducted at the Emory Voice Center, a tertiary care practice in urban Atlanta, Georgia. Additionally, data were collected for each patient's full course of therapy outside of the 3-month windows and analyzed for attendance, no-show, and cancellation patterns. RESULTS Data from 521 patients were available for review from the selected time frame. In 2019 (in-person), 157 patients met inclusion criteria, and in 2020 (telepractice), 176 patients were included. Therapy initiation, therapy attendance, and no-show rates had significant increases in the telepractice year, and cancellations made greater than 24 hr before the appointments had a significant decrease in the telepractice year. Furthermore, the overall course of therapy showed significantly fewer missed appointments and more attended appointments in the telepractice year. CONCLUSIONS Patients participating in voice therapy via telepractice are more likely to initiate treatment and attend treatment and less likely to cancel sessions compared with patients receiving treatment in person. These data combined with extant data on telepractice treatment efficacy indicate that telepractice should be considered standard of care and offered to all patients seeking treatment, as it removes many reported barriers to treatment.
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Affiliation(s)
- Grace M Cutchin
- Department of Otolaryngology, Washington University in St. Louis
| | - Sandeep Shelly
- Department of Otolaryngology, Emory University, Atlanta, GA
| | - Brian Petty
- Department of Otolaryngology, Emory University, Atlanta, GA
| | - Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - Raquel M Tripp
- Department of Otolaryngology, Emory University, Atlanta, GA
| | - Adam M Klein
- Department of Otolaryngology, Emory University, Atlanta, GA
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Sun CA, Perrin N, Maruthur N, Renda S, Levin S, Han HR. Predictors of Follow-Up Appointment No-Shows Before and During COVID Among Adults with Type 2 Diabetes. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chun-An Sun
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nisa Maruthur
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Renda
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Scott Levin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hae-Ra Han
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Jones JW, Saravia A, Mamidi IS, Torres JI, Evans AK. Telehealth Adoption and Perspectives Among Pediatric Otolaryngologists Following the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2022:34894221129014. [PMID: 36217956 DOI: 10.1177/00034894221129014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess use of and physician experiences with pediatric otolaryngology telehealth visits as impacted by the COVID-19 pandemic. STUDY DESIGN/SETTING Cross sectional survey. METHODS A 15-question survey was electronically distributed to 656 members of the American Society of Pediatric Otolaryngology in August 2021, addressing member demographics, experiential practice elements, and use pre-pandemic, during the initial shutdown period of March-May 2020, and current use at the time of survey inquiry. RESULTS There were 124 respondents (response rate = 18.9%). Incident use pre-pandemic and during the shutdown were 21.0% (n = 26), and 92.7% (n = 115), respectively. Current use was 83.9% (n = 104) and the percentage of new current users (79.5%, n = 78) was significant (P < .0001,95% CI = 70.6%-86.4%). Estimated median telehealth visit rates pre-pandemic, during shutdown, and currently were 0 to 1, 4 to 5, and 2 to 3 per week, respectively (P < .0001). A difference in post-covid adoption rates was noted only for location (P = .008), with no differences for years out of training or practice type. Compared to in-person visits, physician satisfaction with telehealth visits was rated equivalent (49.0%) or worse/much worse (48.1%). The most common telehealth uses were follow-up visits (83.7%), pre-operative counseling (76.9%), and post-operative evaluation (69.2%). The need for a detailed exam (89.4%) and initial visits (32.7%) were reasons a telehealth visit was not offered. CONCLUSIONS The COVID-19 pandemic appears to have precipitated a rapid increase in telehealth adoption among surveyed pediatric otolaryngologists, regardless of age or practice type. The most significant limitations remain the need for a detailed exam, perceived low patient technological literacy, and limitations to interpretive services. Technology-based optimization of these barriers could lead to increased use and physician satisfaction.
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Affiliation(s)
- Joel W Jones
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ari Saravia
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ishwarya S Mamidi
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jairo I Torres
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Adele K Evans
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Akintomide E, Shah B, Sridharan S, Visram S, Sebire NJ, Peters C. Clinical perception of effectiveness of virtual appointments and comparison with appointment outcomes at a specialist children's hospital. Future Healthc J 2021; 8:e660-e665. [PMID: 34888461 DOI: 10.7861/fhj.2021-0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction A transition from face-to-face to virtual consultations occurred in response to the COVID-19 pandemic. Evaluation of outcome data is essential for future healthcare modelling. Methods Clinicians at a children's hospital evaluated perceptions of face-to-face video and telephone appointments by questionnaire. Responses were compared with operational outcomes from June 2019 and June 2020. Results Ninety-three clinicians responded from 28 subspecialties. Virtual consultations increased from 6% (2019) to 67% (2020). No differences were found between appointment types for recording a medical and social history; a significant difference (p<0.001) was seen for the perceived ability to detect clinical signs, organise investigations and make a diagnosis. The proportion of appointments resulting in discharge compared with face-to-face visits was unchanged. The proportion of patients requiring further contact increased from 35% (32% face-to-face and 3% telephone) to 46% (14% face-to-face; 21% telephone and 11% video; chi-squared 426; p<0.0001).The percentage of patients offered an appointment following two 'was not brought' appointments increased from 71% (2019) to 81% (2020) and was most common following telephone appointments (20% face-to-face, 43% telephone and 18% video; chi-squared 474; p<0.0001). Conclusion The perception of clinicians is that virtual appointments enabled continuity of paediatric care with improved clinical assessment capability and attendance during video consultations compared with telephone consultations.
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Affiliation(s)
- Eve Akintomide
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Bindi Shah
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shankar Sridharan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sheena Visram
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Catherine Peters
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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11
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Hoi KK, Brazina SA, Kolar-Anderson R, Zopf DA, Bohm LA. A Longitudinal Comparison of Telemedicine Versus In-Person Otolaryngology Clinic Efficiency and Patient Satisfaction During COVID-19. Ann Otol Rhinol Laryngol 2021; 131:34894211055349. [PMID: 34861781 DOI: 10.1177/00034894211055349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Telemedicine was increasingly adopted in otolaryngology as a result of the COVID-19 pandemic, but how it compares to in-person visits over the longitudinal course of the pandemic has not been characterized. This study compares telemedicine visits to in-person visits on measures of clinical efficiency and patient satisfaction. METHODS We examined all in-person and telemedicine encounters that occurred during the 13-month period from April 1, 2020 to April 30, 2021 at a pediatric otolaryngology clinic associated with a large tertiary care children's hospital. We compared patient demographics, primary encounter diagnoses, completions, cancellations, no-shows, cycle time, and patient satisfaction. RESULTS A total of 19 541 (90.5%) in-person visits and 2051 (9.5%) telemedicine visits were scheduled over the study period. There was no difference in patient age or gender between the visit types. There was a difference in race (75% White or Caucasian for in-person and 73% for telemedicine, P = .007) and average travel distance (53.3 miles for in-person vs 71.0 for telemedicine, P = .000). The most common primary diagnosis was Eustachian tube dysfunction for in-person visits (11.8%) and sleep disordered breathing for telemedicine visits (13.7%). Completion rate was greater for telemedicine visits (52.4% in-person vs 62.5% telemedicine). Cancellations were greater for in-person visits (42.6% in-person vs 24.2% telemedicine), but no-shows were greater for telemedicine (5.0% in-person vs 13.3% telemedicine, all P = .000). Average cycle time was shorter for telemedicine visits (56.5 minutes in-person vs 47.6 minutes telemedicine, P = .000). Patient satisfaction with provider interactions and overall care experience was high for both visit types. CONCLUSIONS Telemedicine was utilized more during months of heightened COVID-19 cases, with higher completion rates, fewer cancellations, shorter cycle times, saved travel distance, and comparable patient satisfaction to in-person visits. Telemedicine has the potential to remain an efficient mode of care delivery in the post-pandemic era.
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Affiliation(s)
- Karen K Hoi
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Rachel Kolar-Anderson
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Biomedical Engineering, Michigan Engineering, Ann Arbor, MI, USA
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
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Lee DR, Dedhia K. Pediatric otolaryngology in the coronavirus disease 2019 pandemic: what have we learned? Curr Opin Otolaryngol Head Neck Surg 2021; 29:504-509. [PMID: 34710069 PMCID: PMC8577308 DOI: 10.1097/moo.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) has changed the face of healthcare. The current review is to discuss the major aspects that have changed in pediatric otolaryngology, from surgical operations management, to clinic workflow, to procedural precautions. RECENT FINDINGS There have been many studies over the past year describing different ways to improve the safety of healthcare delivery in pediatric otolaryngology amidst a global pandemic, as well as ways to improve clinic and surgical logistics along with guidelines for telehealth of a surgical specialty. SUMMARY COVID-19 has forever altered how healthcare is viewed and practiced, and pediatric otolaryngology was not exempt. With an increased focus on provider safety, as well as novel ways of utilizing changes in methods of communication, the practice of pediatric otolaryngology has evolved with the rest of healthcare to take on the new challenges brought on by this global pandemic.
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Affiliation(s)
- David R. Lee
- Division of Pediatric Otolaryngology – Head and Neck Surgery, Children's Hospital of Philadelphia
| | - Kavita Dedhia
- Division of Pediatric Otolaryngology – Head and Neck Surgery, Children's Hospital of Philadelphia
- Department of Otolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bašković M. The impact of telemedicine on the quality and satisfaction with the health care provided during the COVID-19 pandemic in the field of pediatrics with special reference to the surgical professions. POLISH JOURNAL OF SURGERY 2021; 93:53-60. [DOI: 10.5604/01.3001.0015.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The COVID-19 pandemic has forced healthcare systems around the world to adopt telemedicine at an unprecedented rate.
Visits to telemedicine have increased to provide access and maintain continuity of care. Internet access has almost become
a necessity, and new technologies allow for the easy flow of data from patient to doctor and vice versa. Doctors of all specialties
were forced to adapt to the pandemic and emerging conditions. The provision of surgical services and the learning ability of
surgeons are particularly disrupted, and the pediatric surgical community is not exempt. During the pandemic, telemedicine
proved to be a viable and safe technique for providing health services. In an environment of a health system that is constantly
facing a shortage of resources, effective telemedicine placement can come with a high benefit-cost ratio and quality of care,
while ensuring patient satisfaction.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Croatia
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Impact of COVID-19 on migrants' access to primary care and implications for vaccine roll-out: a national qualitative study. Br J Gen Pract 2021; 71:e583-e595. [PMID: 33875420 PMCID: PMC8216266 DOI: 10.3399/bjgp.2021.0028] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/07/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND COVID-19 has led to big changes in UK primary care, including rapid digitalisation, with unknown impact on migrant groups. AIM To understand the pandemic's impact on recently-arrived migrants and their access to primary health care, and implications for vaccine roll-out. DESIGN AND SETTING Qualitative study involving semi-structured interviews with primary care professionals (PCPs) and migrants in urban, suburban, and rural settings across England. METHOD Sixty-four PCPs and administrative staff, and 17 recently-arrived migrants were recruited using purposive, convenience, and snowball sampling. In-depth, semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis. RESULTS PCPs and migrants concurred that digitalisation and virtual consultations have amplified existing inequalities in access to health care for many migrants, due to a lack of digital literacy and access to technology, compounded by language barriers. PCPs were concerned that virtual consultations resulted in difficulties building trust and risked missing safeguarding cues. Both PCPs and migrants highlighted challenges around registering and accessing health care due to physical closure of surgeries, as well as indirect discrimination, language and communication barriers, and a lack of access to targeted and tailored COVID-19 information or interventions. Migrants reported a range of specific beliefs, from acceptance to mistrust, around COVID-19 and potential COVID-19 vaccines, often influenced by misinformation. Innovative opportunities were suggested, including translated digital health advice using text templates and YouTube; these merit further exploration. CONCLUSION Pandemic-related changes to primary care delivery may become permanent; some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. Solutions are needed to address vaccine hesitancy in marginalised groups to ensure equitable COVID-19 vaccine uptake.
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Gonzalez JN, Axiotakis LG, Yu VX, Gudis DA, Overdevest JB. Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19. Otolaryngol Head Neck Surg 2021; 166:417-424. [PMID: 34003046 DOI: 10.1177/01945998211013751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has spurred widespread adoption and advancement in telehealth activities, representing a marked change in otolaryngology practice patterns. The present study undertakes a scoping review of research focused on telehealth in otolaryngology (teleotolaryngology) to identify key themes and commonly utilized outcome measures that will assist future development in this growing field. DATA SOURCES PubMed, Embase, and Cochrane databases and reference review. REVIEW METHODS Per guidelines of the PRISMA Extension for Scoping Reviews, we performed database queries using a comprehensive search strategy developed in collaboration with research librarians at the Columbia University Irving Medical Center. We identified 596 unique references to undergo title and abstract review by 2 independent reviewers, leaving 439 studies for full-text review. RESULTS We included 285 studies for extraction of notable findings, leaving 262 unique studies after accounting for content overlap. We identified core outcome measures, including patient and provider satisfaction, costs and benefits, quality of care, feasibility, and access to care. Publication volume increased markedly over time, though only 4% of studies incorporated randomized study group assignment. Using an iterative approach to thematic development, we organized article content across 5 main themes: (1) exploration of teleotolaryngology evolution, (2) role in virtual clinical encounters, (3) applications in interdisciplinary care and educational initiatives, (4) emerging and innovative technologies, and (5) barriers to implementation. CONCLUSION This scoping review of teleotolaryngology documents its evolution and identifies current use cases, limitations, and emerging applications, providing a foundation from which to build future studies, inform policy decision making, and facilitate implementation where appropriate.
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Affiliation(s)
- Joseph N Gonzalez
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Lucas G Axiotakis
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Victoria X Yu
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David A Gudis
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathan B Overdevest
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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