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Sengupta A, Pettigrew S, Jenkins CR. Telemedicine in specialist outpatient care during COVID-19: a qualitative study. Intern Med J 2024; 54:54-61. [PMID: 37926924 DOI: 10.1111/imj.16288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND COVID-19 accelerated healthcare changes, introducing various telehealth services. Work is needed to determine the suitability of telemedicine in the post-pandemic era. AIMS To explore perceptions and experiences of telemedicine among patients and providers (clinicians and health administrators) who were involved in telemedicine appointments in hospital outpatient clinics in 2020-2022. DESIGN, SETTING AND PARTICIPANTS Qualitative study: semi-structured interviews were conducted with 37 participants (16 patients and 21 providers) in various hospital specialist outpatient clinics in a New South Wales local health district. RESULTS Patients were generally satisfied with telemedicine consultations, especially during COVID restrictions, because of the convenience of accessing care from home and minimising the risk of COVID exposure. However, patients considered that the inability to receive a physical examination was a significant disadvantage of telemedicine. Providers had ambivalent perceptions and expressed concerns about mis- and under-diagnoses because of the inability to conduct physical examinations. They considered telemedicine suitable for review appointments but noted an associated increased workload and stressed the need for sustainable funding models (Medicare items). Both patients and providers recognised the need for education/training and better integration of telemedicine platforms into existing infrastructure to facilitate an optimal hybrid model of care. CONCLUSION Despite expressing some concerns over its limitations, patients valued telemedicine for its convenience and for meeting their needs during the pandemic. While acknowledging that patients experienced some benefits from telemedicine, clinicians expressed concerns about potential missed diagnoses, uncertain clinical outcomes and lack of administrative and technological infrastructure. The ultimate test of telemedicine will be its impact on clinical outcomes versus longstanding models of in-person care.
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Affiliation(s)
- Agnivo Sengupta
- Respiratory Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- Health Promotion and Behaviour Change, The George Institute for Global Health, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Christine R Jenkins
- Respiratory Program, The George Institute for Global Health, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Alsoof D, Kasthuri V, McDonald C, Cusano J, Anderson G, Diebo BG, Kuris E, Daniels AH. How much are patients willing to pay for spine surgery? An evaluation of attitudes toward out-of-pocket expenses and cost-reducing measures. Spine J 2023; 23:1886-1893. [PMID: 37619868 DOI: 10.1016/j.spinee.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND CONTEXT With rising healthcare expenditures in the United States, patients and providers are searching to maintain quality while reducing costs. PURPOSE The aim of this study was to investigate patient willingness to pay for anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery. STUDY DESIGN/SETTING A survey was developed and distributed to anonymous respondents through Amazon Mechanical Turk (MTurk). METHODS The survey introduced 3 procedures: ACDF, LF, and ASD surgery. Respondents were asked sequentially if they would pay at each increasing price option. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs. RESULTS In total, 979 of 1,172 total responses (84%) were retained for analysis. The average age was 36.2 years and 44% of participants reported a household income of $50,000 to 100,000. A total of 63% used Medicare and 13% used Medicaid. A total of 40% stated they had high levels of financial stress. A total of 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a LF, and 29.6% were willing to undergo ASD surgery for the cost of $3,000 (p=.98). Regression demonstrated that for ACDF surgery, a $100 increase in price resulted in a 2.1% decrease in willingness to pay. This is comparable to degenerative LF surgery (1.8% decrease), and ASD surgery (2%). When asked which cost-saving measures participants were least comfortable with for ACDF surgery, 60% stated "Use of the older generation implants/devices" (LF: 51%, ASD: 60%,), 61% stated "Having the surgery performed at a community hospital instead of at a major academic center" (LF: 49%, ASD: 56%), and 55% stated "Administration of anesthesia by a nurse anesthetist" (LF: 48.01%, ASD: 55%). Conversely, 36% of ACDF patients were uncomfortable with a "Video/telephone postoperative visit" to cut costs (LF: 51%, ASD: 39%). CONCLUSIONS Patients are unwilling to contribute larger copays for adult spinal deformity correction than for ACDF and degenerative lumbar spine surgery, despite significantly higher procedural costs and case complexity/invasiveness. Patients were most uncomfortable forfeiting newer generation implants, receiving the operation at a community rather than an academic center, and receiving care by physician extenders. Conversely, patients were more willing to convert postoperative visits to telehealth and forgo neuromonitoring, indicating a potentially poor understanding of which cost-saving measures may be implemented without increasing the risk of complications.
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Affiliation(s)
- Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Viknesh Kasthuri
- The Warren Alpert Medical School of Brown University, 222 Richmond St, East Providence, RI 02903, USA
| | - Christopher McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Joseph Cusano
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - George Anderson
- The Warren Alpert Medical School of Brown University, 222 Richmond St, East Providence, RI 02903, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Eren Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA.
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Gallagher T, Choi JS, Garcia E, Chambers T, Ference E. Telemedicine in an Otolaryngology Clinic Serving the Incarcerated Population. Ann Otol Rhinol Laryngol 2023; 132:1321-1329. [PMID: 36647259 DOI: 10.1177/00034894221149547] [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: 01/18/2023]
Abstract
OBJECTIVE There is a paucity of data investigating the effect of implementation of telehealth on vulnerable populations, particularly the incarcerated. Our objective is to evaluate patient and physician satisfaction with telehealth (telephone visits) used in an outpatient otolaryngology clinic serving the incarcerated population. METHODS Incarcerated patients who were served by otolaryngologists via telephone visits from a large tertiary care center from June 2021 to January 2022 were included (n = 20) in this pilot study. Patient and physician satisfaction with the encounters were evaluated using the Telehealth Satisfaction Questionnaire and a modified physician satisfaction questionnaire, respectively. RESULTS Consultations for various otolaryngological complaints were completed via telephone for incarcerated patients including hearing loss, tinnitus, facial fracture, dysphonia, and tonsillitis. Mean patient and physician satisfaction scores were high at 4.25 ± 0.12 and 4.65 ± 0.13 respectively (score range 1-5). Patient satisfactions subdomain scores were 3.92 ± 0.13 for quality of care provided, 3.99 ± 0.13 for similarity to face-to-face encounter, and 4.2 ± 0.17 for perception of the interaction. Imaging or audiogram was available prior to appointment in 60% of cases, with labs, imaging, or audiogram ordered after in 40% of cases and initial pharmaceutical treatment provided to 10% of patients. 45% of patients required follow up in-person, while 40% were discharged pro re nata, and 15% were followed up with another phone visit. There was no statistically significant association between demographic or clinical characteristics and patient or physician satisfaction scores. CONCLUSIONS Consultations for various otolaryngological complaints were completed via telephone with high patient and physician satisfaction within an incarcerated population in this pilot study. Telephone visit is likely a feasible alternative format that can advance otolaryngological care. Studies with larger sample sizes are required to ensure quality of care and advance social justice for this chronically underserved population.
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Affiliation(s)
- Tyler Gallagher
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Janet S Choi
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
| | - Erick Garcia
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Tamara Chambers
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Elisabeth Ference
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Brimioulle M, Arih I, Pervaiz A, Patel W, Davies A, Sekyi-Djan M, Qureishi A, Chaidas K. The role of telephone clinics in ENT. J Laryngol Otol 2023; 137:914-920. [PMID: 36751912 DOI: 10.1017/s0022215123000129] [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: 02/09/2023]
Abstract
OBJECTIVE This quality improvement project assessed the outcomes of telephone consultations for ENT patients in order to identify areas where telephone consultations may be useful in the long term. METHOD New ENT patient appointments in May 2019 and May 2020 were reviewed. Total outcomes as well as subspecialty-specific and presentation-specific outcomes were compared for telephone versus face-to-face consultations. RESULTS There were 638 consultations in total (465 in 2019 and 173 in 2020). Following telephone consultations, more patients were followed up and fewer patients were listed for surgery or discharged. Overall outcomes for subspecialties followed the general trend, albeit with a few variations. CONCLUSION Lack of clinical examination in telephone consultations likely affects confidence in making a diagnosis and therefore discharging or listing patients for surgery. Nevertheless, looking at specialty-specific and presentation-specific data, there may be a role for telephone consultations in selected patients.
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Affiliation(s)
- M Brimioulle
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I Arih
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Pervaiz
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - W Patel
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Davies
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Sekyi-Djan
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Qureishi
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Chaidas
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Hakanen O, Tolvi M, Torkki P. Cost analysis of face-to-face visits, virtual visits, and a digital care pathway in the treatment of tonsillitis patients. Am J Otolaryngol 2023; 44:103868. [PMID: 36996515 DOI: 10.1016/j.amjoto.2023.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE The aim of this study was to compare the costs of two different telemedicine-assisted tonsillitis care pathways with traditional face-to-face visits at the Department of Otorhinolaryngology - Head and Neck Surgery (ORL-HNS) at Helsinki University Hospital. METHODS We characterized and analyzed the patient flows and their individual episodes of all tonsillitis patients at the Department of ORL-HNS between September 2020 and August 2022. Records were collected by doctors at the clinic. We investigated costs and allocated resources in four categories: invoice from the Department of ORL-HNS to the public payer, expenses to the Department, patient fees, and doctor's resource. RESULTS At least a third of the tonsillitis patients were eligible for telemedicine. The digital care pathway was 12.6 % less expensive for the public payer compared to the previous virtual visit model. For the Department, the expense of the digital care pathway was 58.8 % less per patient than the virtual visit model. Patient fees decreased 79.5 %. The digital care pathway reduced the doctor's resource from 30.28 min to 19.78 min, which accounts for a 34.7 % reduction. Patients finished the digital care pathway in a median of 62 min (SD = 60) compared to the 2-4 h which they would spend on an outpatient clinic visit. CONCLUSION Our study demonstrates that tonsillitis patients are eligible for preoperative telemedicine. With at least a third of the tonsillitis patients being eligible for telemedicine, major cost savings can be achieved with efficient e-health-assisted solutions.
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LaBarge B, Lorenz FJ, Ayala A, King TS, Gniady JP. Comparison of Voice Therapy Outcomes: Clinic vs Telehealth. J Voice 2023:S0892-1997(23)00107-8. [PMID: 37150699 DOI: 10.1016/j.jvoice.2023.03.014] [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: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Voice therapy provides patients with valuable exercises and techniques to optimize vocal behaviors and improve their ability to communicate effectively and efficiently. These sessions were typically held by speech-language pathologists (SLPs) in clinic. During the COVID-19 pandemic, SLPs were provisionally able to provide billable voice therapy services in telehealth format. There is a lack of existing research studies comparing outcomes based on the format of voice therapy. METHODS A retrospective chart review was performed on 101 patients who underwent voice therapy at a large academic institution in order to compare outcomes between clinic, telehealth, and mixed voice therapy formats. Demographics, dysphonia etiology, duration of symptoms, number of therapy sessions, and pre- and postvoice therapy scores using reflux symptom index (RSI), voice handicap index (VHI-10), consensus auditory-perceptual evaluation of voice (CAPE-V), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scoring were collected. Statistical comparisons were performed using Fisher's exact test and analysis of covariance. RESULTS There were no statistically significant differences in pre- to postvoice therapy RSI, VHI-10, CAPE-V, or GRBAS scores based on format of voice therapy, after adjustment for number of therapy sessions received. There were no differences in these outcomes when comparing voice therapy by etiology of dysphonia. CONCLUSIONS Overall, these data support the effectiveness of the telehealth voice therapy format. It is a promising platform for greater patient access to therapy. All formats of voice therapy were effective in improving key measures of voice perception.
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Affiliation(s)
- Brandon LaBarge
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania
| | - F Jeffrey Lorenz
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Arin Ayala
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Tonya S King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - John P Gniady
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania.
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Little CC, Russell S, Hwang C, Goldberg L, Brown S, Kirke D, Courey M. Applications of Telemedicine in Speech-Language Pathology: Evaluation of Patient Satisfaction. Laryngoscope 2023; 133:895-900. [PMID: 35848893 DOI: 10.1002/lary.30303] [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: 03/19/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The study aimed to evaluate patient satisfaction with speech-language therapy televisits and to identify factors influencing the level of satisfaction. METHODS Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech-language therapy with a speech-language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7-item survey. Demographic characteristics of participants were collected from a review of patient charts. RESULTS 65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans-female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in-person therapy. CONCLUSION Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits. LAY SUMMARY Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in-person therapy. LEVEL OF EVIDENCE 4 Laryngoscope, 133:895-900, 2023.
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Affiliation(s)
- Christine C Little
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stephen Russell
- Department of Otolaryngology, Naval Medical Center, San Diego, California, U.S.A
| | - Chaewon Hwang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Leanne Goldberg
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sarah Brown
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mark Courey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Hawkins AT, Ueland T, Aher C, Geiger TM, Spann MD, Horst SN, Schafer IV, Ye F, Fan R, Sharp KW. Shared Decision-Making in General Surgery: Prospective Comparison of Telemedicine vs In-Person Visits. J Am Coll Surg 2023; 236:762-771. [PMID: 36728391 DOI: 10.1097/xcs.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making. STUDY DESIGN We performed a mixed-methods, prospective, observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was the level of shared decision-making as captured by top box scores of the CollaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire and satisfaction with consultation survey. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed. RESULTS During a 13-month study period, 387 patients were enrolled, of which 301 (77.8%) underwent in-person visits and 86 (22.2%) underwent telemedicine visits. The groups were similar in age, sex, employment, education, and generic quality-of-life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the CollaboRATE top box score (odds ratio 1.27; 95% CI 0.74 to 2.20) or 9-item Shared Decision-Making Questionnaire (β -0.60; p = 0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality. CONCLUSIONS In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.
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Affiliation(s)
- Alexander T Hawkins
- Section of Colon and Rectal Surgery (Hawkins, Ueland, Geiger, Schafer), Vanderbilt University Medical Center, Nashville, TN
| | - Thomas Ueland
- Section of Colon and Rectal Surgery (Hawkins, Ueland, Geiger, Schafer), Vanderbilt University Medical Center, Nashville, TN
| | - Chetan Aher
- From the Division of General Surgery (Aher, Spann, Sharp), Vanderbilt University Medical Center, Nashville, TN
| | - Timothy M Geiger
- Section of Colon and Rectal Surgery (Hawkins, Ueland, Geiger, Schafer), Vanderbilt University Medical Center, Nashville, TN
| | - Matthew D Spann
- From the Division of General Surgery (Aher, Spann, Sharp), Vanderbilt University Medical Center, Nashville, TN
| | - Sara N Horst
- Departments of Gastroenterology, Hepatology, and Nutrition (Horst), Vanderbilt University Medical Center, Nashville, TN
| | - Isabella V Schafer
- Section of Colon and Rectal Surgery (Hawkins, Ueland, Geiger, Schafer), Vanderbilt University Medical Center, Nashville, TN
| | - Fei Ye
- Biostatistics (Ye, Fan), Vanderbilt University Medical Center, Nashville, TN
| | - Run Fan
- Biostatistics (Ye, Fan), Vanderbilt University Medical Center, Nashville, TN
| | - Kenneth W Sharp
- From the Division of General Surgery (Aher, Spann, Sharp), Vanderbilt University Medical Center, Nashville, TN
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Smith JD, McConville K, Tiner MK, Baldner EF, Rosenberg M, Kupfer RA, Hogikyan ND, Morrison RJ. Examining Use and Effectiveness of Teletherapy for Patients with Dysphonia. J Voice 2023:S0892-1997(23)00034-6. [PMID: 36863957 DOI: 10.1016/j.jvoice.2023.01.034] [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: 12/06/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE(S)/HYPOTHESIS Virtual therapy (teletherapy) for patients with dysphonia has become ubiquitous in the COVID-19 era. However, barriers to widespread implementation are evident, including unpredictable insurance coverage attributed to limited evidence supporting this approach. In our single-institution cohort, our objective was to show strong evidence for use and effectiveness of teletherapy for patients with dysphonia. STUDY DESIGN Single institution, retrospective cohort study. MATERIAL AND METHODS This was an analysis of all patients referred for speech therapy with dysphonia as primary diagnosis from 4/1/2020 to 7/1/2021 and in whom all therapy sessions were delivered in a teletherapy format. We collated and analyzed demographics and clinical characteristics and adherence to the teletherapy program. We assessed changes in perceptual assessments and vocal capabilities (GRBAS, MPT), patient-reported outcomes (V-RQOL), and metrics of session outcomes (complexity of vocal tasks, carry-over of target voice) pre- and post-teletherapy using student's t test and chi-square test. RESULTS Our cohort included 234 patients (mean [SD] age 52 [20] years) residing a mean (SD) distance of 51.3 (67.1) miles from our institution. The most common referral diagnosis was muscle tension dysphonia (n = 145, 62.0% patients). Patients attended a mean (SD) of 4.2 (3.0) sessions; 68.0% (n = 159) of patients completed four or more sessions and/or were deemed appropriate for discharge from teletherapy program. Statistically significant improvements were seen in complexity and consistency of vocal tasks with consistent gains in carry-over of target voice for isolated tasks and connected speech. CONCLUSIONS Teletherapy is a versatile and effective approach for treatment of patients with dysphonia of varying age, geography, and diagnoses.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA
| | - Katherine McConville
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA; Department of Speech-Language Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Margaret K Tiner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA; Department of Speech-Language Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Ford Baldner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA; Department of Speech-Language Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marci Rosenberg
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA; Department of Speech-Language Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Vocal Health Center, Ann Arbor, Michigan, USA.
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Tenfelde K, Bol N, Schoonman GG, Bunt JEH, Antheunis ML. Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction. Digit Health 2023; 9:20552076231203887. [PMID: 37780066 PMCID: PMC10540607 DOI: 10.1177/20552076231203887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations. Methods A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed. Results Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication. Conclusions Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.
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Affiliation(s)
- Kim Tenfelde
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Guus G Schoonman
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jan Erik H Bunt
- Department of Pediatrics, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Marjolijn L Antheunis
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
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Miller LE, Rathi VK, Xiang D, Naunheim MR, Varvares MA, Gray ST. Telemedicine Services Provided to Medicare Beneficiaries by Otolaryngologists in 2020. Otolaryngol Head Neck Surg 2023; 168:105-107. [PMID: 35503528 DOI: 10.1177/01945998221096593] [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: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
Telemedicine utilization among otolaryngologists was rare prior to the COVID-19 pandemic. We sought to understand rates of telemedicine utilization by otolaryngologists amid unprecedented changes in care delivery during the pandemic. Using Medicare Physician/Supplier Procedure Summary data, we performed a retrospective cross-sectional analysis of telemedicine services provided to Medicare beneficiaries by otolaryngologists in 2020. The total number of services and amount of reimbursement received by otolaryngologists for telemedical care increased by 52,989% and 73,147% in 2020 relative to 2019: 139,094 vs 262 services and $9.9 million vs $13,536, respectively. The mean telemedicine revenue per otolaryngologist offset only 8.8% ($9304.69) of losses from the reduction in mean in-person revenue between 2019 and 2020. Further research will be necessary to inform successful adoption of telemedicine within our field amid the ongoing COVID-19 pandemic.
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Affiliation(s)
- Lauren E Miller
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinay K Rathi
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - David Xiang
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Naunheim
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Kim ME, Sund LT, Morton M, Kim J, Choi JS, Castro ME. Provider and Patient Satisfaction with Telemedicine Voice Therapy During the COVID-19 Pandemic. J Voice 2022:S0892-1997(22)00211-9. [PMID: 36038478 PMCID: PMC9289043 DOI: 10.1016/j.jvoice.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The COVID-19 pandemic expanded the use of telemedicine, but there is no literature exploring both patient and provider satisfaction specifically in the provision of voice therapy. This study aims to investigate patient and provider satisfaction with virtual voice therapy, its associated factors, and any correlation between the two. METHODS Cross-sectional study. Participants included 226 adults who underwent voice therapy delivered via telepractice at the USC Voice Center between April and October 2020. Patients and providers self-reported their level of satisfaction on a visual analog scale (VAS; range 0-100). Patient satisfaction was additionally measured using a previously validated Telemedicine Satisfaction Questionnaire (TSQ; range 1-5), and a binary question about their desire to choose telemedicine over in-person therapy in the future. Three speech-language pathologists rated provider satisfaction for all 226 patients. Patient satisfaction survey was completed by 55 patients. Multivariable linear regression analyses and linear mixed-effects models were used to assess the results. RESULTS Patient and provider mean (SD) VAS satisfaction scores were 86.8 (18.6) and 80.6 (19.7), respectively. The mean (SD) TSQ score was 4.4 (0.6). In a multivariable model, patient satisfaction levels were significantly higher for hypofunctional than for hyperfunctional dysphonia diagnoses. Forty-four (73%) patients reported they would prefer telemedicine voice therapy over in-person appointments, which was significantly correlated with internet reliability (P = 0.04). For providers, satisfaction was significantly lower for patients whose diagnosis had changed after initiation of voice therapy (Δ = -16.0 [95% CI: -28.7 to -3.2]) and for encounters with Asian patients compared to White patients (Δ = -11.6 [95% CI: -18.9 to -4.2]). Patient and provider satisfaction scores were weakly correlated (r = 0.19). CONCLUSIONS Our findings suggest that virtual voice therapy is not simply an alternative to in-person service, but rather an effective method useful beyond the current pandemic with proper diagnosis and technical support.
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Affiliation(s)
- Mary E Kim
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California.
| | - Lauren Timmons Sund
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California
| | - Mariah Morton
- Auburn University School of Kinesiology, Auburn, Albama
| | - James Kim
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California
| | - Janet S Choi
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
| | - M Eugenia Castro
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California
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Pogorzelska K, Chlabicz S. Patient Satisfaction with Telemedicine during the COVID-19 Pandemic-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106113. [PMID: 35627650 PMCID: PMC9140408 DOI: 10.3390/ijerph19106113] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/26/2022]
Abstract
Telemedicine is a convenient tool for providing medical care remotely. It is routinely offered as an alternative to face-to-face consultations in healthcare settings all over the world. Due to the COVID-19 pandemic and increased use of telemedicine in everyday clinical practice, the effectiveness of this modality and patient satisfaction with telemedicine is a subject of growing concern. PubMed and Google Scholar databases were searched. Papers published between January 2020 and August 2021 which met inclusion and exclusion criteria were analyzed. During the COVID-19 pandemic patients have found telemedicine a beneficial tool for consulting healthcare providers. A high level of satisfaction with telehealth was observed in each study across every medical specialty. Telemedicine is undoubtedly a convenient tool that has helped ensure continuity of medical care during the COVID-19 pandemic thanks to its considerable potential. In particular situations, telehealth may adequately replace face-to-face consultation. Regular patients’ feedback is necessary to improve the use of telemedicine in the future.
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