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Couch JV, Whitcomb M, Buchheit BM, Dorr DA, Malinoski DJ, Korthuis PT, Ono SS, Levander XA. Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis. Harm Reduct J 2024; 21:125. [PMID: 38937779 PMCID: PMC11210005 DOI: 10.1186/s12954-024-01043-5] [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: 05/03/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma. METHODS In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis. RESULTS The mean age of participants (n = 30) was 40.5 years (range 20-63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2-3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect. CONCLUSIONS The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.
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Affiliation(s)
- Jessica V Couch
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Mackenzie Whitcomb
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bradley M Buchheit
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David A Dorr
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Darren J Malinoski
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
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Hadinata IE, Naren T, Rowland B, Cook J, Nielsen S. Do video or telephone consultations impact attendance rates in an addiction medicine specialist outpatient clinic? Intern Med J 2024. [PMID: 38934477 DOI: 10.1111/imj.16462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Effective alcohol and other drugs (AODs) treatment has been proven to increase productivity and reduce costs to the community. Telehealth has previously been proven effective at delivering AOD treatment in the right settings. Yet, Australia's current Medicare funding restricts telephone consultations. AIM We hypothesise that treatment modality influences attendance rates. Specifically, telephone consultations can remove barriers to accessing treatment and, therefore, can increase attendance. METHODS We conducted a retrospective audit on our addiction medicine specialist outpatient service from 1 July 2022 to 30 June 2023. A mixed-effects logistic regression model was used to analyse factors associated with attendance rates. RESULTS There were 576 participants in the study, and 3354 appointments were booked over the 12-month study period. Of these, 2695 were face-to-face, 541 were telephone and 118 were video. The unadjusted raw attendance rate was highest in the telephone group (87.24%), followed by face-to-face (73.02%) and video (44.92%). After adjusting for covariates, telephone consultation was associated with significantly increased odds of attending compared to face-to-face (odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.90-3.54, P < 0.001). Video consultation was associated with a 69% reduction in the odds of attending compared to face-to-face (OR = 0.31, 95% CI = 0.019-0.49, P < 0.001). CONCLUSIONS While physical attendance may be required for specific clinical care, telephone consultations are associated with increased attendance and can form an important adjunct to delivering addiction treatment. Given the substantial costs of substance use disorders, this could inform government policies and funding priorities to further improve access and treatment outcomes.
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Affiliation(s)
- Ignatius E Hadinata
- Department of Addiction Medicine, Western Health, Melbourne, Victoria, Australia
- Alcohol and Other Drugs Committee, Victoria Faculty, Royal Australian College of General Practitioners, Melbourne, Victoria, Australia
| | - Thileepan Naren
- Department of Addiction Medicine, Western Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Bosco Rowland
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Clinical and Social Research Team, Turning Point, Melbourne, Victoria, Australia
- Faculty of Health, School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Cook
- Department of Addiction Medicine, Western Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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Roitenberg N, Pincus T, Ben Ami N. Physiotherapy services during the COVID-19 pandemic: A mediated model of physiotherapists' self-efficacy, tele-physiotherapy role stressors, and motivation to provide tele-physiotherapy. Physiother Theory Pract 2024; 40:1140-1149. [PMID: 36305357 DOI: 10.1080/09593985.2022.2138662] [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: 03/29/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy. OBJECTIVES The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity). DESIGN AND METHOD Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics. RESULTS PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p < .01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT. CONCLUSIONS It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges.
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Affiliation(s)
- Neta Roitenberg
- Sociology and Anthropology Department, Bar-Ilan University, Ramat-Gan, Israel
| | - Tamar Pincus
- Faculty of the Environment and Life Sciences, University of Southampton, University Road, Southampton, UK
| | - Noa Ben Ami
- Physiotherapy Department, Faculty of Health Sciences, Ariel University, Kiryat Hamada, Israel
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Tay Wee Teck J, Gittins R, Zlatkute G, Oteo Pérez A, Galea-Singer S, Baldacchino A. Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants. JMIR Ment Health 2023; 10:e47186. [PMID: 37851506 PMCID: PMC10620637 DOI: 10.2196/47186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. OBJECTIVE This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. METHODS The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. RESULTS The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. CONCLUSIONS Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care.
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Affiliation(s)
- Joseph Tay Wee Teck
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Giedre Zlatkute
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Alberto Oteo Pérez
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Alexander Baldacchino
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
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Jordan HR, Sahni S, Ahmed MM, Fares JE, Desai BV, Lenchur CN, Jermyn RT. A Comprehensive Literature Review of Digital Health Interventions in the Treatment of Substance Use Disorder With Special Focus on Mobile Applications. Cureus 2023; 15:e47639. [PMID: 38021738 PMCID: PMC10668628 DOI: 10.7759/cureus.47639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
COVID-19 quarantine showed an increase in opioid-related deaths partially due to the limited capacity of clinics and treatment centers. Digital health interventions (DHIs) such as telehealth have improved access to treatment, reduced psychosocial barriers, and helped patients with substance use disorder (SUD). An in-depth literature review was conducted to gauge the efficacy and usefulness of DHIs on substance use disorder. PubMed was used with string search terms to identify studies analyzing telehealth for substance use disorders. Studies were eligible and selected if they used health interventions (HIs) and reported outcomes on the efficacy of DHIs, benefits of DHIs, and limitations of DHIs. The Agency of Healthcare Research and Quality (AHRQ) was used to analyze the impact of DHIs on SUD. Lastly, Apple's App Store was used to identify the current DHI available. The analysis indicated that mobile phone apps were the most appropriate sources to use for patients with substance use disorders. The search also found 36 mobile applications available on the market for patients, containing mainly pain medication diaries and trackers. The study did not find any apps for clinical usage that met the standards necessary for adequate healthcare in the opioid crisis, largely due to a lack of clinician involvement in using applications. Developing adequate DHIs has the potential to improve outcomes in patients with SUD and aid in recovery time. The research concluded that physicians looking to develop DHIs should take into consideration the mode of delivery of DHI, the aim to produce specific health outcomes as opposed to multiple outcomes, and clinician involvement in DHI development. DHIs can become a vital tool for medical professionals, especially during the COVID-19 crisis, as the use of healthcare technology has limited in-person contact, maintained current doctor-patient relationships, and allowed for contact tracing of the disease.
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Affiliation(s)
- Harrison R Jordan
- Medicine, NeuroMusculoskeletal Institute, Rowan Medicine, Stratford, USA
| | - Sidharth Sahni
- Medicine, NeuroMusculoskeletal Institute, Rowan Medicine, Stratford, USA
| | - Mamun M Ahmed
- Medicine, NeuroMusculoskeletal Institute, Rowan Medicine, Stratford, USA
| | - Joseph E Fares
- Medicine, NeuroMusculoskeletal Institute, Rowan Medicine, Stratford, USA
| | - Binoy V Desai
- Medicine, NeuroMusculoskeletal Institute, Rowan Medicine, Stratford, USA
| | | | - Richard T Jermyn
- Medicine, NeuroMusculoskeletal Institute, Rowan Medicine, Stratford, USA
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Kamma HK, Alabbas M, Elashahab M, Abid N, Manaye S, Cheran K, Murthy C, Bornemann EA, Arcia Franchini AP. The Efficacy of Telepsychiatry in Addiction Patients: A Systematic Review. Cureus 2023; 15:e38133. [PMID: 37252504 PMCID: PMC10213379 DOI: 10.7759/cureus.38133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Psychiatry is one of the many medical subspecialties that have benefited from the advent of telemedicine. Substance abuse treatment via telepsychiatry expeditiously increased with the start of the pandemic and has brought changes to its rules and regulations. In this study, we focused on the prognosis of substance abuse patients treated with telepsychiatry, the various changes that occurred during the pandemic, and the difficulties faced by clinicians using telepsychiatry. PubMed and Google Scholar were searched for relevant articles between January 2010 and July 2022 using both broad and narrow keywords in addition to the MeSH (Medical Subject Heading) approach. The total number of records found was 765. Strict criteria for inclusion and exclusion ensured that only relevant information was collected. After removing duplicates, irrelevant studies, and research that did not meet the inclusion criteria, we were left with 373 studies from both electronic databases. From those, we ultimately retrieved 35 studies, which were subjected to a thorough content search and quality evaluation with the help of specialized instruments, and a total of 19 papers were included in our systematic review. We concluded that telepsychiatry use for substance abuse patients increased during the pandemic, and the prognosis of these patients treated with telepsychiatry was similar to that of in-person treatment. However, a combination of telepsychiatry with in-person sessions showed much better results.
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Affiliation(s)
- Hari Krishna Kamma
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammad Alabbas
- Cardiology/Internal Medicine, University of Debrecen, Debrecen, HUN
| | - Mohammad Elashahab
- Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Naushad Abid
- Rheumatology, King Faisal University, Hofuf, SAU
| | - Sara Manaye
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kaaviya Cheran
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chinmayee Murthy
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Elisa A Bornemann
- Medicine/Surgery, Universidad Latina de Panama, Panama City, PAN
- Internal Medicine/Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ana P Arcia Franchini
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Mannino RG, Arconada Alvarez SJ, Greenleaf M, Parsell M, Mwalija C, Lam WA. Navigating the complexities of mobile medical app development from idea to launch, a guide for clinicians and biomedical researchers. BMC Med 2023; 21:109. [PMID: 36959646 PMCID: PMC10035117 DOI: 10.1186/s12916-023-02833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
With today’s pace of rapid technological advancement, many patient issues in modern medicine are increasingly solvable by mobile app solutions, which also have the potential to transform how clinical research is conducted. However, many critical challenges in the app development process impede bringing these translational technologies to patients, caused in large part by the lack of knowledge among clinicians and biomedical researchers of “what it takes” to design, develop, and maintain a successful medical app. Indeed, problems requiring mobile app solutions are often nuanced, requiring more than just clinical expertise, and issues such as the cost and effort required to develop and maintain a well-designed, sustainable, and scalable mobile app are frequently underestimated. To bridge this skill set gap, we established an academic unit of designers, software engineers, and scientists that leverage human-centered design methodologies and multi-disciplinary collaboration to develop clinically viable smartphone apps. In this report, we discuss major misconceptions clinicians and biomedical researchers often hold regarding medical app development, the steps we took to establish this unit to address these issues and the best practices and lessons learned from successfully ideating, developing, and launching medical apps. Overall, this report will serve as a blueprint for clinicians and biomedical researchers looking to better benefit their patients or colleagues via medical mobile apps.
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Affiliation(s)
- Robert G. Mannino
- Georgia Clinical Translational Science Alliance, Atlanta, USA
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, USA
| | - Santiago J. Arconada Alvarez
- Georgia Clinical Translational Science Alliance, Atlanta, USA
- grid.213917.f0000 0001 2097 4943School of Interactive Computing, Georgia Institute of Technology, Atlanta, USA
| | - Morgan Greenleaf
- Georgia Clinical Translational Science Alliance, Atlanta, USA
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, USA
| | - Maren Parsell
- Georgia Clinical Translational Science Alliance, Atlanta, USA
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, USA
| | | | - Wilbur A. Lam
- Georgia Clinical Translational Science Alliance, Atlanta, USA
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, USA
- grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, USA
- grid.428158.20000 0004 0371 6071Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, USA
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Murshidi R, Hammouri M, Taha H, Kitaneh R, Alshneikat M, Al-Qawasmeh A, Al-Oleimat A, Al-Huneidy L, Al-Huneidy Y, Al-Ani A. Knowledge, Attitudes, and Perceptions of Jordanians Toward Adopting and Using Telemedicine: National Cross-sectional Study. JMIR Hum Factors 2022; 9:e41499. [DOI: 10.2196/41499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background
Due to the upsurge of COVID-19, nations are increasingly adopting telemedicine programs in anticipation of similar crises. Similar to all nations worldwide, Jordan is implementing efforts to adopt such technologies, yet it is far from complete.
Objective
This study aims to assess the knowledge, attitudes, and perceptions of Jordanians toward telemedicine, to identify key factors predisposing individuals to its use or acting as barriers to its implementation.
Methods
We implemented a cross-sectional design using an online, self-administered questionnaire executed in Google Forms and distributed through social media. Differences in knowledge and attitude scores were examined using independent sample t tests and ANOVA. A multivariate linear regression model was computed to assess predictors of awareness toward telemedicine.
Results
A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. About 50% (619/1201, 51.5%) of our studied population were aware of telemedicine, while nearly 25% (299/1201, 24.9%) declared they had observed it in action. Approximatively 68% (814/1201, 67.8%) of respondents were willing to use telemedicine. The majority of the sample portrayed favorable and positive views toward telemedicine. Higher educational degrees, living in urban districts, and having a higher perception of electronic usage ability were associated with higher knowledge and better attitudes toward telemedicine (all P<.05). The multivariate linear regression analysis demonstrated that perceived ability to use electronics was associated with positive attitudes (β=0.394; 95% CI 0.224 to 0.563), while living in Southern Jordan predicted poor attitudes toward telemedicine (β=–2.896; 95% CI –4.873 to –0.919).
Conclusions
Jordanians portray favorable perceptions of telemedicine. Nonetheless, concerns with regards to privacy, medical errors, and capacity for accurate diagnoses are prevalent. Furthermore, Jordanians believe that integrating telemedicine within the health care system is not applicable due to limited resources.
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Day N, Wass M, Smith K. Virtual opioid agonist treatment: Alberta's virtual opioid dependency program and outcomes. Addict Sci Clin Pract 2022; 17:40. [PMID: 35902924 PMCID: PMC9330968 DOI: 10.1186/s13722-022-00323-4] [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: 02/10/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Virtually delivered healthcare (telehealth, telemedicine) has the potential to reduce gaps in access to opioid agonist therapy (OAT). Barriers to accessing OAT such as lack of transportation, in-person induction requirements, employment demands and limited childcare options reduce treatment opportunities for clients. A completely virtual model of care has been developed in Alberta, Canada. This paper introduces the unique virtual clinic model and describes outcomes from that model. Methods A retrospective chart review was conducted using datasets within existing electronic health records and databases from Alberta’s Virtual Opioid Dependency Program (VODP). Outcome data were extracted at admission to ongoing care by Case Management within the VODP and at 3, 6 and 12 months for the duration of treatment. Utilization trends over three years were analyzed, including admissions, discharges and active client information. Data regarding clinical outcomes for clients engaged in ongoing care with the VODP were aggregated for analysis over four time periods, including treatment retention rates at 6 and 12 months. Results A total of 440 client records were included in the study sample. Descriptive analysis showed rapid growth in utilization over three fiscal years. Despite rapid growth in utilization, median wait days for treatment decreased from 6 to 0 days with the initiation of a Same Day Start service to support low barrier immediate access to treatment. Treatment retention rates for clients in ongoing care were comparable to published reports, with 90% of the study sample remaining in treatment over 6 months, and 58% showing retention over 12 months. Clients reported high levels of satisfaction (90%) and outcomes reflected reductions in drug use and overdose as well as improved social functioning. Conclusions The VODP model demonstrated high levels of client satisfaction, rapid growth in utilization and positive preliminary clinical outcomes. Entirely virtual delivery of opioid agonist therapy is a promising option to facilitate access to evidence based treatment for opioid use disorder (OUD) in the context of a fentanyl overdose crisis, particularly for individuals living in rural or underserved areas.
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Affiliation(s)
- Nathaniel Day
- Addiction & Mental Health, Alberta Health Services, Ponoka, AB, Canada.,Virtual Opioid Dependency Program, P.O. Box 1000, T4J 1R8, Ponoka, AB, Canada
| | - Maureen Wass
- Addiction & Mental Health, Alberta Health Services, Ponoka, AB, Canada. .,Virtual Opioid Dependency Program, P.O. Box 1000, T4J 1R8, Ponoka, AB, Canada.
| | - Kelly Smith
- Addiction & Mental Health, Alberta Health Services, Ponoka, AB, Canada.,Virtual Opioid Dependency Program, P.O. Box 1000, T4J 1R8, Ponoka, AB, Canada
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Can Teledentistry Replace Conventional Clinical Follow-Up Care for Minor Dental Surgery? A Prospective Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063444. [PMID: 35329133 PMCID: PMC8953526 DOI: 10.3390/ijerph19063444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Born out of necessity, the implementation of digital processes experienced significant increase during the COVID-19 pandemic. Here, telemedicine offered a bridge to care and now an opportunity to reinvent virtual and hybrid care models, with the goal of improved healthcare access, outcomes, and affordability. The aim of this monocentric prospective, randomized trial was to compare conventional to telephone follow-up after minor dentoalveolar surgery on the basis of special aftercare questionnaires. (2) Methods: Sixty patients who underwent dentoalveolar surgery under local anesthesia were randomly assigned to both groups. After an average of four days, either telephone follow-up (test) or conventional personal aftercare (control) was performed. Based on the questionnaire, the following subject areas were evaluated: symptoms, complications, satisfaction with practitioner, travel, and waiting time, as well as the preferred form of follow-up care. (3) Results: There was no statistically significant difference regarding frequency of symptoms or complication rate. Patients who were assigned to the test group showed a clear tendency to prefer telephone follow-up (83.3%) to conventional aftercare (16.7%, p = 0.047). (4) Conclusions: The data suggest high acceptance of telephone-only follow-up after dentoalveolar surgery. The implementation of telemedicine could be a time- and money-saving alternative for both patients and healthcare professionals and provide healthcare access regardless of time and space.
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Klingemann J, Wieczorek Ł. Mobile application recovery support for patients with an alcohol use disorder. Acceptance, usability, and perceived helpfulness. J Addict Dis 2022; 40:559-567. [PMID: 35274601 DOI: 10.1080/10550887.2022.2049177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to qualitatively explore the experiences of patients of abstinence-oriented treatment programs, who were using a mobile application (mWSPARCIE) after completing a 6-week inpatient treatment program, and to assess its role as a tool supporting the process of recovery initiated in the treatment facility. Telephone in-depth interviews were conducted after six months of application use among a convenience sample of former patients of the inpatient treatment (n = 33). Transcriptions of the interviews were analyzed and coded sentence-by-sentence. The coding procedure allowed researchers to establish the main analytical categories. Most respondents did not install the application or did not use it despite installing it, due to individual preferences and needs as well as to technical limitations. However, two thirds of the respondents who downloaded the application, used it on a regular basis, and four out of five considered it helpful in their recovery process. The application was used primarily for self-observation, allowing subjects to monitor their abstinence as well as the frequency and intensity of their alcohol craving. Acceptance of mHealth is low among patients of abstinence-oriented treatment programs. Therefore, this is clearly not a solution for all patients, because of individual preferences and needs as well as technical and financial barriers. However for those who use it, the tested application was an attractive source of additional support, a tool to maintain the motivation to change and to monitor abstinence and craving during the six months following their completion of treatment.
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Affiliation(s)
- Justyna Klingemann
- Department of Studies on Alcohol and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Wieczorek
- Department of Studies on Alcohol and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
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Aliberti GM, Bhatia R, Desrochers LB, Gilliam EA, Schonberg MA. Perspectives of Primary Care Clinicians in Massachusetts on use of Telemedicine with Adults aged 65 and Older during the COVID-19 Pandemic. Prev Med Rep 2022; 26:101729. [PMID: 35155085 PMCID: PMC8824169 DOI: 10.1016/j.pmedr.2022.101729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 02/06/2023] Open
Abstract
PCPs have disparate attitudes towards telemedicine primary care for adults >65. Multilevel interventions are needed to optimize telemedicine care for older adults. PCPs find telemedicine most effective for chronic disease management. PCPs appreciate telemedicine’s convenience but worry about the lack of touch.
To learn how to improve telemedicine for adults >65, we asked primary care clinicians (“PCPs”) affiliated with one large Boston-area health system their views on using telemedicine (which included phone-only or video visits) with adults >65 during the COVID-19 pandemic. In open-ended questions, we asked PCPs to describe any challenges or useful experiences with telemedicine and suggestions for improving telemedicine as part of a larger web-based survey conducted between September 2020 and February 2021. Overall, 163/383 (42%) PCPs responded to the survey. Of these, 114 (70%) completed at least one open-ended question, 85% were non-Hispanic white, 59% were female, 75% were community-based, and 75% were in practice >20 years. We identified three major themes in participants’ comments including the need to optimize telemedicine; integrate telemedicine within primary care; and that PCPs had disparate attitudes towards telemedicine for older adults. To optimize telemedicine, PCPs recommended more effective digital platforms, increased utilization of home medical equipment (e.g., blood pressure cuffs), and better coordination with caregivers. For integration, PCPs recommended targeting telemedicine for certain types of visits (e.g., chronic disease management), enabling video access, and reducing administrative burdens on PCPs. As for PCP attitudes, some felt telemedicine enhanced the doctor-patient relationship, improved the patient experience, and improved show rates. Others felt that telemedicine visits were incomplete without a physical exam, were less rewarding, and could be frustrating. Overall, PCPs saw a role for telemedicine in older adults’ care but felt that more support is needed for these visits than currently offered.
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Affiliation(s)
| | | | | | | | - Mara A. Schonberg
- Corresponding author at: 1309 Beacon Street, 2 Fl, Brookline, MA 02446.
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13
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Challenges and opportunities in the provision of mental health care services during the COVID-19 pandemic and beyond. LESSONS FROM COVID-19 2022. [PMCID: PMC9347459 DOI: 10.1016/b978-0-323-99878-9.00008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The provision of services to people with mental health problems and their families has been substantially affected by the COVID-19 pandemic. Often face-to-face clinical work had to be replaced with telehealth, in line with COVID-19 regulations of social distancing. Currently, different types of online services have been implemented to meet the mental health needs of the population. This change from face-to-face to online service provision has been disruptive to many South Africans and at times resulted in people not being able to access these services. Aim: This chapter aims to describe specifically the use of online psychological service delivery pre-COVID-19 and during the lockdown. Method: We conducted a literature review exploring the delivery of psychological services through online channels pre-COVID-19 and during the lockdown. We highlight lessons learned and opportunities for psychological service provision beyond the pandemic. Conclusion: We conclude that online service platforms can increase access to psychological services and identify strategies that can be adopted to strengthen service provision.
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14
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Feasibility, Acceptability and Limitations of Speech and Language Telerehabilitation during COVID-19 Lockdown: A Qualitative Research Study on Clinicians' Perspectives. Healthcare (Basel) 2021; 9:healthcare9111503. [PMID: 34828549 PMCID: PMC8618578 DOI: 10.3390/healthcare9111503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 12/25/2022] Open
Abstract
The COVID-19 pandemic brought out the need to deliver health care services at a distance in the form of telerehabilitation (TR). This study aimed to analyse the Italian speech and language therapists' (SLTs) opinions on the feasibility of the TR in the field of speech-language therapy during the COVID-19 pandemic. We developed an anonymous survey to determine the SLTs' opinions on feasibility of TR during lockdown caused by COVID-19. We analysed the survey's answers provided by 136 SLTs. Cronbach's alpha coefficient showed good reliability of the survey. The SLTs working previously with TR showed better judgements regarding this method. The comparison analysis between TR and face-to-face treatment delivery showed statistically significant differences as follows: "importance" (4.35 vs. 3.32, p = 0.001), "feasibility" (3.37 vs. 2.11, p < 0.001), "alternative form" (3.64 vs. 2.58, p = 0.001) and "comparison" (2.24 vs. 1.69, p < 0.001), but not with "familiarity" (p = 0.81). The survey showed that most of the Italian SLTs were not satisfied with TR systems. SLTs who used TR previously had a better opinion on this treatment modality. Experience and familiarity with TR systems were key factors for the use of this new rehabilitation modality.
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15
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Sharma A, Das K, Sharma S, Ghosh A. Feasibility and preliminary effectiveness of internet-mediated 'relapse prevention therapy' for patients with alcohol use disorder: A pilot study. Drug Alcohol Rev 2021; 41:641-645. [PMID: 34704318 DOI: 10.1111/dar.13395] [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: 07/19/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess the feasibility, acceptability and preliminary effectiveness of synchronous internet-mediated relapse prevention therapy (i-RPT) in alcohol use disorder. METHODS This was a pilot, quasi-experimental study. Thirty-two adult men with alcohol use disorder were recruited through purposive sampling from an outpatient setting. We assessed patterns of drinking, craving, motivation and coping. Patients received five twice-weekly sessions of i-RPT. They were reassessed 12 weeks post-intervention (CTRI Trial REF/2020/09/036392). RESULTS Thirty-two (48%) of the 67 patients fulfilled the eligibility criteria and all consented to the study. All participants completed at least two sessions and 23 (71.9%) completed all five sessions. Two-thirds of participants reported high satisfaction in the Telehealth Satisfaction Questionnaire. We observed modest intervention effects on days of abstinence in both per-protocol (P <0.001; r = 0.6) and worst-case (P <0.001, r = 0.5) analyses. There were also reductions in the amount of alcohol use, frequency of drinking and heavy drinking, craving and maladaptive coping behaviours. Per-protocol analysis revealed a positive post-intervention change in the motivational level to change alcohol use. CONCLUSION iRPT appears to be feasible, acceptable and possibly effective in alcohol use disorder.
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Affiliation(s)
- Anu Sharma
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karobi Das
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunita Sharma
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry and Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Vogt EL, Welch BM, Bunnell BE, Barrera JF, Paige SR, Owens M, Coffey P, Diazgranados N, Goldman D. Quantifying COVID-19's Impact on Telemedicine Utilization. Interact J Med Res 2021; 11:e29880. [PMID: 34751158 PMCID: PMC8797150 DOI: 10.2196/29880] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND While telemedicine has been expanding over the past decade, the COVID-19 pandemic era restrictions regarding in-person care have led to unprecedented levels of telemedicine utilization. To the authors' knowledge, no studies to date have quantitatively analyzed both national and regional trends in telemedicine utilization during COVID-19, both of which have key implications for informing health policy. OBJECTIVE To investigate how trends in telemedicine utilization changed across the course of the COVID-19 pandemic. METHODS Using data from doxy.me, the largest free telemedicine platform, and the NIH Clinical Center, the largest U.S. clinical research hospital, we assessed changes in total telemedicine minutes, new provider registrations, monthly sessions, and average session length from March-November 2020. We also conducted state-level analysis of how telemedicine expansion differed by region. RESULTS National telemedicine utilization peaked in April 2020 at 291 million minutes and stabilized at 200-220 million monthly minutes from May to November 2020. Surges were strongest in New England and weakest in the South and West. Greater telemedicine expansion during COVID-19 was geographically associated with lower COVID-19 cases per capita. The nature of telemedicine visits also changed, as the average monthly visits per provider doubled and average visit length decreased by 60%. CONCLUSIONS The COVID-19 pandemic led to an abrupt and subsequently sustained uptick in telemedicine utilization. Regional and institute-level differences in telemedicine utilization should be further investigated to inform policy and procedures for sustaining meaningful telemedicine use in clinical practice.
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Affiliation(s)
- Emily Louise Vogt
- University of Michigan Medical School, Michigan Medicine, Ann Arbor, US.,Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, US
| | - Brandon M Welch
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, US.,Doxy.me Research, Doxy.me, LLC, Rochester, US
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, US.,Doxy.me Research, Doxy.me, LLC, Rochester, US
| | - Janelle F Barrera
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, US.,Doxy.me Research, Doxy.me, LLC, Rochester, US
| | | | - Marisa Owens
- Clinical Center, National Institutes of Health, Bethesda, US
| | - Patricia Coffey
- Clinical Center, National Institutes of Health, Bethesda, US
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, US
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, US.,Lab of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers LaneRm 3S-32: MSC 9412, Rockville, US
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17
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Constant HMRM, Ferigolo M, Barros HMT, Moret-Tatay C. A clinical trial on a brief motivational intervention in reducing alcohol consumption under a telehealth supportive counseling. Psychiatry Res 2021; 303:114068. [PMID: 34217102 DOI: 10.1016/j.psychres.2021.114068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/15/2021] [Indexed: 02/04/2023]
Abstract
It is known that among those seeking to cease consumption of alcohol, there can be as high as a 50% relapse rate in the first 12 months. Different tools for treatments have been developed, such as telehealth, with the aim of helping this population. As a result of this demand, technology has gained strength in recent years. A new point of view about the treatment will broaden our knowledge far beyond just efficacy. It seems that understanding the mechanisms that lead to treatment success is as important as knowing its effectiveness. Therefore, the present study examined the relationships between Brief Motivational Intervention by telephone (BMI), motivational stage, outcome, and coping strategies using path analysis. In the post-evaluation, variables such as BMI (randomized individuals), motivational stage and decreased consumption of alcohol reached statistical significance (p<.001), suggesting that BMI might improve motivational stage and reduced consumption of alcohol. In terms of coping, the results also indicate that positive thinking might be a variable of interest when planning to decrease alcohol consumption. More research is needed to recognize the potential of new technology in the health area and to uncover the innumerable possibilities of using these tools as a strategy to help alcohol users.
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Affiliation(s)
- Hilda Maria Rodrigues Moleda Constant
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Ligue 132- Serviço Nacional de Orientações e Informações sobre Prevenção do Uso de Drogas (VIVAVOZ), Rua Sarmento Leite, 245 - Porto Alegre, Rio Grande do Sul, Brasil CEP 90050-170; Departamento de Neuropsicobiología, Metodología y Psicología Social Facultad de Psicología Universidad Católica de Valencia "San Vicente Mártir" Sede de San Juan Bautista.
| | - Maristela Ferigolo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Ligue 132- Serviço Nacional de Orientações e Informações sobre Prevenção do Uso de Drogas (VIVAVOZ), Porto Alegre, Rio Grande do Sul, Brasil
| | - Helena Maria Tannhauser Barros
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Farmacociências- Ligue 132- Serviço Nacional de Orientações e Informações sobre Prevenção do Uso de Drogas (VIVAVOZ), Porto Alegre, Rio Grande do Sul, Brasil
| | - Carmen Moret-Tatay
- Departamento de Neuropsicobiología, Metodología y Psicología Social Facultad de Psicología Universidad Católica de Valencia "San Vicente Mártir" Sede Padre Jofré, Valencia, Spain; Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, NESMOS Università La Sapienza, Rome, Italy
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18
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Ahuja AS, Bommakanti S, Farford B, Byrnes ÉS, Ten Hulzen RD, Dorairaj S. Teleophthalmology's Value in Screening for Blinding Eye Diseases. J Curr Ophthalmol 2021; 33:101-103. [PMID: 34409217 PMCID: PMC8365573 DOI: 10.4103/joco.joco_140_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/12/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abhimanyu S Ahuja
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sarvika Bommakanti
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Bryan Farford
- Department of Ophthalmology, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Éamonn S Byrnes
- Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Richard D Ten Hulzen
- Department of Ophthalmology, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Syril Dorairaj
- Department of Ophthalmology, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
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19
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Grigg J, Volpe I, Tyler J, Hall K, McPherson B, Lubman DI, Manning V. Ready2Change: Preliminary effectiveness of a telephone-delivered intervention program for alcohol, methamphetamine and cannabis use problems. Drug Alcohol Rev 2021; 41:517-527. [PMID: 34343370 DOI: 10.1111/dar.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Telehealth has considerable potential to overcome many of the barriers to accessing care for substance use problems, thereby increasing the opportunity for earlier intervention. The Ready2Change program is a multiple-session outbound telephone-delivered cognitive and behavioural intervention for mild-to-moderate substance use disorders, embedded within a long-established 24/7 alcohol and drug helpline. We sought to analyse routinely collected program data in a preliminary study to examine the effectiveness of Ready2Change in reducing substance use problem severity and psychological distress. METHODS A retrospective analysis of program data from December 2013 to June 2018 was performed. Analysed cases were 249 clients living in Victoria, Australia with alcohol (n = 191), methamphetamine (n = 40) or cannabis (n = 18) as their primary drug of concern. A within-subjects design was used to examine pre- and post-intervention substance use problem severity and psychological distress. RESULTS For alcohol cases, there was a statistically significant decrease in alcohol problem severity [AUDIT, mean difference = -12.7, 95% confidence interval (CI) -14.0, -11.5]. Statistically significant reductions in drug problem severity (DUDIT) were observed for methamphetamine (mean difference = -17.3, 95% CI -20.9, -13.7) and cannabis (mean difference = -15.9, 95% CI -22.3, -9.6) cases. All groups showed reductions in problem severity for other substances used (P < 0.05) and psychological distress (P < 0.001). DISCUSSION AND CONCLUSIONS Results suggest Ready2Change benefits clients with alcohol, methamphetamine and cannabis use problems, with the potential to improve treatment access for health inequity groups including those living in remote areas. These findings warrant further investigation into the effectiveness of this program.
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Affiliation(s)
- Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | | | - Kate Hall
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Australia
| | | | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
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20
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Barbosa W, Zhou K, Waddell E, Myers T, Dorsey ER. Improving Access to Care: Telemedicine Across Medical Domains. Annu Rev Public Health 2021; 42:463-481. [PMID: 33798406 DOI: 10.1146/annurev-publhealth-090519-093711] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that (a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; (b) telemedicine in select circumstances has demonstrated improved health outcomes; and (c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.
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Affiliation(s)
- William Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA;
| | - Kina Zhou
- School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA
| | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA; .,Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
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21
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Watson DP, Swartz JA, Robison-Taylor L, Mackesy-Amiti ME, Erwin K, Gastala N, Jimenez AD, Staton MD, Messmer S. Syringe service program-based telemedicine linkage to opioid use disorder treatment: protocol for the STAMINA randomized control trial. BMC Public Health 2021; 21:630. [PMID: 33789642 PMCID: PMC8010496 DOI: 10.1186/s12889-021-10669-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background A key strategy for mitigating the current opioid epidemic is expanded access to medications for treating opioid use disorder (MOUD). However, interventions developed to expand MOUD access have limited ability to engage opioid users at higher levels of overdose risk, such as those who inject opioids. This paper describes the study protocol for testing STAMINA (Syringe Service Telemedicine Access for Medication-assisted Intervention through NAvigation), an intervention that engages high-risk opioid users at community-based syringe service programs (SSP) and quickly links them to MOUD using a telemedicine platform. Methods This randomized control trial will be conducted at three SSP sites in Chicago. All participants will complete an initial assessment with a provider from a Federally Qualified Health Center who can prescribe or refer MOUD services as appropriate. The control arm will receive standard referral to treatment and the intervention arm will receive immediate telemedicine linkage to the provider and (depending on the type of MOUD prescribed) provided transportation to pick up their induction prescription (for buprenorphine or naltrexone) or attend their intake appointment (for methadone). We aim to recruit a total of 273 participants over two years to provide enough power to detect a difference in our primary outcome of MOUD treatment linkage. Secondary outcomes include treatment engagement, treatment retention, and non-MOUD opioid use. Data will be collected using structured interviews and saliva drug tests delivered at baseline, three months, and six months. Fixed and mixed effects generalized linear regression analyses and survival analysis will be conducted to compare the probabilities of a successful treatment linkage between the two arms, days retained in treatment, and post-baseline opioid and other drug use. Discussion If successful, STAMINA’s telemedicine approach will significantly reduce the amount of time between SSP clients’ initial indication of interest in the medication and treatment initiation. Facilitating this process will likely lead to stronger additional treatment- and recovery-oriented outcomes. This study is also timely given the need for more rigorous testing of telemedicine interventions in light of temporary regulatory changes that have occurred during the COVID-19 pandemic. Trial registration ClinicalTrials.gov (Clinical Trials ID: NCT04575324 and Protocol Number: 1138–0420). Registered 29 September 2020. The study protocol is also registered on the Open Science Framework (DOI 10.17605/OSF.IO/4853 M).
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Affiliation(s)
- Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, 221 W Walton St, Chicago, IL, 60610, USA.
| | - James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison St, Chicago, IL, 60607, USA
| | - Lisa Robison-Taylor
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL, 60612, USA
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Kim Erwin
- Institute for Healthcare Delivery Design, University of Illinois at Chicago, 1220 S. Wood Street, Chicago, IL, 60612, USA
| | - Nicole Gastala
- Mile Square Health Centers, Department of Family Medicine, University of Illinois College of Medicine at Chicago, 1220 S Wood Street, Chicago, IL, 60608, USA
| | - Antonio D Jimenez
- Community Outreach Intervention Projects, University of Illinois - Chicago, School of Public Health, 1603 W. Taylor, Chicago, IL, 60612, USA
| | - Monte D Staton
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL, 60612, USA
| | - Sarah Messmer
- Departments of Academic Internal Medicine and Pediatrics, University of Illinois Chicago, 840 S Wood St, Chicago, IL, 60612, USA
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22
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Han Y, Lu Y, Wang D, Ran M, Ren Q, Xie D, Aziz TZ, Li L, Wang JJ. The Use of Remote Programming for Spinal Cord Stimulation for Patients With Chronic Pain During the COVID-19 Outbreak in China. Neuromodulation 2021; 24:441-447. [PMID: 33751731 PMCID: PMC8250774 DOI: 10.1111/ner.13382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/14/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
ObjectiveS Due to the impact of COVID-19 epidemic, face-to-face follow-up treatments for patients with chronic pain and implanted spinal cord stimulation (SCS) devices are forced to be delayed or stopped. This has led to more follow ups being done remotely. Meanwhile, with the development of 4G/5G networks, smartphones, and novel devices, remote programming has become possible. Here, we investigated the demand and utility of remote follow-ups including remote programming for SCS for patients with chronic pain. Materials and Methods A questionnaire including questions on demographic characteristics, pain history, postimplantation life quality, standard follow-up experience, remote follow-up, and remote programming experience was sent to patients diagnosed as chronic intractable pain and treated with SCS during January 2019 to January 2020. Results A total of 64 participants completed the questionnaire. About 70% of participants expressed demands for remote follow-ups due to the inconvenience, high costs, and time consumption of traditional follow-up visits. Nearly 97% of participants have attempted remote follow-ups, and about 81% of participants have further tried remote programming. Approximately, 96% of them recognized the benefits. Conclusions The remote programming was in high demand among participants. Most of the participants have tried remote follow-ups or even remote programming. The remote programming appeared to be more efficient, economic and were widely recognized among participants.
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Affiliation(s)
- Yan Han
- School of Medicine, Tsinghua University, Beijing, China
| | - Yang Lu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.,National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Dengyu Wang
- School of Medicine, Tsinghua University, Beijing, China
| | - Mingshan Ran
- Department of Rehabilitation Medicine, Peking University Shougang Hospital, Beijing, China
| | - Qidong Ren
- School of Medicine, Tsinghua University, Beijing, China
| | - Duo Xie
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Tipu Z Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China.,IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China.,Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - James Jin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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23
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Mehtani NJ, Ristau JT, Snyder H, Surlyn C, Eveland J, Smith-Bernardin S, Knight KR. COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management. Subst Abus 2021; 42:205-212. [PMID: 33684331 DOI: 10.1080/08897077.2021.1890676] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). METHODS We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured. RESULTS Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose. CONCLUSIONS ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.
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Affiliation(s)
- Nicky J Mehtani
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA
| | - Jessica T Ristau
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA
| | - Hannah Snyder
- Department of Family & Community Medicine, University of California, San Francisco, California, USA
| | - Colleen Surlyn
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Joanna Eveland
- San Francisco Department of Public Health, San Francisco, California, USA
| | | | - Kelly R Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, California, USA
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Ghosh A, Sharma K. Screening and brief intervention for substance use disorders in times of COVID-19: potential opportunities, adaptations, and challenges. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:154-159. [PMID: 33481639 DOI: 10.1080/00952990.2020.1865996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The ongoing pandemic has led to a sudden disruption of routine treatment services. Consequently, the already existing treatment gap for substance use disorders is likely to widen. There is an opportunity to expand the scope of Screening and Brief Intervention (SBI) to meet this unprecedented challenge. Its brevity, flexibility, and generalizability have positioned SBI to deal with additional systemic, structural, and attitudinal barriers that pertain to the pandemic. The standard content of SBI could be modified to adapt to the current context. SBI could also be used as a vehicle to render strategies for infection risk minimization. In this Perspective, we anticipate the challenges of expanding and implementing SBI in the present circumstances and present potential solutions. SBI, with adaptations, could bridge the augmented treatment gap for substance use disorders during COVID-19.
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Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kshitiz Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Molfenter T, Roget N, Chaple M, Behlman S, Cody O, Hartzler B, Johnson E, Nichols M, Stilen P, Becker S. Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study. JMIR Ment Health 2021; 8:e25835. [PMID: 33481760 PMCID: PMC7895293 DOI: 10.2196/25835] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/01/2020] [Accepted: 01/19/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Social distancing guidelines for COVID-19 have caused a rapid transition to telephone and video technologies for delivering treatment for substance use disorders (SUDs). OBJECTIVE This study examined the adoption of these technologies across the SUD service continuum, acceptance of these technologies among service providers, and intent of providers to use these technologies after the pandemic. Additional analysis using the validated technology acceptance model (TAM) was performed to test the potential applications of these technologies after the pandemic. The study objectives were as follows: (1) to assess the use of telehealth (telephone and video technologies) for different SUD services during COVID-19 in May-June 2020, (2) to assess the intended applications of telehealth for SUD services beyond COVID-19, (3) to evaluate the perceived ease of use and value of telehealth for delivering SUD services, and (4) to assess organizational readiness for the sustained use of telehealth services. METHODS An online survey on the use of telephonic and video services was distributed between May and August 2020 to measure the current use of these services, perceived organizational readiness to use these services, and the intent to use these services after COVID-19. In total, 8 of 10 regional Addiction Technology Transfer Centers representing 43 states distributed the survey. Individual organizations were the unit of analysis. RESULTS In total, 457 organizations responded to the survey. Overall, the technology was widely used; >70% (n>335) of organizations reported using telephone or video platforms for most services. The odds of the intent of organizations to use these technologies to deliver services post COVID-19 were significantly greater for all but two services (ie, telephonic residential counseling and buprenorphine therapy; mean odds ratio 3.79, range 1.87-6.98). Clinical users preferred video technologies to telephone technologies for virtually all services. Readiness to use telephone and video technologies was high across numerous factors, though telephonic services were considered more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced the intent to use both telephone and video technologies. CONCLUSIONS The overall perceived ease of use and usefulness of telephonic and video services suggest promising post-COVID-19 applications of these services. Survey participants consistently preferred video services to telephonic services; however, the availability of telephonic services to those lacking easy access to video technology is an important characteristic of these services. Future studies should review the acceptance of telehealth services and their comparative impact on SUD care outcomes.
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Affiliation(s)
- Todd Molfenter
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Nancy Roget
- Center for the Application of Substance Abuse Technologies, University of Nevada-Reno, Reno, NV, United States
| | - Michael Chaple
- New York State Psychiatric Institute, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, United States
| | - Stephanie Behlman
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Olivia Cody
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA, United States
| | - Edward Johnson
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, United States
| | - Maureen Nichols
- Addiction Research Institute, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
| | - Sara Becker
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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Patel M, Miller R, Haddad H, An L, Devito J, Neff A, Rajkumar A, Ellimoottil C. Assessing patient usability of video visits. Mhealth 2021; 7:22. [PMID: 33898591 PMCID: PMC8063020 DOI: 10.21037/mhealth-20-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Telehealth is being adopted by health systems across the country and many barriers to the expansion of video visit programs have been identified. Our study focused on the usability of video visit technology by examining technical challenges faced by patients over the course of a video visit. METHODS We conducted a survey of patients who received care from the Michigan Medicine video visit program from January 31, 2019 to July 31, 2019. The video visit program includes more than 1,300 visits a year across more than 30 specialties. Following the completion of their video visit, all patients were invited to participate in our online survey through the patient portal. The survey included questions on patient satisfaction, motivation and technical challenges. RESULTS We received responses from 180 patients (response rate of 26%). Overall patient satisfaction was high; 90% of respondents agreed that their video visit experience was similar to that of in-person visits and 93.3% of respondents would recommend video visits. Despite this high satisfaction rate, 36 out of 180 (20.0%) respondents cited technical issues during their video visit: video issues (n=11), audio issues (n=5), video and audio issues (n=2), slow/dropped connection (n=7), initial set-up issues (n=4), long wait time (n=3), and other (n=4). CONCLUSIONS While most patients report a high degree of satisfaction with their video visit, a meaningful subset of patients continue to experience technical challenges.
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Affiliation(s)
- Milan Patel
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rebecca Miller
- Michigan Medicine Virtual Care Team, University of Michigan, Ann Arbor, MI, USA
| | - Haley Haddad
- Michigan Medicine Virtual Care Team, University of Michigan, Ann Arbor, MI, USA
| | - Larry An
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Michigan Medicine Virtual Care Team, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jessie Devito
- Michigan Medicine Virtual Care Team, University of Michigan, Ann Arbor, MI, USA
| | - Alison Neff
- Michigan Medicine Virtual Care Team, University of Michigan, Ann Arbor, MI, USA
| | - Abishek Rajkumar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Michigan Medicine Virtual Care Team, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
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Oesterle TS, Kolla B, Risma CJ, Breitinger SA, Rakocevic DB, Loukianova LL, Hall-Flavin DK, Gentry MT, Rummans TA, Chauhan M, Gold MS. Substance Use Disorders and Telehealth in the COVID-19 Pandemic Era: A New Outlook. Mayo Clin Proc 2020; 95:2709-2718. [PMID: 33276843 PMCID: PMC7577694 DOI: 10.1016/j.mayocp.2020.10.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/19/2020] [Indexed: 02/05/2023]
Abstract
During the current coronavirus disease 2019 epidemic, many outpatient chemical dependency treatment programs and clinics are decreasing their number of in-person patient contacts. This has widened an already large gap between patients with substance use disorders (SUDs) who need treatment and those who have actually received treatment. For a disorder where group therapy has been the mainstay treatment option for decades, social distancing, shelter in place, and treatment discontinuation have created an urgent need for alternative approaches to addiction treatment. In an attempt to continue some care for patients in need, many medical institutions have transitioned to a virtual environment to promote safe social distancing. Although there is ample evidence to support telemedical interventions, these can be difficult to implement, especially in the SUD population. This article reviews current literature for the use of telehealth interventions in the treatment of SUDs and offers recommendations on safe and effective implementation strategies based on the current literature.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | | | | | | | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Mohit Chauhan
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Mark S Gold
- Department of Psychiatry, National Council, Institute for Public Health, Washington University School of Medicine Washington University in St Louis, St Louis, MO
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Implementation and Patient Satisfaction of Telemedicine in Spine Physical Medicine and Rehabilitation Patients During the COVID-19 Shutdown. Am J Phys Med Rehabil 2020; 99:1079-1085. [PMID: 32969967 DOI: 10.1097/phm.0000000000001600] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the implementation and patient satisfaction of telemedicine visits in a physical medicine and rehabilitation spine practice during COVID-19. DESIGN This is a prospective cohort study. RESULTS Of 172 patients, 97.6% were very satisfied or satisfied (83.7% of the patients were very satisfied) with their telemedicine appointment. In 44.4% of the cases, the physical medicine and rehabilitation physician prescribed medication to the patient, and in 21.6% of the cases, either an injection or radiofrequency ablation was ordered. Most patients (87%) did not have any issues during their encounter. Lastly, 64.5% of the patients preferred telemedicine over in-person appointments, whereas 56.1% of the patients who are 60 yrs and older responded the same. A total of 67.4% of those who had a follow-up visit would choose telemedicine over in-person. CONCLUSIONS The results of this study show that telemedicine can provide very effective and satisfactory care in a physical medicine and rehabilitation spine practice. This was especially notable with follow-up visits where imaging and treatment plan can easily be discussed over telemedicine. Stay-at-home orders and improved reimbursement during the COVID-19 pandemic have spurred adoption of telemedicine with high patient satisfaction. We hope that physical medicine and rehabilitation physicians will be able to continue expanding patient access in the postpandemic world.
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30
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White VM, Molfenter T, Gustafson DH, Horst J, Greller R, Gustafson DH, Kim JS, Preuss E, Cody O, Pisitthakarm P, Toy A. NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol. Implement Sci 2020; 15:94. [PMID: 33097097 PMCID: PMC7582427 DOI: 10.1186/s13012-020-01053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation. METHODS This cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizations DISCUSSION: This study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies. TRIAL REGISTRATION ClinicalTrials.gov , NCT03954184 . Posted 17 May 2019.
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Affiliation(s)
- Veronica M White
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA.
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Rachelle Greller
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Educational Sciences, 1025 West Johnson St, Madison, WI, 53706-1706, USA
| | - Eric Preuss
- Division of Behavioral Health, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, IA, 50319-0075, USA
| | - Olivia Cody
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Praan Pisitthakarm
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
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Coughlin LN, Bonar EE, Bickel WK. Considerations for remote delivery of behavioral economic interventions for substance use disorder during COVID-19 and beyond. J Subst Abuse Treat 2020; 120:108150. [PMID: 33298296 PMCID: PMC7532990 DOI: 10.1016/j.jsat.2020.108150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/10/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
The response to the COVID-19 crisis has created direct pressure on health care providers to deliver virtual care, and has created the opportunity to develop innovations in remote treatment for people with substance use disorders. Remote treatments provide an intervention delivery framework that capitalizes on technological innovations in remote monitoring of behaviors and can efficiently use information collected from people and their environment to provide personalized treatments as needed. Interventions informed by behavioral economic theories can help to harness the largely untapped potential of virtual care in substance use treatment. Behavioral economic treatments, such as contingency management, the substance-free activity session, and episodic future thinking, are positioned to leverage remote monitoring of substance use and to use personalized medicine frameworks to deliver remote interventions in the COVID-19 era and beyond. With increased remote care, there is an opportunity for virtual treatment development. Treatments can capitalize on remote technology to increase effectiveness. Behavioral economic interventions are well positioned to fill this need. Remote behavioral economic interventions can add to current treatments.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, United States of America.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, United States of America; Injury Prevention Center, University of Michigan, United States of America
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech, United States of America
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Jacob C, Sanchez-Vazquez A, Ivory C. Factors Impacting Clinicians' Adoption of a Clinical Photo Documentation App and its Implications for Clinical Workflows and Quality of Care: Qualitative Case Study. JMIR Mhealth Uhealth 2020; 8:e20203. [PMID: 32965232 PMCID: PMC7542402 DOI: 10.2196/20203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) tools have shown promise in clinical photo and wound documentation for their potential to improve workflows, expand access to care, and improve the quality of patient care. However, some barriers to adoption persist. OBJECTIVE This study aims to understand the social, organizational, and technical factors affecting clinicians' adoption of a clinical photo documentation mHealth app and its implications for clinical workflows and quality of care. METHODS A qualitative case study of a clinical photo and wound documentation app called imitoCam was conducted. The data were collected through 20 in-depth interviews with mHealth providers, clinicians, and medical informatics experts from 8 clinics and hospitals in Switzerland and Germany. RESULTS According to the study participants, the use of mHealth in clinical photo and wound documentation provides numerous benefits such as time-saving and efficacy, better patient safety and quality of care, enhanced data security and validation, and better accessibility. The clinical workflow may also improve when the app is a good fit, resulting in better collaboration and transparency, streamlined daily work, clinician empowerment, and improved quality of care. The findings included important factors that may contribute to or hinder adoption. Factors may be related to the material nature of the tool, such as the perceived usefulness, ease of use, interoperability, cost, or security of the app, or social aspects such as personal experience, attitudes, awareness, or culture. Organizational and policy barriers include the available clinical practice infrastructure, workload and resources, the complexity of decision making, training, and ambiguity or lack of regulations. User engagement in the development and implementation process is a vital contributor to the successful adoption of mHealth apps. CONCLUSIONS The promising potential of mHealth in clinical photo and wound documentation is clear and may enhance clinical workflow and quality of care; however, the factors affecting adoption go beyond the technical features of the tool itself to embrace significant social and organizational elements. Technology providers, clinicians, and decision makers should work together to carefully address any barriers to improve adoption and harness the potential of these tools.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Choy MA, Sturgiss E, Goodyear-Smith F, Smith GJ. Digital Health Tools and Patients With Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case-Finding and Help Assessment Tool (eCHAT). J Med Internet Res 2020; 22:e19256. [PMID: 32924959 PMCID: PMC7522726 DOI: 10.2196/19256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states. Objective The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders. Methods A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis. Results The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy. Conclusions eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor.
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Affiliation(s)
- Melinda Ada Choy
- Academic Unit of General Practice, College of Health and Medicine, The Australian National University, Garran, Australia
| | - Elizabeth Sturgiss
- Research School of Population Health, College of Health and Medicine, The Australian National University, Garran, Australia.,Department of General Practice, Monash University, Melbourne, Australia
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Gavin Jd Smith
- School of Sociology, The Australian National University, Canberra, Australia
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Byaruhanga J, Atorkey P, McLaughlin M, Brown A, Byrnes E, Paul C, Wiggers J, Tzelepis F. Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review. J Med Internet Res 2020; 22:e18621. [PMID: 32915156 PMCID: PMC7519427 DOI: 10.2196/18621] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility.
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Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Prince Atorkey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Matthew McLaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
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Uscher-Pines L, Raja P, Mehrotra A, Huskamp HA. Health center implementation of telemedicine for opioid use disorders: A qualitative assessment of adopters and nonadopters. J Subst Abuse Treat 2020; 115:108037. [PMID: 32600625 PMCID: PMC7327134 DOI: 10.1016/j.jsat.2020.108037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although use of telemedicine for the treatment of opioid use disorders (Tele-OUD) is growing, there is limited research on how it is actually being deployed in treatment. We explored how health centers across the U.S. are using tele-OUD in treatment as well as reasons for nonadoption. METHODS We used the 2018 SAMHSA Behavioral Health Treatment Services Locator database and literature review to create a sample of community mental health centers and federally qualified health centers with telemental health services. From this list of health centers, we ued maximum diversity sampling to identify and recruit health center leaders to participate in semistructured interviews. We used inductive and deductive approaches to develop site summaries. RESULTS Twenty-two health centers from 14 different states participated. Of these, 8 offered tele-OUD. Among centers with tele-OUD, medication management was the most common service provided via video. Typically, health centers offered telemedicine visits after an initial, in-person visit with a waivered (prescribing) provider. Some programs only offered counseling via telemedicine. Leading barriers to treatment that tele-OUD program representatives mentioned included regulations on the prescribing of controlled substances, including buprenorphine, and difficulties in sending lab results to distant (prescribing) providers. Nonadopters reported not offering tele-OUD due to regulations in controlled substance prescribing, complexities and regulatory barriers to offering group visits, and the belief that in-person OUD services were meeting patient need. CONCLUSIONS Tele-OUD is being deployed in a variety of ways. Describing current delivery models can inform strategies to promote and implement tele-OUD to combat the opioid epidemic.
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Affiliation(s)
| | - Pushpa Raja
- Los Angeles VA Medical Center, Los Angeles, CA, United States of America
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America; Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
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Legha RK, Moore L, Ling R, Novins D, Shore J. Telepsychiatry in an Alaska Native Residential Substance Abuse Treatment Program. Telemed J E Health 2020; 26:905-911. [PMID: 31804905 DOI: 10.1089/tmj.2019.0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Alaska Native communities experience high rates of alcohol and substance abuse and face challenges accessing quality, culturally appropriate treatment. Telepsychiatry could help bridge this gap, but no publications have examined its impacts for alcohol and substance abuse treatment directed at Alaska Native communities. This study explores one telepsychiatry clinic's impact on a residential substance abuse treatment serving the Alaska Native community in Anchorage, Alaska. Methods: Using a matched case - control design, 103 cases receiving telepsychiatry services between 2007 and 2012 were matched with 103 controls who did not. Outcome measures included length of stay, discharge plans, emergency room visits, and hospital admissions; clinical history, including previous suicide attempts, history of violence, and trauma history; social stressors such as current legal issues, unemployment, and homelessness; mental health, medical, and substance abuse diagnoses; and number of telepsychiatry appointments and nature of telepsychiatry services rendered. Results: Both groups exhibited high rates of mental and medical illness, socioeconomic challenges, and substance abuse. However, the telepsychiatry group demonstrated a significantly higher rate of post-traumatic stress disorder, history of violence, ongoing legal issues, and children in outside custody. It also remained engaged in treatment longer, had fewer discharges against medical advice, and was more likely to complete treatment. Discussion/Conclusions: Our study highlights this telepsychiatry clinic's real-world difference serving the complex substance abuse treatment needs of Alaska Native individuals. It also reinforces telepsychiatry's promise in serving other communities facing a high burden of addiction and mental illness yet facing barriers to high-quality, culturally competent services.
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Affiliation(s)
- Rupinder K Legha
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Health Services and Society, University of California Los Angeles, Los Angeles, California, USA
| | - Laurie Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rebecca Ling
- Cook Inlet Tribal Council, Inc., Anchorage, Alaska, USA
| | - Douglas Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay Shore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020; 8:e15935. [PMID: 32130167 PMCID: PMC7059085 DOI: 10.2196/15935] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/31/2019] [Indexed: 01/22/2023] Open
Abstract
Background There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom.,University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020. [PMID: 32130167 DOI: 10.2196/preprints.15935] [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: 05/15/2023] Open
Abstract
BACKGROUND There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. OBJECTIVE The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians' adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. METHODS A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. RESULTS The technological factors impacting clinicians' adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Brunet N, Moore DT, Lendvai Wischik D, Mattocks KM, Rosen MI. Increasing buprenorphine access for veterans with opioid use disorder in rural clinics using telemedicine. Subst Abus 2020; 43:39-46. [PMID: 32078492 DOI: 10.1080/08897077.2020.1728466] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - David T. Moore
- Yale University Department of Psychiatry, New Haven, CT, USA
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
| | | | - Kristin M. Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Marc I. Rosen
- Yale University Department of Psychiatry, New Haven, CT, USA
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
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Spivak S, Spivak A, Cullen B, Meuchel J, Johnston D, Chernow R, Green C, Mojtabai R. Telepsychiatry Use in U.S. Mental Health Facilities, 2010-2017. Psychiatr Serv 2020; 71:121-127. [PMID: 31615370 DOI: 10.1176/appi.ps.201900261] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the use of telepsychiatry in U.S. mental health facilities between 2010 and 2017. METHODS Changes over time in the availability of telepsychiatry were examined by using multiple waves of a national survey of mental health facilities. State and facility correlates of offering telepsychiatry in 2017 were examined. RESULTS The proportion of state facilities that self-reported offering telepsychiatry increased significantly from 15.2% in 2010 to 29.2% in 2017, with wide variability among states.. In 2017, facilities with telepsychiatry were more commonly publicly owned than to have others forms of ownership (odds ratio [OR]=2.72, 95% confidence interval [CI]=2.47-2.99, p<0.001), although the percentage of privately owned facilities offering telepsychiatry has increased significantly since 2010 (OR=2.94, 95% CI=2.14-4.05, p<.001). Facilities offering telepsychiatry had lower odds of receiving funding from Medicaid (OR=0.86, 95% CI=0.75-0.98, p<0.001) but higher odds of receiving funding from all other sources. Facilities in states that did not fund telepsychiatry had lower odds of offering these services in 2017 (OR=0.57, 95% CI=0.51-0.62, p<0.001). Telepsychiatry was more commonly offered in states with higher proportions of rural population (OR=1.64, 95% CI=1.45-1.85, p<0.001) and designated medically underserved areas (OR=1.36, 95% CI=1.25-1.47, p<0.001), compared with other states. CONCLUSIONS Nearly twice as many U.S. mental health facilities offered telepsychiatry in 2017 than in 2010. Medicaid funding lagged behind other funding sources, suggesting state administrative barriers. Telepsychiatry was commonly used by facilities in medically underserved and rural areas.
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Affiliation(s)
- Stanislav Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Amethyst Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Jennifer Meuchel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Rachel Chernow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Charee Green
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
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41
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Correction to Hopper et al. Psychiatr Serv 2020; 71:127. [PMID: 32008474 DOI: 10.1176/appi.ps.712correction] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lai JT, Chapman BP, Carreiro SP, Costigan AD, Rodriguez-Perez KM, Gonzalez G, Babu KM. A Pilot Study of a Telemedicine-based Substance Use Disorder Evaluation to Enhance Access to Treatment Following Near-Fatal Opioid Overdose. PROCEEDINGS OF THE ... ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES. ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES 2020; 2020:3488-3496. [PMID: 32015694 PMCID: PMC6996105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The opioid epidemic is a growing public health emergency in the United States, with deaths from opioid overdose having increased five-fold since 1999. Emergency departments (EDs) are the primary sites of medical care after near-fatal opioid overdose but are poorly equipped to provide adequate substance use treatment planning prior to discharge. In many underserved locales, limited access to clinicians trained in addiction medicine and behavioral health exacerbates this disparity. In an effort to improve post-overdose care in the ED, we developed a telemedicine protocol to facilitate timely access to substance use disorder evaluations. In this paper, we describe the conception and refinement of the telemedicine program, our experience with the first 20 participants, and potential implications of the platform on health disparities for individuals with opioid use disorder.
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Affiliation(s)
- Jeffrey T Lai
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Brittany P Chapman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Stephanie P Carreiro
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy D Costigan
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Gerardo Gonzalez
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kavita M Babu
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Schreiweis B, Pobiruchin M, Strotbaum V, Suleder J, Wiesner M, Bergh B. Barriers and Facilitators to the Implementation of eHealth Services: Systematic Literature Analysis. J Med Internet Res 2019; 21:e14197. [PMID: 31755869 PMCID: PMC6898891 DOI: 10.2196/14197] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods For this study, a twofold approach was applied. First, we gathered experts’ current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers.
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Affiliation(s)
- Björn Schreiweis
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany.,Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany
| | - Monika Pobiruchin
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Veronika Strotbaum
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,Zentrum für Telematik und Telemedizin GmbH, Bochum, Germany
| | - Julian Suleder
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,ERNW Research GmbH, Heidelberg, Germany
| | - Martin Wiesner
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Björn Bergh
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
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Felzen M, Beckers SK, Kork F, Hirsch F, Bergrath S, Sommer A, Brokmann JC, Czaplik M, Rossaint R. Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study. J Med Internet Res 2019; 21:e14907. [PMID: 31596244 PMCID: PMC6806125 DOI: 10.2196/14907] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 01/20/2023] Open
Abstract
Background As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany. Objective We sought to assess the utilization, safety, and technical performance of this telemedical emergency service. Methods We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations. Results The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations. Conclusions The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.
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Affiliation(s)
- Marc Felzen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefan Kurt Beckers
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Felix Kork
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Frederik Hirsch
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sebastian Bergrath
- Emergency Department, Maria Hilf-Hospital Moenchengladbach, Moenchengladbach, Germany
| | - Anja Sommer
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Michael Czaplik
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Zhao X, Innes KE, Bhattacharjee S, Dwibedi N, LeMasters TM, Sambamoorthi U. Facility and state-level factors associated with telemental health (TMH) adoption among mental health facilities in the United States. J Telemed Telecare 2019; 27:244-257. [PMID: 31475879 DOI: 10.1177/1357633x19868902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Telemental health (TMH) is a promising approach to increase access to mental healthcare. This study examined the TMH adoption rates and associations with facility- and state-level factors among US mental health (MH) facilities. METHODS This retrospective, cross-sectional study used linked data for 2016 from the National Mental Health Services Survey (N = 11,833), Area Health Resources File, and national reports for broadband access and telehealth policies. The associations of facility and state-level characteristics with TMH adoption were examined with multi-level logistic regressions. RESULTS Overall, 25.9% had used TMH. Having veteran affiliation [Adjusted Odds Ratio (AOR) = 18.53, 95% Confidence Interval (95%CI): 10.66-32.21] and greater Information Technology (IT) capacity [AOR(95%CI): 2.89(2.10-3.98)] were the strongest correlates of TMH adoption. Other facility characteristics associated with higher likelihood of TMH adoption were: public ownership, high patient volumes, having comprehensive MH treatments or Quality Improvement practices, having private or non-Medicaid public payers, and treating elderly patients (AORs: 1.16-2.41). TMH adoption was less likely among facilities treating more African Americans or patients with substance abuse disorders. TMH adoption varied substantially across states, with adoption more likely in states issuing special telehealth licences and those with more rural counties. DISCUSSION One in four MH facilities adopted TMH in 2016. TMH adoption varied by multiple facility- and state-level factors. Our findings suggest that: legal/regulatory burden and lower facility IT capacity may discourage TMH adoption; significant racial disparities exist in TMH adoption; and there is a need to increase TMH use for substance abuse disorders.
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Affiliation(s)
- Xiaohui Zhao
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Kim E Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Traci M LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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Pan K, Blankley AI, Hughes PJ. An examination of opioid prescription for Medicare Part D patients among family practice prescribers. Fam Pract 2019; 36:467-472. [PMID: 30239656 DOI: 10.1093/fampra/cmy090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the USA, opioid overdose accounted for more than 60% of drug overdose deaths in 2015. Of these deaths, 40% were due to use of prescription opioids. OBJECTIVES The aims of the study were to (i) study family medicine physician opioid-prescribing rate and duration of prescription, (ii) study the distribution of prescription by medication potency, (iii) study opioid-prescribing trends in health care shortage areas and (iv) study the association between extreme high prescribing rates and medical board discipline. METHODS This is a retrospective cross-sectional study of the 2015 Medicare Part D claim data. RESULTS Family practitioners have opioid prescription rates (5.6%) similar to medical subspecialists (6.0%), but lower than pain specialists (53.2%) and surgical specialists (36.6%). Family practitioners have an average opioid prescription duration (21.5 days) similar to medical subspecialists (23.1 days) and pain specialists (27.1 days), but longer than surgical specialists (8.9 days). Family practitioners tend to prescribe lower potency opioids. Family practitioners in rural health care shortage areas have a higher opioid prescription rate than other family practitioners (6.5% versus 5.6%). Among the 52 family practitioners who prescribed opioids as frequently as pain specialists, 26 of the 52 (50%) were certified in pain management or worked with a partner certified in pain management. Of the other 26 family practitioners, 3 (12%) had medical board disciplinary actions regarding opioid prescription. CONCLUSIONS While monitoring extreme prescribers is important and needs to be continued, the next step in policies to reduce prescription opioids will require systemic change, especially providing support for family practitioners in rural health care shortage areas.
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Affiliation(s)
- Kevin Pan
- Department of Economics, Finance, and Quantitative Analysis, Samford University, Birmingham, AL, USA
| | - Alan I Blankley
- Department of Accounting, Samford University, Birmingham, AL, USA
| | - Peter J Hughes
- Department of Pharmacy Practice, Samford University, Birmingham, AL, USA
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Abstract
INTRODUCTION Healthcare providers and systems increasingly utilize telehealth modalities to address barriers and challenges for healthcare delivery. Specialties, such as psychiatry, are testing asynchronous methods for telehealth delivery. The National Quality Forum (NQF) developed a framework with which to assess the quality of telemedicine according to measures and measure concepts within four domains. This review assesses existing asynchronous telepsychiatry (ATP) research according to the telehealth domains established by NQF, evaluates the prevalence and quality of ATP, and identifies the areas in which more research must be conducted. METHODS A systematic review of ATP methods was conducted according to PRISMA guidelines. Studies were categorized according to NQF telehealth domains and subdomains to further examine study outcomes. RESULTS The review initially identified 205 studies that were narrowed down to a final sample of 11 articles. Of the final articles, most studies addressed the effectiveness of ATP or users' experience with ATP. DISCUSSION The initial investigation of published ATP literature suggests promising results. ATP studies suggest that these services improve access to care, can be feasibly implemented by the clinical team, maintain patient/family satisfaction, and potentially reduce the cost of services. The limited sample of published literature necessitates further study of the practice in order to assess ATP according to the quality domains identified by NQF, especially access to care for patients and caregivers, the financial costs incurred by both providers and patients, and barriers to uptake.
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Affiliation(s)
- Molly O'Keefe
- Department of Health Management & Systems Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
| | - Kelsey White
- Department of Health Management & Systems Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
| | - J'Aime C Jennings
- Department of Health Management & Systems Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
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Current use of telehealth in urology: a review. World J Urol 2019; 38:2377-2384. [PMID: 31352565 DOI: 10.1007/s00345-019-02882-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Applications of telehealth have been growing in popularity. However, there is little information on how telehealth is being used in Urology. In this review, we examine current applications of telehealth in urological practices as well as barriers to implementation. METHODS A review was conducted of original research within the past 10 years describing telehealth applications in urology. Articles on telehealth as applied to other specialties were reviewed for discussion on real or perceived barriers to implementation. RESULTS Twenty-four articles met the inclusion criteria. The most common application of telehealth was using a video visit to assess or follow-up with patients. The second most commonly described applications of telehealth were telementorship, or the use of telehealth technology to help train providers, and telemedicine used in diagnostics. Studies consistently stated the effectiveness of the telehealth applications and the high level of patient and provider satisfaction. CONCLUSIONS Telehealth is sparingly used in urology. Barriers to implementation include technological literacy, reimbursement uncertainties, and resistance to change in workflow. When used, telehealth technologies are shown to be safe, effective, and satisfactory for patients and providers. Further investigation is necessary to determine the efficacy of telehealth applications.
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Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension. Curr Hypertens Rep 2019; 21:59. [DOI: 10.1007/s11906-019-0966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lin LA, Casteel D, Shigekawa E, Weyrich MS, Roby DH, McMenamin SB. Telemedicine-delivered treatment interventions for substance use disorders: A systematic review. J Subst Abuse Treat 2019; 101:38-49. [PMID: 31006553 DOI: 10.1016/j.jsat.2019.03.007] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/04/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
With increased negative impacts from opioid and other substance use disorders in the US, it is important for treatments to not only be effective, but also accessible to patients. Treatment delivery via telemedicine, specifically, the use of videoconferencing, which allows real time communication between a patient and a clinician at a distant site, has been shown to be an effective approach for increasing reach and access to treatments for mental health disorders and other chronic illnesses. This systematic review identified and summarized studies examining the effectiveness of telemedicine interventions to deliver treatment for patients with substance use disorders. Out of 841 manuscripts that met our search criteria, 13 studies met the inclusion criteria. Studies covered interventions for nicotine, alcohol and opioid use disorders. They varied widely in size, quality, and in the comparison groups examined. Studies examined both delivery of psychotherapy and medication treatments. Most studies suggested telemedicine interventions were associated with high patient satisfaction and are an effective alternative, especially when access to treatment is otherwise limited. However, there were substantial methodological limitations to the research conducted to date. Further studies are needed, including larger scale randomized studies that examine different models of telemedicine that can be integrated into existing healthcare delivery settings, to increase the use of effective treatments for patients with substance use disorders.
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Affiliation(s)
- Lewei Allison Lin
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd, Ann Arbor, MI 48109, United States of America.
| | - Danielle Casteel
- University of California San Diego, Health Services Research Center, Department of Family Medicine and Public Health, 9500 Gilman Drive, La Jolla, CA 92093, United States of America
| | - Erin Shigekawa
- California Health Benefits Review Program, University of California, Berkeley, CA 94720-3116, United States of America
| | - Meghan Soulsby Weyrich
- University of California, Davis, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Dylan H Roby
- University of Maryland, College Park, School of Public Health, Department of Health Services Administration, 4200 Valley Dr, Suite 3310, College Park, MD 20742, United States of America
| | - Sara B McMenamin
- University of California, San Diego, School of Medicine, Department of Family Medicine and Public Health, 9500 Gilman Drive #0725, La Jolla, CA 92093-0725, United States of America
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