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Charlly N, Swedlund M. Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population. Telemed J E Health 2024; 30:e1719-e1726. [PMID: 38452338 DOI: 10.1089/tmj.2023.0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.
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Affiliation(s)
- Nithin Charlly
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Swedlund
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Amura CR, Thorne J, Bean M, Avery LK, Sylla LN, Liss HK, Cook PF. Evolution of HIV Health Care Workforce Needs in the U.S. Mountain West During the COVID-19 Pandemic: A Mixed Method Study. J Assoc Nurses AIDS Care 2024; 35:78-90. [PMID: 38949905 PMCID: PMC11217585 DOI: 10.1097/jnc.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at risk of acquiring HIV experienced interruptions in care. Simultaneously, traditional training approaches to help providers adapt were disrupted. Using a mixed method approach to examine changes over time, we integrated data on trainee needs collected by the Mountain West AIDS Education and Training Center (AETC): a 10-state needs assessment survey in 2020; feedback from a 2020 community of practice; aggregate training data from 2000 to 2022; and a second survey in 2022. HIV care providers' training needs evolved from wanting support on telemedicine and COVID-19 patient care issues, to a later focus on mental health and substance use, social determinants of health, and care coordination. This integrative analysis demonstrates the vital role that AETCs can play in addressing evolving and emergent public health challenges for the HIV workforce.
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Affiliation(s)
- Claudia R Amura
- Claudia R. Amura, PhD, MPH, is an Assistant Professor of Research, University of Colorado College of Nursing, and is a Director of the Latino Health Certificate, Latino Research of Policy Center, Colorado School of Public University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Julia Thorne, is an MPH Graduate, Colorado School of Public Health, Aurora, Colorado, USA. Meagan Bean, is a Latino Health Certificate and MPH Candidate, Colorado School of Public Health, Aurora, Colorado, USA. Lisa Krug Avery, MSW, is a Professional Research Assistant, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Laurie N. Sylla, MHSA, is the Director, Mountain West AIDS Training Education Center, Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA. Hillary K. Liss, MD, is a Clinical Associate Professor, Division of General Internal Medicine, University of Washington, Seattle, Washington, USA. Paul F. Cook, PhD, is a Professor and Chair, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Phuong J, Ordóñez P, Cao J, Moukheiber M, Moukheiber L, Caspi A, Swenor BK, Naawu DKN, Mankoff J. Telehealth and digital health innovations: A mixed landscape of access. PLOS DIGITAL HEALTH 2023; 2:e0000401. [PMID: 38100519 PMCID: PMC10723719 DOI: 10.1371/journal.pdig.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
In the wake of emergent natural and anthropogenic disasters, telehealth presents opportunities to improve access to healthcare when physical access is not possible. Yet, since the beginning of the COVID pandemic, lessons learned reveal that various populations in the United States do not or cannot adopt telehealth due to inequitable access. We explored the Digital Determinants of Health (DDoHs) for telehealth, characterizing the role of accessibility, broadband connectivity and electrical grids, and patient intersectionality. In addition to its role as an existing Social Determinant of Health, Policies and Laws directly and indirectly affect these DDoHs, making access more complex for marginalized populations. Digital systems lack the flexibility, accessibility, and usability to inclusively provide the essential services patients need in telehealth. We propose the following recommendations: (1) design technology and systems using accessibility and value sensitive design principles; (2) support a range of technologies and settings; (3) support multiple and diverse users; and (4) support clear paths for repair when technical systems fail to meet users' needs. Addressing these requires change not only from providers but also from the institutions providing these systems.
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Affiliation(s)
- Jimmy Phuong
- UW Medicine Research Information Technologies, University of Washington, Seattle, Washington, United States of America
| | - Patricia Ordóñez
- Department of Information Systems, University of Maryland Baltimore County, Baltimore, Maryland, United States of America
| | - Jerry Cao
- Paul G. Allen School of Computer Science, University of Washington, Seattle, Washington, United States of America
| | - Mira Moukheiber
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Lama Moukheiber
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Anat Caspi
- Paul G. Allen School of Computer Science, University of Washington, Seattle, Washington, United States of America
- Taskar Center for Accessible Technology, Seattle, Washington, United States of America
| | - Bonnielin K. Swenor
- Johns Hopkins Disability Health Research Center, Baltimore, Maryland, United States of America
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David Kojo N. Naawu
- Meharry Medical College School of Medicine, Nashville, Tennessee, United States of America
| | - Jennifer Mankoff
- Paul G. Allen School of Computer Science, University of Washington, Seattle, Washington, United States of America
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Nkemdirim Okere A, Balogun A, Smith A, Stevens J. Association between pharmacist-led telehealth services and improvements in cardiovascular outcomes among patients with cardiovascular risk factors: A scoping review. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200206. [PMID: 37663032 PMCID: PMC10472224 DOI: 10.1016/j.ijcrp.2023.200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Background Cardiovascular disease is the leading cause of death globally. Despite the effectiveness of lifestyle changes and recommended therapeutics, access to primary care and treatments to improve cardiovascular risk-factors (CRFs) remains challenging. Pharmacists and telehealth services have been proposed as potential solutions to overcome these barriers. Methods PubMed, OVID, and CINAHL databases were searched from January 2006 to March 2023. The primary outcomes were changes from baseline in systolic/diastolic blood pressure, glycated hemoglobin (A1c), cholesterol levels, and adherence to any patient counseling. Only studies conducted in the United States and Canada were included in the review. Results Of 110 screened bibliographic records, 14 studies were included in the review. The pharmacist-led telehealth interventions included medication therapy management, medication reviews, and counseling on lifestyle changes. Nine studies reported significant improvements with intervention, 7 studies on CRFs and 2 studies on medication adherence at the 12-month follow-up, when pharmacist-led telehealth services were compared to usual care or historical data (p < 0.05). Conclusion This scoping review provides evidence for continued support to the development and implementation of pharmacist-led telehealth services in primary cardiovascular care. The findings suggest that pharmacist-led telehealth interventions can improve cardiovascular outcomes and adherence to drug and non-drug therapy among patients with CRFs. However, because of lack of published randomized clinical studies on patients with CRFs residing in underserved communities, future directions in research should focus on exploring the implementation of pharmacist-led telehealth services in rural or underserved communities, utilizing various payment models to enhance accessibility and feasibility.
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Affiliation(s)
- Arinze Nkemdirim Okere
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
| | - Aliyah Balogun
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
| | - Angela Smith
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
| | - Jade Stevens
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
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Fell LA, Albright CM, Kryszak EM, Butter E, Kuhlthau KA. Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:1196-1203. [PMID: 36871611 PMCID: PMC9985515 DOI: 10.1016/j.acap.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns. METHODS From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified. RESULTS Providers across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care. CONCLUSIONS Results suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.
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Affiliation(s)
- Lucy A Fell
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston.
| | - Charles M Albright
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Elizabeth M Kryszak
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Eric Butter
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Karen A Kuhlthau
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, MA
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Paixão LC, Ferreira EF, Ribeiro-Sobrinho AP, Martins RC. National analysis of dental teleconsulting of the Brazilian Telehealth Program. Braz Oral Res 2022; 36:e110. [PMID: 35946738 DOI: 10.1590/1807-3107bor-2022.vol36.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional study nationally evaluated asynchronous dental teleconsulting services offered by the Telehealth Brazil Networks Program, using the 2019 Telehealth Results Monitoring and Evaluation System database and considering Brazilian regional differences. The following teleconsulting variables were collected: dentist's sex and specialty, date/time of question and answer, response time; dental specialty, professional satisfaction, and patient referral. Five Brazilian regions were socioeconomically characterized according to the Human Development Index, estimated population, Gini coefficient, coverage of dental specialty centers, oral health teams in Family Health Strategy, and oral health teams in primary health care (PHC). In total, 2,703 teleconsulting sessions occurred in Brazil in the analyzed period. The Southeast exhibited the highest demand (49.1%). Most dentists were female (60.6%) and were dental surgeons from the Family Health Strategy (61.3%). Most teleconsulting sessions occurred during working hours (85.5%) and questions were answered within 72 hours (66.7%). Level of satisfaction and avoidance of referral yielded rates of 90.9% and 66.8%, respectively, among dentists who answered about these topics. Semiology was the most frequently demanded area in teleconsulting (33.9%). The different demands from the regions reflected regional differences. The most frequently demanded specialties represent the Brazilian PHC scenario. Professionals incorporated teleconsulting into their work routine and most teleconsultants responded within the stipulated timeframe. Professional feedback should be encouraged.
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Affiliation(s)
- Lígia Cristelli Paixão
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Belo Horizonte , MG , Brazil
| | - Efigênia Ferreira Ferreira
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Department of Community and Preventive Dentistry , Belo Horizonte , MG , Brazil
| | - Antônio Paulino Ribeiro-Sobrinho
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Department of Restorative Dentistry , Belo Horizonte , MG , Brazil
| | - Renata Castro Martins
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry , Department of Community and Preventive Dentistry , Belo Horizonte , MG , Brazil
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Nataliansyah MM, Merchant KAS, Croker JA, Zhu X, Mohr NM, Marcin JP, Rahmouni H, Ward MM. Managing innovation: a qualitative study on the implementation of telehealth services in rural emergency departments. BMC Health Serv Res 2022; 22:852. [PMID: 35780165 PMCID: PMC9250734 DOI: 10.1186/s12913-022-08271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telehealth studies have highlighted the positive benefits of having the service in rural areas. However, there is evidence of limited adoption and utilization. Our objective was to evaluate this gap by exploring U.S. healthcare systems' experience in implementing telehealth services in rural hospital emergency departments (TeleED) and by analyzing factors influencing its implementation and sustainability. METHODS We conducted semi-structured interviews with 18 key informants from six U.S. healthcare systems (hub sites) that provided TeleED services to 65 rural emergency departments (spoke sites). All used synchronous high-definition video to provide the service. We applied an inductive qualitative analysis approach to identify relevant quotes and themes related to TeleED service uptake facilitators and barriers. RESULTS We identified three stages of implementation: 1) the start-up stage; 2) the utilization stage; and 3) the sustainment stage. At each stage, we identified emerging factors that can facilitate or impede the process. We categorized these factors into eight domains: 1) strategies; 2) capability; 3) relationships; 4) financials; 5) protocols; 6) environment; 7) service characteristics; and 8) accountability. CONCLUSIONS The implementation of healthcare innovation can be influenced by multiple factors. Our study contributes to the field by highlighting key factors and domains that play roles in specific stages of telehealth operation in rural hospitals. By appreciating and responding to these domains, healthcare systems may achieve more predictable and favorable implementation outcomes. Moreover, we recommend strategies to motivate the diffusion of promising innovations such as telehealth.
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Affiliation(s)
- Mochamad Muska Nataliansyah
- Department of Surgery, Division of Surgical Oncology, Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53005, USA.
| | - Kimberly A S Merchant
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, USA
| | - James A Croker
- Cardiovascular Research Institute, University of California School of Medicine, San Francisco, CA, USA
| | - Xi Zhu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - James P Marcin
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Hicham Rahmouni
- Richard G. Lugar Center for Rural Health, Union Health, Terre Haute, IN, USA
| | - Marcia M Ward
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, USA
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Baird A, Cheng Y, Xia Y. Telehealth Adoption and Discontinuation by US Hospitals: Results From 2 Quasi-Natural Experiments. JMIR Form Res 2022; 6:e28979. [PMID: 35179503 PMCID: PMC8900896 DOI: 10.2196/28979] [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: 03/20/2021] [Revised: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prior US hospital telehealth (video visit) studies have focused on describing factors that influence telehealth adoption or performance effects for specific patient segments, hospital systems, or geographic regions. To our knowledge, a larger-scale, national-level (US) study has yet to be conducted on the causal impacts of hospital telehealth adoption as well as discontinuation. Objective The aim of this study is to understand the causal impact of US hospital telehealth adoption or discontinuation on hospital performance from 2016 to 2018. Methods We analyzed impacts of telehealth adoption or discontinuation by US hospitals on emergency department visits, total ambulatory visits (minus emergency department visits), outpatient services revenue, total facility expenses, and total hospital revenue for the 2016-2018 period. We specifically focused on performance effects for hospitals that switched from not having telehealth to adopting telehealth, or vice versa, during the 2016-2018 period, thus exploiting 2 quasi-natural experiments. We applied a difference-in-differences research design to each of the 2 main analyses. We compared hospitals that have made a telehealth change to groups of hospitals with similar characteristics that did not make a telehealth change, which established a counterfactual. To appropriately match hospitals between treatment and control groups, we applied propensity score matching. Our primary data were from the American Hospital Association Annual Survey and the Healthcare Cost Report Information System data. Several control variables were obtained from additional sources, including the Area Health Resource File and the Federal Communications Commission. Results We found that telehealth adoption by US hospitals during the 2016-2018 period resulted in, on average, an increased number of total ambulatory visits (P=.008), increased total facility expenses (P<.001), and increased hospital revenue (P=.004) compared with the control group. We found that telehealth discontinuation during the same period resulted in, on average, decreased outpatient services revenue (P=.02) compared with the control group. Conclusions Our findings suggest that telehealth adoption increases use but has mixed impacts on performance, given that cost and revenue increase. However, once telehealth is offered, removing it can have a negative impact on performance, implying that returning to prior performance levels, if telehealth is removed, may be challenging.
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Affiliation(s)
- Aaron Baird
- Institute of Health Administration, Georgia State University, Atlanta, GA, United States.,Department of Computer Information Systems, Robinson College of Business, Georgia State University, Atlanta, GA, United States
| | - Yichen Cheng
- Institute for Insight, Robinson College of Business, Georgia State University, Atlanta, GA, United States
| | - Yusen Xia
- Institute for Insight, Robinson College of Business, Georgia State University, Atlanta, GA, United States
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Becker S, Kisicki A, Chaple M, Freese TE, Gotham H, Greller R, Hagle H, Henry M, Krom L, Martin R, Powell K, Roget N, Velez-Echevarria II, Yáñez R, Molfenter T. Providing behavioral workforce development technical assistance during COVID-19: adjustments and needs. Transl Behav Med 2022; 12:ibab097. [PMID: 34409456 PMCID: PMC8499729 DOI: 10.1093/tbm/ibab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
COVID-19 social distancing policies have triggered a historic shift in the delivery of behavioral health prevention and treatment services. Among the first responders to this monumental workforce development challenge were the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers (TTCs), which are charged with building the behavioral health workforce's capacity to provide evidence-based prevention, treatment, and recovery services. TTCs documented unprecedented attendance at their events in the early months of the pandemic. This study applied content analysis to identify the most common COVID-related technical assistance (TA) topics and examine attendance by topic from March to July 2020. Across 393 events, TA topics explicitly related to COVID-19 encompassed eight emergent themes: (a) delivering services via telehealth, (b) providing support and services to behavioral health consumers, (c) promoting workforce self-care, (d) understanding new laws/policies, (e) delivering evidence-based practices, (f) advancing racial equity, (g) offering networking spaces, and (h) altering organizational management and communication infrastructure. The most heavily attended events focused on the TA themes "Advancing Racial Equity" (average = 352) and "Telehealth Service Delivery" (average = 271). There was a documented shift from more intensive TA to briefer, more targeted TA provision. The TTCs rapidly virtualized training and TA offerings to address workforce needs and serve as a model for providing remote workforce development support during the COVID-19 pandemic and future national crises.
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Li J, Zhu C, Liu C, Su Y, Peng X, Hu X. Effectiveness of eHealth interventions for cancer-related pain, fatigue, and sleep disorders in cancer survivors: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2021; 54:184-190. [PMID: 34791779 DOI: 10.1111/jnu.12729] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To systematically evaluate the effects of Electronic health (eHealth) interventions on fatigue, pain, and sleep disorders in cancer survivors. DESIGN A systematic review and meta-analysis was conducted. METHODS Relevant studies were searched from five databases (MEDLINE, Embase, the Cochrane Central Register of Controlled trials, CINAHL, and PsycINFO). The comprehensive literature search was done in December 2020. Only randomized controlled trials (RCTs) that examined the effects of eHealth interventions among cancer survivors were included. FINDINGS Twenty-five RCTs were included. The meta-analysis showed that eHealth interventions had a positive impact on pain interference (SMD = -0.37, 95% CI: -0.54 to -0.20, p = 0.0001) and sleep disorders (SMD = -0.43, 95% CI: -0.77 to -0.08, p = 0.02) but not on pain severity or fatigue in cancer survivors. The sensitivity and subgroup analyses indicated that the pooled results were robust and reliable. CONCLUSION eHealth interventions are effective in improving pain interference and sleep disorders in cancer survivors. Additional high-quality RCTs are needed to test the effectiveness of eHealth interventions on fatigue, pain, and sleep disorders in cancer survivors. CLINICAL RELEVANCE This systematic review and meta-analysis provides evidence to offer effective and sustainable eHealth care for symptom management among cancer survivors.
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Affiliation(s)
- Juejin Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chuanmei Zhu
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chunhua Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yonglin Su
- Department of Rehabilitation/Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiaolin Hu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, PR China
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Following the COVID-19 Experience, Many Patients with Type 1 Diabetes Wish to Use Telemedicine in a Hybrid Format. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111309. [PMID: 34769826 PMCID: PMC8583150 DOI: 10.3390/ijerph182111309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
Background: The COVID-19 pandemic has brought to light both challenges and unique opportunities regarding type 1 diabetes (T1D) management, including the usage of telemedicine platforms. Methods: This study was conducted in a tertiary hospital diabetes clinic. All consecutive T1D patients during March and June 2021 were asked to fill out a structured anonymous questionnaire that aimed to determine their preference regarding continuous use of a virtual platform. Results: In total, 126 T1D patients answered the questionnaire, of whom 51% were under the age of 40, half were men, half used insulin pumps, and 69% used continuous glucose monitoring. During the pandemic, the exposure of patients to virtual visits has grown about twofold, from 29% to 53%. Of the respondents, 49% expressed an interest in future usage of a virtual platform, but most of them preferred use in a hybrid manner. We found an association between preference to use telemedicine in the future and younger age, previous virtual platform experience, and confidence in being able to download data. Conclusions: Our data demonstrate that the COVID-19 experience has led to a growing interest of T1D patients in using the hybrid format of telemedicine. However, we still need to better understand who will benefit most from this platform and assess its cost-effectiveness and organization.
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Commiskey P, Armstrong AW, Coker TR, Dorsey ER, Fortney JC, Gaines KJ, Gibbons BM, Nguyen HQ, Singla DR, Szigethy E, Krupinski EA. A Blueprint for the Conduct of Large, Multisite Trials in Telemedicine. J Med Internet Res 2021; 23:e29511. [PMID: 34542417 PMCID: PMC8491114 DOI: 10.2196/29511] [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: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes despite the wide variability in results. Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. This viewpoint presents relevant challenges and solutions for conducting multisite telemedicine trials using 7 ongoing and completed studies funded by the Patient-Centered Outcomes Research Institute portfolio of large multisite trials to highlight the challenges in implementing telemedicine trials. Critical issues of ensuring leadership and buy-in, appropriate funding, and diverse and representative trials are identified and described, as well as challenges related to clinical, informatics, regulatory, legal, quality, and billing. The lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multisite telemedicine trials.
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Affiliation(s)
- Patricia Commiskey
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Earl Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - John C Fortney
- Division of Population Health, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veteran's Affairs, Seattle, WA, United States
| | - Kenneth J Gaines
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brittany M Gibbons
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Huong Q Nguyen
- Division of Health Services Research & Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, ON, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Szigethy
- Center for High Value Health Care, UPMC Insurances Division, Department of Psychiatry, Medicine, and Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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13
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Cortez C, Mansour O, Qato DM, Stafford RS, Alexander GC. Changes in Short-term, Long-term, and Preventive Care Delivery in US Office-Based and Telemedicine Visits During the COVID-19 Pandemic. JAMA HEALTH FORUM 2021; 2:e211529. [PMID: 35977211 PMCID: PMC8796900 DOI: 10.1001/jamahealthforum.2021.1529] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/14/2021] [Indexed: 12/01/2022] Open
Abstract
Question Has the COVID-19 pandemic been associated with any changes in the clinical content of ambulatory care in the US? Findings In this cross-sectional study of serial data from the IQVIA National Disease and Therapeutic Index, there was a moderate rebound in office-based care during the second half of 2020, while telemedicine accounted for 23.9% of care observed. Office-based care during the pandemic (quarters 2-4 of 2020) involved 58.0% long-term, 23.0% short-term, and 25.6% preventive diagnoses, while telemedicine care involved substantially greater long-term (77.2%), modestly greater short-term (26.8%), and almost no preventive (2.7%) diagnoses. Meaning In contrast to office-based care, telemedicine was more commonly used for established patients and substantially greater delivery of psychiatric or behavioral treatments than preventive care. Importance While the COVID-19 pandemic has been associated with some substitution of telemedicine for office-based care in the US, to our knowledge, little is known regarding the pandemic’s association with the clinical content of ambulatory care. Objective To characterize changes in the clinical content of ambulatory care among office-based vs telemedicine encounters in the US before vs during the COVID-19 pandemic. Design, Settings, and Participants This analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index was a 2-stage, stratified nationally representative audit of outpatient care in the US from January 1, 2018, through December 31, 2020. The National Disease and Therapeutic Index generates approximately 33 617 quarterly visits that are projected to 306.7 million national visits based on the survey design. Main Outcomes and Measures (1) Prevalence of common diagnoses and (2) mix of long-term, short-term, and preventive care. Results The mean (SD) number of projected quarterly, in-person, office-based visits was 282.1 (1.4) million in 2018 and 284.7 (10.3) in 2019 before declining to 250.8 million in quarter 1 of 2020 and 147.8 million in quarter 2 of 2020 and then increasing moderately to 181.5 million in quarter 3 of 2020 and 180.2 million in quarter 4 of 2020. The mean (SD) number of telemedicine visits was 2.8 (0.4) million in 2018 and 3.0 (0.1) million in 2019 before increasing to 8.6 million in quarter 1 of 2020 and 72.2 million in quarter 2 of 2020 and then declining notably to 43.8 million in quarter 3 of 2020 and 44.2 million in quarter 4 of 2020. Office-based care during the second through fourth quarters of 2020 involved 58.0% long-term, 23.0% short-term, and 25.6% preventive care. In contrast to office-based care, 4 of the top 10 diagnoses that were treated by telemedicine during 2020 were for psychiatric or behavioral conditions: depression, attention deficit/hyperactivity, anxiety, and bipolar disorders. Throughout this period, approximately half of office-based visits and nearly two-thirds of telemedicine visits were for established rather than new patients. Conclusions and Relevance This cross-sectional study’s findings suggest that while telemedicine rapidly increased early during course of the COVID-19 pandemic, its use declined modestly since then. In contrast to office-based care, telemedicine was more commonly used for established patients and substantially greater delivery of psychiatric or behavioral treatments rather than preventive care.
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Affiliation(s)
| | | | - Dima M. Qato
- Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Randall S. Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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14
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Shah MK, Gibbs AC, Ali MK, Narayan KMV, Islam N. Overcoming the Digital Divide in the Post-COVID-19 "Reset": Enhancing Group Virtual Visits with Community Health Workers. J Med Internet Res 2021; 23:e27682. [PMID: 34152995 PMCID: PMC8274676 DOI: 10.2196/27682] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/12/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
The COVID-19 pandemic created numerous barriers to the implementation of participant-facing research. For most, the pandemic required rapid transitioning to all virtual platforms. During this pandemic, the most vulnerable populations are at highest risk of falling through the cracks of engagement in clinical care and research. Nonetheless, we argue that we should reframe the discussion to consider how this transition may create opportunities to engage extensively to reach populations. Here, we present our experience in Atlanta (Georgia, United States) in transitioning a group visit model for South Asian immigrants to a virtual platform and the pivotal role community members in the form of community health workers can play in building capacity among participants. We provide details on how this model helped address common barriers to group visit models in clinical practice and how our community health worker team innovatively addressed the digital challenges of working with an elderly population with limited English proficiency.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Dunwoody, GA, United States
| | - Ashley Christina Gibbs
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Dunwoody, GA, United States
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Dunwoody, GA, United States.,Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Nadia Islam
- Division of Population Health, Grossman School of Medicine, New York University, New York City, NY, United States
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15
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Day SC, Day G, Keller M, Touchett H, Amspoker AB, Martin L, Lindsay JA. Personalized implementation of video telehealth for rural veterans (PIVOT-R). Mhealth 2021; 7:24. [PMID: 33898593 PMCID: PMC8063014 DOI: 10.21037/mhealth.2020.03.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/09/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A national shortage of mental health (MH) professionals leaves more than 90% of rural individuals without adequate access to services each year, troubling because 33% of Veterans Health Administration (VHA) enrollees live in rural areas and rural Veterans have a greater risk of suicide than urban Veterans. Additional barriers such as travel distance and cost, stigma and extreme weather or geography add to challenges of rural Veterans seeking treatment. Although the VHA has addressed this disparity by providing telemental health services, provision of services via traditional hub-and-spoke and/or establishment of regional centers has not fully addressed barriers or resource limitations. Video telehealth to home (VTH) has assisted in better addressing geographic, attitudinal and systematic barriers to in-person care; however, its uptake and implementation have been problematic. This article describes the Personalized Implementation of Video Telehealth for Rural Veterans (PIVOT-R) approach, developed in response to the unique needs of rural veterans. METHODS We developed PIVOT, a flexible implementation strategy that is adaptive to site-specific contexts and different digital innovations and relies on a collaborative relationship between external facilitators, internal facilitators and clinical champions. We used formative evaluation (FE) to gather ongoing information about our quality improvement (QI) implementation approach of VTH. Our FE of PIVOT at rural sites provided insight into adaptations to improve rural implementation. This led to development of PIVOT-R, which explicitly focuses on rural implementation. PIVOT-R, developed from provider and patient feedback plus lessons learned during implementation, focuses on rurality as an important diversity factor and addresses relationship building, engaging the site, assessing context and infrastructure and balancing national expectations with site-level goals. During fiscal year 2018 we partnered with a VHA healthcare system in a Western mountain state to pilot the PIVOT-R approach, again using FE which included quantitative and qualitative data collection to evaluate its impact. RESULTS PIVOT-R effectively increased uptake of VTH for MH care at the healthcare system evaluated. In fiscal year 2019 the percentage of Veterans receiving MH care via VTH at the site was 10 times greater than in fiscal year 2018, matching the mean VHA nationwide percentage and increasing by 43.24% by the end of 2019. Veteran feedback supported a positive experience by users. CONCLUSIONS Inclusion of a comprehensive assessment of the rural system, including infrastructure and resources, greatly improves understanding of a system's specific needs and enables a tailored approach targeting relevant barriers. Our FE suggests the potential of PIVOT-R to increase VTH uptake at other rural locations and reinforces the value of telehealth technology as an important resource for rural sites.
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Affiliation(s)
- Stephanie C. Day
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Giselle Day
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Michele Keller
- Veterans Affairs Medical Center-Fort Harrison, Fort Harrison, MT, USA
| | - Hilary Touchett
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Amber B. Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Lindsey Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Jan A. Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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16
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Werneke MW, Deutscher D, Grigsby D, Tucker CA, Mioduski JE, Hayes D. Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study. Phys Ther 2021; 101:6224412. [PMID: 33848335 PMCID: PMC8083284 DOI: 10.1093/ptj/pzab110] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE COVID-19 has widely affected delivery of health care. In response, telerehabilitation (TR) has emerged as alternative care model. Aims were: (1) to describe baseline patient characteristics and available unadjusted outcomes for episodes of care administered during COVID-19 using TR versus traditional in-person care, and (2) to describe TR frequency levels by condition and telecommunication modes. METHODS A descriptive retrospective observational design was used to report patient variables and outcomes including physical function, number of visits, and patient satisfaction, by TR frequency (few, most, or all visits) and telecommunication modes. Standardized differences were used to compare baseline characteristics between episodes with and without TR. RESULTS Sample consisted of 222,680 patients (59% female; mean [SD] age = 55 [18] years). Overall TR rate was 6% decreasing from 10% to 5% between second and third quarters of 2020. Outcome measures were available for 90% to 100% of episodes. Thirty-seven percent of clinicians administered care via TR. Patients treated using TR compared with in-person care were more likely to be younger and live in large metropolitan areas. From those with TR, 55%, 20%, and 25% had TR during few, most, or all visits, respectively. TR care was administered equally across orthopedic body parts, with lower use for nonorthopedic conditions such as stroke, edema, and vestibular dysfunction. TR was primarily administered using synchronous (video or audio) modes. The rate of patients reported being very satisfied with their treatment results was 3% higher for no TR compared with TR. CONCLUSIONS These results provide new knowledge about to whom and how TR is being administered during the pandemic in outpatient rehabilitation practices throughout the United States. The database assessed was found to be suitable for conducting studies on associations between TR and diverse outcome measures, controlling for a comprehensive set of patient characteristics, to advance best TR care models, and promote high-quality care. IMPACT This study provided detailed and robust descriptive information using an existing national patient database containing patient health and demographic characteristics, outcome measures, and telerehabilitation (TR) administration data. Findings support the feasibility to conduct future studies on associations between TR care and patient outcomes, adjusting for a wide range of patient characteristics and clinical setting factors that may be associated with the probability of receiving TR. The finding of limited and decreasing use of TR over the study period calls for studies aimed to better understand facilitators and inhibitors of TR use by rehabilitation therapists during everyday practice to promote its use when clinically appropriate.
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Affiliation(s)
- Mark W Werneke
- Address all correspondence to Mark Werneke PT, MS, E-mail address: , Postal address: 95-1031 Ohiaha St Mililani HI USA
| | - Daniel Deutscher
- Net Health Systems, Inc., Pittsburgh PA, USA,MaccabiTech Institute for Research & Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - David Grigsby
- MidSouth Orthopaedic Rehabilitation, Cordova, TN, USA
| | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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17
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Campos-Castillo C, Anthony D. Racial and ethnic differences in self-reported telehealth use during the COVID-19 pandemic: a secondary analysis of a US survey of internet users from late March. J Am Med Inform Assoc 2021; 28:119-125. [PMID: 32894772 PMCID: PMC7499625 DOI: 10.1093/jamia/ocaa221] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Widespread technological changes, like the rapid uptake of telehealth in the US during the COVID-19 pandemic, risk creating or widening racial/ethnic disparities. We conducted a secondary analysis of a cross-sectional, nationally representative survey of internet users to evaluate whether there were racial/ethnic disparities in self-reported telehealth use early in the pandemic. Materials and Methods The Pew Research Center fielded the survey March 19–24, 2020. Telehealth use because of the pandemic was measured by asking whether respondents (N = 10 624) “used the internet or e-mail to connect with doctors or other medical professionals as a result of the coronavirus outbreak.” We conducted survey-weighted logistic regressions, adjusting for respondents’ socioeconomic characteristics and perceived threat of the pandemic to their own health (eg, no threat, minor, major). Results Approximately 17% of respondents reported using telehealth because of the pandemic, with significantly higher unadjusted odds among Blacks, Latinos, and those identified with other race compared to White respondents. The multivariable logistic regressions and sensitivity analyses show Black respondents were more likely than Whites to report using telehealth because of the pandemic, particularly when perceiving the pandemic as a minor threat to their own health. Discussion Black respondents are most likely to report using telehealth because of the COVID-19 pandemic, particularly when they perceive the pandemic as a minor health threat. Conclusion The systemic racism creating health and health care disparities has likely raised the need for telehealth among Black patients during the pandemic. Findings suggest opportunities to leverage a broadly defined set of telehealth tools to reduce health care disparities postpandemic.
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Affiliation(s)
| | - Denise Anthony
- Department of Health Management & Policy, University of Michigan, Ann Arbor, Michigan, USA
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18
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Felker BL, McGinn MM, Shearer EM, Raza GT, Gold SD, Kim JM, Rojas SM, Roussev MS, Varkovitzky RL, Liu H, Morrison KL, McCann RA. Implementation of a Telemental Health Training Program Across a Mental Health Department. TELEMEDICINE REPORTS 2021; 2:26-31. [PMID: 33575684 PMCID: PMC7869919 DOI: 10.1089/tmr.2020.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 05/07/2023]
Abstract
Introduction: Telemental health (TMH) has increased substantially. However, health care systems have found it challenging to implement TMH ubiquitously. A quality improvement project guided by implementation science methodology was used to design and implement a TMH training program. Materials and Methods: Implementation science methodology (Promoting Access to Research Implementation in Health Services, Reach-Effectiveness-Adoption-Implementation-Maintenance, Implementation/Facilitation) provided the framework to design and implement the training program. A total of 100 interdisciplinary mental health providers from outpatient mental health clinics participated. Results: Providers reported satisfaction with the training program. Results indicated that the training increased providers' TMH knowledge and competence. The number of providers using TMH and patients who received TMH nearly doubled. Conclusions: Implementation science methodology was important in creating an organizational framework at this facility to design, evaluate, and implement an innovative TMH training program.
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Affiliation(s)
- Bradford L. Felker
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Washington, USA
| | - Meghan M. McGinn
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Washington, USA
| | - Erika M. Shearer
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Washington, USA
- Department of Veterans Affairs VA Puget Sound Health Care System, Tacoma, Washington, USA
| | - Gina T. Raza
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Sari D. Gold
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Washington, USA
| | - Jean M. Kim
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Sasha M. Rojas
- Department of Veterans Affairs VA Puget Sound Health Care System, Tacoma, Washington, USA
| | - Milena S. Roussev
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Ruth L. Varkovitzky
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Washington, USA
- Department of Veterans Affairs VA Puget Sound Health Care System, Tacoma, Washington, USA
| | - Huiting Liu
- Department of Veterans Affairs VA Puget Sound Health Care System, Tacoma, Washington, USA
| | - Kate L. Morrison
- Department of Veterans Affairs VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Russell A. McCann
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Washington, USA
- Department of Veterans Affairs VA Puget Sound Health Care System, Tacoma, Washington, USA
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19
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Yu J, Afridi SM, Cozart AC, Isea L, Guan J. Evaluation and Feedback for Telehealth From Patients and Physicians During the Early Stage of COVID-19 Pandemic Period. Cureus 2021; 13:e12633. [PMID: 33585121 PMCID: PMC7875567 DOI: 10.7759/cureus.12633] [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] [Indexed: 11/08/2022] Open
Abstract
Purpose Many health care providers adopted telehealth during the coronavirus disease 2019 (COVID-19) pandemic. This unprecedented transformation in medical practice posed challenges to both physicians and patients. However, little is known about the adaptation of attendings, residents, and patients to this new normal. Thus, a survey was sent out to investigate the feedback of both physicians and patients on telehealth. Methods Surveys were administered via phone call to patients and electronic survey to physicians at an internal medicine resident clinic in one tertiary community hospital from April to June 2020. Demographic information and assessment of overall experience, satisfaction, and concerns of telehealth were collected. Statistical analyses were performed to compare feedback between patients and physicians. Results Fifty patients and 45 physicians participated in the study. Eighty-four percent of patients were first- or second-time users, and 50% of patients were older than 60 years. Eighty-four percent of patients were very or extremely satisfied with telehealth, while 72% wanted to continue telehealth in the future. Ninety-four percent of patients believed that their concerns were adequately addressed, but 14% experiencing technical issues. Physicians' feedback to telehealth was less positive than the patients'. More than 60% of physicians experienced technical issues, and nearly 60% of physicians were neutral or not satisfied with telehealth. Nearly 50% of physicians had difficulty transitioning to telehealth, while only 29% believed that their patients’ complaints were adequately addressed. Most physicians had to schedule in-person visits after telehealth. Patients were more satisfied with telehealth than physicians (84% vs. 42%; p<0.001) and were more likely to believe that their concerns were properly addressed by telehealth (94% vs. 29%; p<0.001). Conclusion This survey revealed that patients were more satisfied with telehealth than physicians. Further research with a larger sample should be considered to confirm this conclusion, and subjective studies are needed to determine the imbalance of satisfaction.
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Affiliation(s)
- James Yu
- Internal Medicine, AdventHealth Orlando, Orlando, USA
| | | | - Ashley C Cozart
- Internal Medicine, University of Central Florida, Orlando, USA
| | - Luis Isea
- Internal Medicine, AdventHealth Orlando, Orlando, USA
| | - Jian Guan
- Internal Medicine, AdventHealth Orlando, Orlando, USA
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20
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Carolan K, Grabowski DC, Mehrotra A, Hatfield LA. Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study. J Med Internet Res 2020; 22:e23014. [PMID: 33331827 PMCID: PMC7775198 DOI: 10.2196/23014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 12/01/2022] Open
Abstract
Background Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. Objective We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. Methods In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. Results Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. Conclusions Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.
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Affiliation(s)
- Kelsi Carolan
- School of Social Work, University of Connecticut, Hartford, CT, United States
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
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21
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Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of Telehealth During the COVID-19 Pandemic: Scoping Review. J Med Internet Res 2020; 22:e24087. [PMID: 33147166 PMCID: PMC7710390 DOI: 10.2196/24087] [Citation(s) in RCA: 317] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With over 37.8 million cases and over 1 million deaths worldwide, the COVID-19 pandemic has created a societal and economic upheaval of unparalleled magnitude. A positive transformation has been brought about by innovative solutions in the health care sector that aim to mitigate the impact of COVID-19 on human health. For instance, the use of telehealth has been on the rise amidst this public health emergency. OBJECTIVE Given the unprecedented scale of the pandemic with no definitive endpoint, we aimed to scope the existing telehealth-related literature during a defined period of the ongoing pandemic (ie, January to June 2020). METHODS Our scoping review was guided by the Joanna Briggs Institute Reviewer Manual. We systematically searched PubMed and Embase databases with specific eligibility criteria. Data extracted from the shortlisted articles included first author and affiliation, journal title, publication type, terminologies used to describe telehealth and their accompanying definitions, health discipline or medical specialties and subspecialties wherein telehealth had been applied, the purpose of telehealth use, and the authors' overall sentiment on telehealth use. We collated the available information and used descriptive statistics to analyze the synthesized data. RESULTS In all, 543 articles published across 331 different journals were included in this scoping review. The Journal of Medical Internet Research and its sister journals featured the highest number of articles (25/543, 4.6%). Nearly all (533/543, 98.2%) articles were in English. The majority of the articles were opinions, commentaries, and perspectives (333/543, 61.3%). Most authors of the articles reviewed were from high-income countries (470/543, 86.6%), especially from the United States of America (237/543, 43.6%). In all, 39 different definitions were used to describe terms equivalent to telehealth. A small percentage (42/543, 7.7%) of the articles focused on the provision of COVID-19-related care. Moreover, 49.7% (270/543) of the articles primarily focused on the provision of multiple components of clinical care, and 23% (125/543) of the articles focused on various specialties and subspecialties of internal medicine. For a vast majority (461/543, 84.9%) of the articles, the authors expressed a celebratory sentiment about the use of telehealth. CONCLUSIONS This review identified considerable emerging literature on telehealth during the first six months of the COVID-19 pandemic, albeit mostly from high-income countries. There is compelling evidence to suggest that telehealth may have a significant effect on advancing health care in the future. However, the feasibility and application of telehealth in resource-limited settings and low- and middle-income countries must be established to avail its potential and transform health care for the world's population. Given the rapidity with which telehealth is advancing, a global consensus on definitions, boundaries, protocols, monitoring, evaluation, and data privacy is urgently needed.
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Affiliation(s)
| | - Amit Abraham
- Institute for Population Health, Weill Cornell Medicine, Doha, Qatar
| | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine, Doha, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine, Doha, Qatar
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22
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Jonk YC, Burgess A, Williamson ME, Thayer D, MacKenzie J, McGuire C, Fox K, Coburn AF. Telehealth Use in a Rural State: A Mixed-Methods Study Using Maine's All-Payer Claims Database. J Rural Health 2020; 37:769-779. [PMID: 33085154 DOI: 10.1111/jrh.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study assesses trends in telehealth use in Maine-a rural state with comprehensive telehealth policies-across payers, services, and rurality, and identifies barriers and facilitators to the adoption and use of telehealth services. METHODS Using a mixed-methods approach, researchers analyzed data from Maine's All Payer Claims Database (2008-2016) and key informant interviews with health care organization leaders to examine telehealth use and explore factors impacting telehealth adoption and implementation. FINDINGS Despite a 14-fold increase in the use of telehealth over the 9-year study period, use remains low-0.28% of individuals used telehealth services in 2016 compared with 0.02% in 2008. Services provided via telehealth varied by rurality; speech language pathology (SLP) was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for over 70% of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. Issues challenging organizations seeking to deploy telehealth included provider resistance, staff turnover, provider shortages, and lack of broadband. Key informants identified inadequate and inconsistent reimbursement as barriers to comprehensive, systematic billing for telehealth services, resulting in underrepresentation of telehealth services in claims data. CONCLUSIONS Claims covered by Medicaid account for much of the observed expansion of telehealth use in Maine. Telehealth appears to be improving access to behavioral health and SLP services. Provider shortages, broadband, and Medicare and commercial coverage policies limit the use of telehealth services in rural areas.
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Affiliation(s)
- Yvonne C Jonk
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine
| | - Amanda Burgess
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.,Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | | | - Deborah Thayer
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.,Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Jennifer MacKenzie
- Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Catherine McGuire
- Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Kimberley Fox
- Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Andrew F Coburn
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.,Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
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Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US. JAMA Netw Open 2020; 3:e2021476. [PMID: 33006622 PMCID: PMC7532385 DOI: 10.1001/jamanetworkopen.2020.21476] [Citation(s) in RCA: 292] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 01/26/2023] Open
Abstract
Importance Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US. Objective To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters. Design, Setting, and Participants Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020. Main Outcomes and Measures Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region; assessment of blood pressure or cholesterol measurement; and initiation or continuation of prescription medications. Results In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122.4 million (95% CI, 117.3-127.5 million) and 130.3 million (95% CI, 124.7-135.9 million) quarterly primary care visits occurred in the US (mean, 125.8 million; 95% CI, 121.7-129.9 million), most of which were office-based (92.9%). In 2020, the total number of encounters decreased to 117.9 million (95% CI, 112.6-123.2 million) in Q1 and 99.3 million (95% CI, 94.9-103.8 million) in Q2, a decrease of 21.4% (27.0 million visits) from the average of Q2 levels during 2018 and 2019. Office-based visits decreased 50.2% (59.1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1.1% of total Q2 2018-2019 visits (1.4 million quarterly visits) to 4.1% in Q1 of 2020 (4.8 million visits) and 35.3% in Q2 of 2020 (35.0 million visits). Decreases occurred in blood pressure level assessment (50.1% decrease, 44.4 million visits) and cholesterol level assessment (36.9% decrease, 10.2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9.6% vs 69.7% for blood pressure; P < .001; 13.5% vs 21.6% for cholesterol; P < .001). New medication visits in Q2 of 2020 decreased by 26.0% (14.1 million visits) from Q2 2018-2019 levels. Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19.3% vs 20.5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15.1% of visits [East North Central region], high of 26.8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden. Conclusions and Relevance The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters.
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Affiliation(s)
- G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Matthew Tajanlangit
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Student, Johns Hopkins University, Baltimore, Maryland
| | - James Heyward
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Dima M. Qato
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago
| | - Randall S. Stafford
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
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Patient and physician perspectives on training to improve communication through secure messaging: Clarifying the rules of engagement. Health Care Manage Rev 2020; 47:3-11. [PMID: 32379081 DOI: 10.1097/hmr.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to incorporate the perspectives of both patients and providers into the development of training to improve the exchange of secure messages through a patient portal as well as to identify management strategies that support patient engagement. METHODOLOGY Three patient focus groups (17 patients) and interviews with 21 ambulatory physicians across 17 outpatient clinics at a large Midwestern academic medical center using Epic MyChart were performed. Rigorous thematic analysis was guided by the Systems Engineering Initiative for Patient Safety 2.0 framework adapted to patient portal implementation. RESULTS Patients and physicians identified strategies at the patient, portal, physician, and health system levels that could help each group navigate the portal to communicate via secure messages more efficiently. Patient-focused training strategies included multimodal materials addressing how to navigate portal features and direction on when, what, and how to message. Changes to the format of the messaging feature and pop-ups with communication tips were also frequently mentioned. Physician and clinic-level strategies focused on how the clinic and health system management could enhance physician training on the patient-facing portal features and on how to manage patient care within the portal. Physicians also requested that the health system administration standardize physician and care team work processes related to secure messages within the portal and communicate clear management expectations of physician portal management. CONCLUSION As communication via secure messaging has become more common, our study identified patient, physician, portal and health system-level management and training strategies to enhance patient portal use. PRACTICE IMPLICATIONS Health system administrators and outpatient clinic management could implement these strategies to clarify the rules of engagement in the collaborative work of incorporating a patient portal into the primary care workflow and facilitating provider and patient use.
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25
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Schwamm LH, Erskine A, Licurse A. A digital embrace to blunt the curve of COVID19 pandemic. NPJ Digit Med 2020; 3:64. [PMID: 32377575 PMCID: PMC7198549 DOI: 10.1038/s41746-020-0279-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/16/2020] [Indexed: 12/21/2022] Open
Abstract
Digital health, virtual care, telehealth, and telemedicine are all terms often used interchangeably to refer to the practice of care delivered from a distance. Because virtual care collapses the barriers of time and distance, it is ideal for providing care that is patient-centered, lower cost, more convenient and at greater productivity. All these factors make virtual care tools indispensable elements in the COVID19 response. In this perspective, we offer implementation guidance and policy insights relevant to the use of virtual care tools to meet the challenges of the COVID19 pandemic.
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Affiliation(s)
- Lee H. Schwamm
- Harvard Medical School, Boston, USA
- Partners Healthcare, Boston, USA
- Massachusetts General Hospital, Boston, USA
| | - Alistair Erskine
- Harvard Medical School, Boston, USA
- Partners Healthcare, Boston, USA
| | - Adam Licurse
- Harvard Medical School, Boston, USA
- Partners Healthcare, Boston, USA
- Brigham Health, Boston, USA
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Huilgol YS, Miron-Shatz T, Joshi AU, Hollander JE. Hospital Telehealth Adoption Increased in 2014 and 2015 and Was Influenced by Population, Hospital, and Policy Characteristics. Telemed J E Health 2020; 26:455-461. [DOI: 10.1089/tmj.2019.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yash S. Huilgol
- Department of Surgery, University of California San Francisco, San Francisco, California
- Center for Health and Well-Being, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Ono, Israel
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, United Kingdom
| | - Aditi U. Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Telehealth and JeffConnect, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Telehealth and JeffConnect, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
- National Academic Center for Telehealth, Thomas Jefferson University, Philadelphia, Pennsylvania
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27
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Mishkind MC. Serving remote locations and isolated population. Mhealth 2020; 6:24. [PMID: 32632362 PMCID: PMC7327292 DOI: 10.21037/mhealth.2020.03.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/19/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matthew C Mishkind
- Deputy Director, and Director of Operations for Military and Veteran Programs, Departments of Psychiatry and Family Medicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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28
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Telehealth Approaches to Care Coordination in Autism Spectrum Disorder. INTERPROFESSIONAL CARE COORDINATION FOR PEDIATRIC AUTISM SPECTRUM DISORDER 2020. [PMCID: PMC7310994 DOI: 10.1007/978-3-030-46295-6_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This chapter examines the current literature regarding the use of telehealth, and its potential benefits and limitations for diagnosis, treatment, and coordination of care for children diagnosed with Autism Spectrum Disorder (ASD). Barriers to access drive the need to have telehealth as a modality for delivering evidence-based diagnostic and therapeutic processes, which can be impactful in improving developmental trajectories and functional outcomes. The chapter concludes with guidance for clinicians interested in leveraging telehealth, with directions elucidated to further advance the use of telehealth to support families with ASD. More recently, in light of Coronavirus disease 2019 (COVID-19) pandemic and social distancing guidelines and restrictions, this chapter highlights changes in telehealth policy and the use of telehealth for diagnosis and treatment of ASD as well as thoughts about future directions.
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Kirkland EB, DuBose-Morris R, Duckett A. Telehealth for the internal medicine resident: A 3-year longitudinal curriculum. J Telemed Telecare 2019; 27:599-605. [PMID: 31888396 DOI: 10.1177/1357633x19896683] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Across the United States of America, patients are increasingly receiving healthcare using innovative telehealth technologies. As healthcare continues to shift away from traditional office-based visits, providers face new challenges. Telehealth champions are needed to adapt technologies to meet the needs of patients, providers and communities, especially within the realm of primary care specialties. Given these challenges, this intervention aimed to incorporate telemedicine into internal medicine resident training across multiple training years to prepare them for practice in the current and changing healthcare system. METHODS Education and telehealth leaders at the Medical University of South Carolina identified key topics relevant to telehealth and the provision of general internal medicine services. With this as a framework, we developed a 3-year longitudinal telehealth curriculum for internal medicine resident physicians, consisting of an introduction to telemedicine equipment in the first year, didactic learning through in-person education and online modules in the second year and experiential learning through remote monitoring of chronic disease in the third year. Participants included approximately 100 internal medicine residents per year (2016-2019). Self-perceived knowledge, comfort and ability to provide telehealth services was assessed via a survey completed before and after participation in the curriculum. RESULTS Resident physicians' self-reported knowledge of telehealth history, access to care, contributions of telehealth applications and quality of care and communication each improved after completion of the online curriculum. There were also significant improvements in resident comfort and perceived ability to provide telehealth services after participation in the curriculum, as assessed via a survey. Overall, 41% of residents felt their ability to utilize telehealth as part of their current or future practice was greater than average after completion of the online modules compared to only 2% at baseline (p<0.01). Results also show residents accurately identify barriers to telehealth adoption at the healthcare system level, including the lack of clinical time to implement services (67% post- vs 47% pre-curriculum, p = 0.02), unfamiliarity with concepts (65% post- vs 21% pre-curriculum, p<-0.01) and concerns about consistent provider reimbursement (74% post- vs 39% pre-curriculum, p < 0.01). CONCLUSION Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres.
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Affiliation(s)
| | | | - Ashley Duckett
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, USA
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Abstract
Telemental health is a demonstrated and effective aspect of the overall mental health system and considered a standard of care for many treatments. Adoption has not been as robust as expected and failure to properly develop implementation plans is a significant barrier. This article provides an overview of a step-by-step planning process to more effectively implement and sustain telemental health programs.
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Affiliation(s)
- Matthew C Mishkind
- Departments of Family Medicine and Psychiatry, Johnson Depression Center, University of Colorado School of Medicine, 13199 East Montview Boulevard, Suite 330, Aurora, CO 80045, USA.
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31
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Lindsay JA, Day SC, Amspoker AB, Fletcher TL, Hogan J, Day G, Helm A, Stanley MA, Martin LA. Personalized Implementation of Video Telehealth. Psychiatr Clin North Am 2019; 42:563-574. [PMID: 31672207 DOI: 10.1016/j.psc.2019.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes the Personalized Implementation for Video Telehealth strategy to increase adoption of video telehealth to home (VTH) across a large, urban Veterans Health Administration medical center and applications for broader use in non-VHA settings. The authors fully integrated VTH into existing mental health clinics, resulting in (1) a significant increase in the number of patients receiving VTH, (2) a significant increase in the number of VTH visits relative to median national improvement, (3) a greater number of unique specialty mental health clinics offering VTH in Houston, and (4) a greater number of community clinics active in delivering VTH.
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Affiliation(s)
- Jan A Lindsay
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Stephanie C Day
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Terri L Fletcher
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Julianna Hogan
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Giselle Day
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ashley Helm
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Melinda A Stanley
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Lindsey A Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Doarn CR, Merrell RC. Telemedicine, Telehealth, and the Public Health Good. Telemed J E Health 2019; 25:773-774. [PMID: 31509094 DOI: 10.1089/tmj.2019.29028.crd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dang S, Olsan T, Karuza J, Cai X, Gao S, Intrator O, Li J, Gillespie SM. Telehealth in Home‐Based Primary Care: Factors and Challenges Associated With Integration Into Veteran Care. J Am Geriatr Soc 2019; 67:1928-1933. [DOI: 10.1111/jgs.16045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Stuti Dang
- Miami Veterans Affairs Geriatric Research Education and Clinical Center Miami Florida
- Miami Veterans Affairs Healthcare System Miami Florida
- Division of Geriatrics and Palliative Care University of Miami Miller School of Medicine Miami Florida
| | - Tobie Olsan
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- School of Nursing, University of Rochester Rochester New York
| | - Jurgis Karuza
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- Division of Geriatrics and Aging Department of Medicine, University of Rochester School of Medicine and Dentistry Rochester New York
- Department of Psychology Buffalo State College Buffalo New York
| | - Xueya Cai
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- Department of Biostatistics and Computational Biology University of Rochester School of Medicine and Dentistry Rochester New York
| | - Shan Gao
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- Department of Biostatistics and Computational Biology University of Rochester School of Medicine and Dentistry Rochester New York
| | - Orna Intrator
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- Department of Public Health Sciences University of Rochester Rochester New York
| | - Jiejin Li
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- Department of Public Health Sciences University of Rochester Rochester New York
| | - Suzanne M. Gillespie
- Canandaigua Veteran Affairs Medical Center Canandaigua New York
- Division of Geriatrics and Aging Department of Medicine, University of Rochester School of Medicine and Dentistry Rochester New York
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McLiesh P. Telehealth in contemporary orthopaedic nursing. Int J Orthop Trauma Nurs 2019; 33:1-3. [DOI: 10.1016/j.ijotn.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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