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Amura CR, Medina R, Bean M, Centi S, Cook PF, Barton AJ, Jones J. Socio-Structural Intersect With Post-COVID-19 Telehealth Utilization for Hispanic/Latino Groups in Colorado: A Mixed Methods Study. J Transcult Nurs 2024:10436596241271301. [PMID: 39189347 DOI: 10.1177/10436596241271301] [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: 08/28/2024] Open
Abstract
INTRODUCTION We evaluated telehealth utilization among Colorado Hispanics/Latinos during the COVID-19 pandemic. METHODS A mixed methods design was used with urban and rural patients recruited through two Colorado Federally Qualified Health Centers (FQHCs) serving large Hispanic/Latino communities. Linguistically and culturally adapted Patient Attitudes Toward Telehealth (PATAT) surveys were collected electronically. Semi-structured interviews were conducted with a purposeful sample of Spanish-speaking Hispanics/Latinos. RESULTS Although the FQHCs serve a Hispanic/Latino population, only 40% of survey respondents (82/204) were Hispanic/Latinos, and they reported less telehealth utilization (p < .01). Trust in telehealth seemed driven by previous use, with no differences in PATAT scores by ethnicity or geolocation. Interviews with Spanish-speaking Hispanics/Latinos showed they highly preferred in-person care, and factors that influenced telehealth utilization were situated within the intersection of culture and trust with socio-structural determinants of health. DISCUSSION Resolving disparities in telehealth utilization requires patient-centric approaches and equitable transcultural care for underserved Hispanic/Latino populations.
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Cullenward J, Curtin M, Dos Santos V. Characteristics of effective parent-mediated interventions for parents of children with neurodevelopmental disorders in rural areas: a systematic review protocol. BMJ Open 2024; 14:e083464. [PMID: 39142676 PMCID: PMC11331994 DOI: 10.1136/bmjopen-2023-083464] [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: 12/20/2023] [Accepted: 06/17/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Parent-mediated interventions are therapeutic approaches that use parent training to enable parents to provide primary support and intervention to their child through the development of necessary skills, knowledge, and resources.Parent-mediated interventions can be broadly divided into two stages: (1) Clinicians educating, training and coaching parents in the implementation of an intervention and relevant information regarding their child's condition and (2) Parent(s) mediating and implementing the intervention based on the coaching and education received. These interventions can act as the primary intervention for children or supplement clinical interventions. This review will include both stages of the implementation process as well as both primary and supplementary interventions. Outcomes of parent-mediated interventions include long-term symptom reduction, improved prognosis for a wide range of behavioural and brain functions and enhanced parent-child dyadic social communication. METHODS AND ANALYSIS This systematic review aims to synthesise existing evidence and identify the characteristics of effective parent-mediated intervention for parents of children with neurodevelopmental disorders residing in rural areas. Systematic searches of CINAHL, PsycINFO, ProQuest allied health and nursing database, Ebscohost Psych and Behavioural database and SocINDEX were conducted twice with the latest completed on 5 March 2024 using preidentified search terms. Citations will be imported into EndNote V.20.6 (Clarivate Analytics, Pennsylvania, USA) to organise and de-duplicate and then Covidence to complete screening and extraction. The articles will be screened and reviewed following the Joanna Briggs Institute (JBI) guidelines for systematic reviews of Mixed methods. The JBI appraisal tools for systematic reviews will be used to assess the trustworthiness, relevance and results of qualitative, quantitative and mixed-methods studies. The scope of the literature analysed will include articles published between 2013 and 2024 in English. Literature was limited to the last 10 years to ensure the relevance of results as the intention is to report on current evidence. The start date of the study was March 2023 and the planned completion date is October 2024. ETHICS AND DISSEMINATION This study will neither involve human nor animal subjects and does not require ethics approval. Results will be disseminated to relevant groups in peer-reviewed journal(s) and at relevant children and parent health conferences or rural conferences. The key outcomes will also be shared on social media to support access for non-research audiences.
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Affiliation(s)
- Julia Cullenward
- School of Allied Health, Exercise & Sport Sciences, Charles Sturt University, Albury/Port Macquarie, New South Wales, Australia
| | - Michael Curtin
- School of Allied Health, Exercise & Sport Sciences, Charles Sturt University, Albury/Port Macquarie, New South Wales, Australia
| | - Vagner Dos Santos
- School of Allied Health, Exercise & Sport Sciences, Charles Sturt University, Albury/Port Macquarie, New South Wales, Australia
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Holtz BE, Mitchell KM, Strand D, Hirko K. Perceptions of Telehealth-Based Cancer Support Groups at a Rural Community Oncology Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:418-425. [PMID: 38539005 DOI: 10.1007/s13187-024-02428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 07/03/2024]
Abstract
Cancer peer support groups are crucial in improving quality of life outcomes and extending cancer survival. Using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB) as guiding frameworks, this study examined perceptions of telehealth-based cancer support groups among individuals treated for cancer at a rural oncology program. We distributed online surveys to 34 survivors or individuals undergoing cancer treatment who actively participated in virtual cancer support groups, achieving a 79.4% response rate (27 participants). The survey, blending quantitative and qualitative methodologies, assessed demographic characteristics, overall telehealth satisfaction, satisfaction with telehealth-based peer support, and perceived social support. Quantitative data were analyzed using descriptive statistics, while qualitative responses were examined through template analysis, focusing on the HBM and TPB constructs. Participants expressed general satisfaction with telehealth and indicated a willingness to use telehealth services again. Participants cited ease of use and broader access to cancer support groups with telehealth approaches. Barriers to telehealth included the lack of interpersonal connection, internet access, and technical difficulties. The findings underscore the nuanced perceptions of telehealth-based cancer support groups in a rural oncology setting. Despite acknowledging telehealth's limitations, participants appreciated its role in facilitating access to support. The findings provide valuable insights for optimizing digital health interventions, emphasizing the need for a balanced approach that considers both the potential and the challenges of telehealth in cancer care. This study offers critical guidance in optimizing digital health interventions and ensuring accessible, effective support for cancer patients in rural areas.
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Affiliation(s)
- Bree E Holtz
- College of Communication Arts & Sciences, Michigan State University, 404 Wilson Road, Rm 309, East Lansing, MI, 48824, USA.
| | - Katharine M Mitchell
- College of Communication Arts & Sciences, Michigan State University, 404 Wilson Road, Rm 309, East Lansing, MI, 48824, USA
| | | | - Kelly Hirko
- Epidemiology & Biostatistics, Michigan State University, Traverse City, MI, USA
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Tedeschi A, Palazzini M, Trimarchi G, Conti N, Di Spigno F, Gentile P, D’Angelo L, Garascia A, Ammirati E, Morici N, Aschieri D. Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts. J Clin Med 2024; 13:2592. [PMID: 38731120 PMCID: PMC11084728 DOI: 10.3390/jcm13092592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients' deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence.
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Affiliation(s)
- Andrea Tedeschi
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
| | - Matteo Palazzini
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Nicolina Conti
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Francesco Di Spigno
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
| | - Piero Gentile
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Luciana D’Angelo
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Andrea Garascia
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Enrico Ammirati
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Nuccia Morici
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
| | - Daniela Aschieri
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
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Al Baalharith IM, Aboshaiqah AE. A Delphi Study on Identifying Competencies in Virtual Healthcare for Healthcare Professionals. Healthcare (Basel) 2024; 12:739. [PMID: 38610161 PMCID: PMC11011667 DOI: 10.3390/healthcare12070739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Virtual care adoption accelerated during the COVID-19 pandemic, highlighting the need for healthcare professionals to develop relevant competencies. However, limited evidence exists on the core competencies required for quality virtual care delivery. OBJECTIVE This study aimed to identify the critical competencies physicians, nurses, and other health professionals need for adequate virtual care provision in Saudi Arabia using a Delphi method. METHODS A 3-round Delphi technique was applied with a panel of 42 experts, including policymakers, healthcare professionals, academicians, and telehealth specialists. In Round 1, an open-ended questionnaire elicited competencies needed for virtual care. The competencies were distilled and rated for importance in Rounds 2 and 3 until consensus was achieved. RESULTS Consensus emerged on 151 competencies across 33 domains. The most prominent domains were communication (15 competencies), professionalism (13), leadership (12), health informatics (5), digital literacy (5), and clinical expertise (11).
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Affiliation(s)
- Ibrahim Mubarak Al Baalharith
- College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia;
- Governance and Excellence, SEHA Virtual Hospital, Riyadh 11421, Saudi Arabia
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Anawade PA, Sharma D, Gahane S. A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus 2024; 16:e55996. [PMID: 38618307 PMCID: PMC11009553 DOI: 10.7759/cureus.55996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.
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Affiliation(s)
- Pankajkumar A Anawade
- Management, School of Allied Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepak Sharma
- Management, School of Allied Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shailesh Gahane
- Science and Technology, School of Allied Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cook-Cottone C, Harriger JA, Tylka TL, Wood-Barcalow NL. Virtually possible: strategies for using telehealth in eating disorder treatment learned from the COVID-19 pandemic. Eat Disord 2024; 32:99-119. [PMID: 37772856 DOI: 10.1080/10640266.2023.2261762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The COVID-19 pandemic resulted in an abrupt shift from in-person to virtual treatment, and clinicians continue to offer telehealth due to its advantages. Telehealth may be a viable, effective, and safe treatment modality for many clients with eating disorders. We consider contemporary issues regarding the use of telehealth in eating disorder treatment and identify strategies to enhance its delivery. First, we emphasize key factors when choosing therapy delivery (telehealth, in-person, or hybrid). Second, we address telehealth-specific planning, preparation, safety, and privacy considerations. Third, we discuss how eating disorder assessment and evidence-based interventions can be adapted for telehealth delivery. Fourth, we raise telehealth-specific challenges related to group-based delivery and the therapeutic alliance offering alternative avenues for connection and engagement. We conclude with a discussion of how additional research is needed to refine the presented strategies, develop new strategies, and assess their efficacy and effectiveness.
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Affiliation(s)
- Catherine Cook-Cottone
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York
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Hodges J, Calvo R. Telehealth for All? Assessing Remote Service Delivery for Latinx Immigrants. HEALTH & SOCIAL WORK 2023:7194690. [PMID: 37308313 DOI: 10.1093/hsw/hlad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/30/2022] [Accepted: 09/22/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic spurred a widespread shift to remotely delivered health services. Telehealth has shown promise in making healthcare more accessible. Little research has looked at the effects of this change on access to healthcare for Latinx immigrants. This qualitative study explored the shift to remote services during the COVID-19 pandemic in a new immigrant destination. Authors interviewed 23 service providers to assess if telehealth increased access to healthcare for Latinx immigrants. Results showed that telehealth improved access to services overall. Still, barriers to care remained. Immigrants experienced (a) limited access to technology and low digital literacy, (b) lack of privacy during the provision of services, (c) inability to utilize certain digital platforms due to confidentiality regulations, and (d) decreased quality of services. Findings suggest that telehealth is a promising modality to decrease healthcare disparities, but providers need to thoughtfully address barriers unique to Latinx immigrants to ensure their full participation.
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Affiliation(s)
- James Hodges
- LCSW, is a doctoral candidate School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Rocío Calvo
- PhD, is professor, School of Social Work, Boston College, Chestnut Hill, MA, USA
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Watson JD, Pierce BS, Tyler CM, Donovan EK, Merced K, Mallon M, Autler A, Perrin PB. Barriers and Facilitators to Psychologists' Telepsychology Uptake during the Beginning of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085467. [PMID: 37107748 PMCID: PMC10139141 DOI: 10.3390/ijerph20085467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 05/11/2023]
Abstract
The COVID-19 pandemic transformed the delivery of psychological services as many psychologists adopted telepsychology for the first time or dramatically increased their use of it. The current study examined qualitative and quantitative data provided by 2619 practicing psychologists to identify variables facilitating and impeding the adoption of telepsychology in the U.S. at the beginning of the COVID-19 pandemic. The top five reported barriers were: inadequate access to technology, diminished therapeutic alliance, technological issues, diminished quality of delivered care or effectiveness, and privacy concerns. The top five reported facilitators were: increased safety, better access to patient care, patient demand, efficient use of time, and adequate technology for telepsychology use. Psychologists' demographic and practice characteristics robustly predicted their endorsement of telepsychology barriers and facilitators. These findings provide important context into the implementation of telepsychology at the beginning of the pandemic and may serve future implementation strategies in clinics and healthcare organizations attempting to increase telepsychology utilization.
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Affiliation(s)
- Jack D. Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Bradford S. Pierce
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Carmen M. Tyler
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Emily K. Donovan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kritzia Merced
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
| | - Margaret Mallon
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Aaron Autler
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Paul B. Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
- School of Data Science and Department of Psychology, University of Virginia, Charlottesville, VA 22903, USA
- Correspondence:
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Morris ME, Brusco NK, Jones J, Taylor NF, East CE, Semciw AI, Edvardsson K, Thwaites C, Bourke SL, Raza Khan U, Fowler-Davis S, Oldenburg B. The Widening Gap between the Digital Capability of the Care Workforce and Technology-Enabled Healthcare Delivery: A Nursing and Allied Health Analysis. Healthcare (Basel) 2023; 11:healthcare11070994. [PMID: 37046921 PMCID: PMC10094715 DOI: 10.3390/healthcare11070994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations’ adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery.
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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Berry KR, Gliske K, Schmidt C, Cray LDE, Killian M, Fenkel C. LGBTQIA+ Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment (Preprint). JMIR Form Res 2023; 7:e45796. [PMID: 37083637 PMCID: PMC10163404 DOI: 10.2196/45796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. OBJECTIVE This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. METHODS Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. RESULTS LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. CONCLUSIONS This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.
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Affiliation(s)
| | - Kate Gliske
- Charlie Health, Inc, Bozeman, MT, United States
| | | | | | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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Ludrosky JM, Newhouse A, Hudnall E, Sheree A, Perle JG. When a Straight Line Is Not the Most Direct Method: an Evaluation of Straight Line Versus True Distance Metrics for Patients in Rural Settings. J Behav Health Serv Res 2023; 50:214-220. [PMID: 35945480 PMCID: PMC9362975 DOI: 10.1007/s11414-022-09812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
Telehealth has been hypothesized as a solution for rural barriers precluding access to healthcare, of which distance remains one of the most significant. Providers, institutions, and policymakers may use distance as a metric to determine whether to keep, or to end, telehealth services. Although commonly used, straight line distance (SLD) may not reflect the true burden of distance (TD) for rural patients. A retrospective record review was conducted to determine the difference between SLD and TD for patients seeking behavioral health care at a large outpatient center. The discrepancy between SLD and TD ranged from 0.5 to 83.4 miles of additional actual travel distance (mean = - 17.6). The mean percentage that SLD underestimated TD was 31.9%. Findings highlight that when considering distance as a determining factor for telehealth services, SLD is an inaccurate representation of the travel burden on this sample of rural patients, suggesting the utility of TD as an alternative.
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Affiliation(s)
- Jennifer M Ludrosky
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute West Virginia University, 930 Chestnut Ridge Road, Morgantown, WV, 26508, USA.
| | - Amanda Newhouse
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute West Virginia University, 930 Chestnut Ridge Road, Morgantown, WV, 26508, USA
| | - Erin Hudnall
- West Virginia Prevention Research Center, WVU School of Public Health, Social and Behavioral Sciences Department, West Virginia University, Morgantown, WV, USA
| | | | - Jonathan G Perle
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute West Virginia University, 930 Chestnut Ridge Road, Morgantown, WV, 26508, USA
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14
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Shoib S, Armiya'u AY, Roza TH, Saeed F, Swed S, Arif N, Park C, Chandradasa M. Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers and prospects. Asian J Psychiatr 2022; 75:103203. [PMID: 35870308 DOI: 10.1016/j.ajp.2022.103203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/17/2023]
Abstract
Telehealth is being broadly developed in all fields of medicine, and online visits seem a particularly suitable alternative to in-person visits in outpatient psychiatry especially in conflict setting. Telepsychiatry has numerous advantages over in-person visits.
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Affiliation(s)
- Sheikh Shoib
- Jawaharlal Nehru Memorial hospital, Directorate of Health Services, Jammu and Kashmir, India.
| | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, College of Medical Sciences, Abubakar Tafawa Balewa University, University Teaching Hospital Bauchi state, Nigeria.
| | - Thiago Henrique Roza
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fahimeh Saeed
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Nigar Arif
- Republican Psychiatric Hospital, Azerbaijan.
| | - Chan Park
- 2nd year Resident at UCLA-VA Psychiatry Residency Program, United States.
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15
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Whaibeh E, Vogt EL, Mahmoud H. Addressing the Behavioral Health Needs of Sexual and Gender Minorities During the COVID-19 Pandemic: a Review of the Expanding Role of Digital Health Technologies. Curr Psychiatry Rep 2022; 24:387-397. [PMID: 35841471 DOI: 10.1007/s11920-022-01352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To review the role of digital health technologies in behavioral health treatment and promotion for sexual and gender minorities (SGM). RECENT FINDINGS Digital technologies have advantages and limitations at multiple levels in addressing SGM's behavioral health needs. For patients, digital technologies improve convenience and may reduce stigma; however, privacy concerns in the home may limit their utilization. Providers also benefit from the convenience of these technologies; however, not all providers are comfortable delivering virtual care to SGM. For society, digital technologies reduce transportation-related costs and increase access to healthcare in an increasingly hostile political climate for SGM; however, these advantages are limited by technological access and anti-SGM policies. Digital technologies can improve the behavioral health of SGM at the patient, provider, and systemic levels. Further efforts are necessary to standardize provider training, improve SUD-specific care delivery, and increase quality and accessibility of these technologies.
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Affiliation(s)
- Emile Whaibeh
- Department of Public Health, University of Balamand, Beirut, Lebanon.,École Doctorale Sciences Et Santé, Saint Joseph University, Beirut, Lebanon
| | - Emily L Vogt
- University of Michigan Medical School, Ann Arbor, MI, USA.
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16
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Bistre M, Juven-Wetzler A, Argo D, Barash I, Katz G, Teplitz R, Said MM, Kohn Y, Linkovski O, Eitan R. Comparable reliability and acceptability of telepsychiatry and face-to-face psychiatric assessments in the emergency room setting. Int J Psychiatry Clin Pract 2022; 26:228-233. [PMID: 34565277 DOI: 10.1080/13651501.2021.1979586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to compare the reliability and acceptability of psychiatric interviews using telepsychiatry and face-to-face modalities in the emergency room setting. METHODS In this prospective observational feasibility study, psychiatric patients (n = 38) who presented in emergency rooms between April and June 2020, went through face-to-face and videoconference telepsychiatry interviews in a non-randomised varying order. Interviewers and a senior psychiatry resident who observed both interviews determined diagnosis, recommended disposition and indication for involuntary admission. Patients and psychiatrists completed acceptability post-assessment surveys. RESULTS Agreement between raters on recommended disposition and indication for involuntary admission as measured by Cohen's kappa was 'strong' to 'almost perfect' (0.84/0.81, 0.95/0.87 and 0.89/0.94 for face-to-face vs. telepsychiatry, observer vs. face-to-face and observer vs. telepsychiatry, respectively). Partial agreement between the raters on diagnosis was 'strong' (Cohen's kappa of 0.81, 0.85 and 0.85 for face-to-face vs. telepsychiatry, observer vs. face-to-face and observer vs. telepsychiatry, respectively).Psychiatrists' and patients' satisfaction rates, and psychiatrists' perceived certainty rates, were comparably high in both face-to-face and telepsychiatry groups. CONCLUSIONS Telepsychiatry is a reliable and acceptable alternative to face-to-face psychiatric assessments in the emergency room setting. Implementing telepsychiatry may improve the quality and accessibility of mental health services.Key pointsTelepsychiatry and face-to-face psychiatric assessments in the emergency room setting have comparable reliability.Patients and providers report a comparable high level of satisfaction with telepsychiatry and face-to-face modalities in the emergency room setting.Providers report a comparable level of perceived certainty in their clinical decisions based on telepsychiatry and face-to-face psychiatric assessments in the emergency room setting.
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Affiliation(s)
- Moises Bistre
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | | | - Daniel Argo
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Igor Barash
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Gregory Katz
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Ronen Teplitz
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | | | - Yoav Kohn
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Omer Linkovski
- The Jerusalem Mental Health Center, Jerusalem, Israel.,Psychology, Bar Ilan University, Israel
| | - Renana Eitan
- The Jerusalem Mental Health Center, Jerusalem, Israel.,Medical Neurobiology, The Hebrew University, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Williams HE, Aiyar L, Dinulos MB, Flannery D, McClure ML, Lloyd-Puryear MA, Sanghavi K, Trotter TL, Viskochil D. Considerations for policymakers for improving health care through telegenetics: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2022; 24:2211-2219. [PMID: 36040445 DOI: 10.1016/j.gim.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Heather E Williams
- Department of Pathology and Cell Biology, Columbia University, New York, NY; School of Management, Yale University, New Haven, CT
| | - Lila Aiyar
- Genomics Section, Hawaii Department of Health, Honolulu, HI
| | - Mary Beth Dinulos
- Departments of Pediatrics and Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Flannery
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH
| | | | - Michele A Lloyd-Puryear
- Retired from Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, The Jackson Laboratory, Farmington, CT
| | - Tracy L Trotter
- Department of Pediatrics, John Muir Health, San Francisco, CA
| | - David Viskochil
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT
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- American College of Medical Genetics and Genomics, Bethesda, MD
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18
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Tang A, Woldemariam S, Roger J, Sirota M. Translational Bioinformatics to Enable Precision Medicine for All: Elevating Equity across Molecular, Clinical, and Digital Realms. Yearb Med Inform 2022; 31:106-115. [PMID: 36463867 PMCID: PMC9719766 DOI: 10.1055/s-0042-1742513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVES Over the past few years, challenges from the pandemic have led to an explosion of data sharing and algorithmic development efforts in the areas of molecular measurements, clinical data, and digital health. We aim to characterize and describe recent advanced computational approaches in translational bioinformatics across these domains in the context of issues or progress related to equity and inclusion. METHODS We conducted a literature assessment of the trends and approaches in translational bioinformatics in the past few years. RESULTS We present a review of recent computational approaches across molecular, clinical, and digital realms. We discuss applications of phenotyping, disease subtype characterization, predictive modeling, biomarker discovery, and treatment selection. We consider these methods and applications through the lens of equity and inclusion in biomedicine. CONCLUSION Equity and inclusion should be incorporated at every step of translational bioinformatics projects, including project design, data collection, model creation, and clinical implementation. These considerations, coupled with the exciting breakthroughs in big data and machine learning, are pivotal to reach the goals of precision medicine for all.
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Affiliation(s)
- Alice Tang
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Graduate Program in Bioengineering, UCSF, San Francisco, CA, USA
- School of Medicine, UCSF, San Francisco, CA, USA
| | - Sarah Woldemariam
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- School of Medicine, UCSF, San Francisco, CA, USA
| | - Jacquelyn Roger
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Graduate Program in Biological and Medical Informatics, UCSF, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Department of Pediatrics, UCSF, San Francisco, CA, USA
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19
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Feasibility, satisfaction, acceptability and safety of telehealth for First Nations and culturally and linguistically diverse people: a scoping review. Public Health 2022; 207:119-126. [DOI: 10.1016/j.puhe.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
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20
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Nicholson N, Rhoades EA, Glade RE. Analysis of Health Disparities in the Screening and Diagnosis of Hearing Loss: Early Hearing Detection and Intervention Hearing Screening Follow-Up Survey. Am J Audiol 2022; 31:764-788. [PMID: 35613624 DOI: 10.1044/2022_aja-21-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to (a) provide introductory literature regarding cultural constructs, health disparities, and social determinants of health (SDoH); (b) summarize the literature regarding the Centers for Disease Control and Prevention (CDC) Early Hearing Detection and Intervention (EHDI) Hearing Screening Follow-Up Survey (HSFS) data; (c) explore the CDC EHDI HSFS data regarding the contribution of maternal demographics to loss-to-follow-up/loss-to-documentation (LTF/D) between hearing screening and audiologic diagnosis for 2016, 2017, and 2018; and (d) examine these health disparities within the context of potential ethnoracial biases. METHOD This is a comprehensive narrative literature review of cultural constructs, hearing health disparities, and SDoH as they relate to the CDC EHDI HSFS data. We explore the maternal demographic data reported on the CDC EHDI website and report disparities for maternal age, education, ethnicity, and race for 2016, 2017, and 2018. We focus on LTF/D for screening and diagnosis within the context of racial and cultural bias. RESULTS A literature review demonstrates the increase in quality of the CDC EHDI HSFS data over the past 2 decades. LTF/D rates for hearing screening and audiologic diagnostic testing have improved from higher than 60% to current rates of less than 30%. Comparisons of diagnostic completion rates reported on the CDC website for the EHDI HSFS 2016, 2017, and 2018 data show trends for maternal age, education, and race, but not for ethnicity. Trends were defined as changes more than 10% for variables averaged over a 3-year period (2016-2018). CONCLUSIONS Although there have been significant improvements in LTF/D over the past 2 decades, there continue to be opportunities for further improvement. Beyond neonatal screening, delays continue to be reported in the diagnosis of young children with hearing loss. Notwithstanding the extraordinarily diverse families within the United States, the imperative is to minimize such delays so that all children with hearing loss can, at the very least, have auditory accessibility to spoken language by 3 months of age. Conscious awareness is essential before developing a potentially effective plan of action that might remediate the problem.
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Affiliation(s)
| | | | - Rachel E. Glade
- Communication Science and Disorders, University of Arkansas, Fayetteville
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21
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King HC, Wu S, Bloomfield BS, Fischer AJ, Martone LE. A Practical Guide on Problem-Solving Teleconsultation in Schools. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2070495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Budhwani S, Fujioka J, Thomas-Jacques T, De Vera K, Challa P, De Silva R, Fuller K, Shahid S, Hogeveen S, Chandra S, Bhatia RS, Seto E, Shaw J. Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews. J Am Med Inform Assoc 2022; 29:990-999. [PMID: 35187571 PMCID: PMC9006706 DOI: 10.1093/jamia/ocac022] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We sought to understand and synthesize review-level evidence on the challenges associated with accessibility of virtual care among underserved population groups and to identify strategies that can improve access to, uptake of, and engagement with virtual care for these populations. MATERIALS AND METHODS A scoping review of reviews was conducted (protocol available at doi: 10.2196/22847). A total of 14 028 records were retrieved from MEDLINE, EMBASE, CINAHL, Scopus, and Epistemonikos databases. Data were abstracted, and challenges and strategies were identified and summarized for each underserved population group and across population groups. RESULTS A total of 37 reviews were included. Commonly occurring challenges and strategies were grouped into 6 key thematic areas based on similarities across communities: (1) the person's orientation toward health-related needs, (2) the person's orientation toward health-related technology, (3) the person's digital literacy, (4) technology design, (5) health system structure and organization, and (6) social and structural determinants of access to technology-enabled care. We suggest 4 important directions for policy development: (1) investment in digital health literacy education and training, (2) inclusive digital health technology design, (3) incentivizing inclusive digital health care, and (4) investment in affordable and accessible infrastructure. DISCUSSION AND CONCLUSION Challenges associated with accessibility of virtual care among underserved population groups can occur at the individual, technological, health system, and social/structural determinant levels. Although the policy approaches suggested by our review are likely to be difficult to achieve in a given policy context, they are essential to a more equitable future for virtual care.
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Affiliation(s)
- Suman Budhwani
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Tyla Thomas-Jacques
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ryan De Silva
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Simone Shahid
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Sophie Hogeveen
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Shivani Chandra
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ontario Health, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, University Health Network, Techna Institute, Toronto, Ontario, Canada
| | - James Shaw
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
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23
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Gingles D. Center the margin: Equity-Based Assessment and Response Strategies to Reach Underserved Communities Using a Telehealth Service Delivery Model. Behav Anal Pract 2022; 15:981-985. [PMID: 35378773 PMCID: PMC8966857 DOI: 10.1007/s40617-022-00685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/30/2022] Open
Abstract
While the COVID-19 pandemic has initiated drastic personal, social, organizational, and governmental level changes, it also sparked a unique opportunity. More Behavior Analysis providers had the option to respond to this crisis by offering telehealth services. As providers address their ability to conduct sessions using electronic delivery methods, there is also a need to prioritize those who historically have been forgotten in the formation of systemwide change: Black Indigenous People of Color (BIPOC). This paper outlines barriers to accessing telehealth treatment and includes options for individual providers and organizations to address disparity and other relevant contextual variables within their telehealth models.
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Affiliation(s)
- Denisha Gingles
- Signature Behavior Analytic Services, LLC, Mill, Windsor, MD USA
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24
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Godfrey TM, Villavicencio EA, Barra K, Sanderson PR, Shea K, Sun X, Garcia DO. Advancing Liver Cancer Prevention for American Indian Populations in Arizona: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063268. [PMID: 35328956 PMCID: PMC8948724 DOI: 10.3390/ijerph19063268] [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] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in American Indian populations in Arizona and identifies factors of structural inequality affecting these groups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology, and a literature search was conducted in PubMed, EMBASE, CINAHL, and PsycInfo for articles including Arizona American Indian adults and liver disease outcomes. Seven articles met the inclusion criteria in the final review. Five of the studies used an observational study design with secondary analysis. One article used a quasiexperimental approach, and another employed a community-engagement method resulting in policy change. The results revealed a lack of empirical evidence on liver cancer prevention, treatment, and health interventions for American Indian populations in Arizona. Research is needed to evaluate the high rates of liver disease and cancer to inform culturally relevant interventions for liver cancer prevention. Community-engaged research that addresses structural inequality is a promising approach to improve inequities in liver cancer for American Indian people.
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Affiliation(s)
- Timian M. Godfrey
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA; (T.M.G.); (K.S.)
| | - Edgar A. Villavicencio
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (E.A.V.); (X.S.)
| | - Kimberly Barra
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ 85206, USA;
| | - Priscilla R. Sanderson
- College of Health and Human Services, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | - Kimberly Shea
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA; (T.M.G.); (K.S.)
| | - Xiaoxiao Sun
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (E.A.V.); (X.S.)
| | - David O. Garcia
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (E.A.V.); (X.S.)
- Correspondence:
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25
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Ibragimov K, Palma M, Keane G, Ousley J, Crowe M, Carreño C, Casas G, Mills C, Llosa A. Shifting to Tele-Mental Health in humanitarian and crisis settings: an evaluation of Médecins Sans Frontières experience during the COVID-19 pandemic. Confl Health 2022; 16:6. [PMID: 35164807 PMCID: PMC8845383 DOI: 10.1186/s13031-022-00437-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/01/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND 'Tele-Mental Health (MH) services,' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format. METHODS From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred. RESULTS Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure. CONCLUSION Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
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Affiliation(s)
| | - Miguel Palma
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France.
| | - Gregory Keane
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | - Janet Ousley
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | | | | | - German Casas
- Fundación Santa Fe University Hospital, Universidad de Los Andes, Bogotá, Colombia
| | - Clair Mills
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
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26
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Peritogiannis V, Samakouri M. Research on psychotic disorders in rural areas: Recent advances and ongoing challenges. Int J Soc Psychiatry 2021; 67:1046-1057. [PMID: 34024174 DOI: 10.1177/00207640211019456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research on patients with chronic psychotic disorders in rural areas is scarce. Those patients may not receive adequate mental health care. Mental health disparities among rural and urban areas have been recognized. AIMS This review aims to present the most recent research on psychotic disorders in rural areas. METHOD We conducted a search in the PubMed and Scopus databases. The search involved articles published over the last decade (2011-2020). All types of research design were included, if studies had used a controlled group of urban patients and reported on the differences among rural/urban residents with psychotic disorders. The focus of the review was on outcome and treatment. RESULTS A total of 12 studies were included in this review. Most have been conducted in China or India. Reports from Western countries are rare. Outcome studies showed that employment rates are significantly higher in rural patients, as well as rates of marriage in women. It is not clear what is the impact of those outcomes on patients' lives. The finding of lower cost of psychotic disorders in some rural areas, should be viewed with scepticism. Studies on treatment aspects suggested that rural patients were less likely to receive antipsychotics, antipsychotic combination or clozapine. Those results were attributed to limited access to specialized treatment. When rural patients receive specialized community care they seem to have better outcomes than urban patients. CONCLUSION There is an ongoing, but still scarce research on patients with chronic psychotic disorders in rural areas. Researchers pointed out the impact of socioeconomic inequalities on outcome and treatment, and stressed the importance of minimizing mental health disparities. These findings may have potential implications for future research; for the introduction of accessible, locally based mental health services in rural areas; and for political initiatives that would address poverty and social inequalities.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Maria Samakouri
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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NACNS White Paper on Telehealth Competency for the Clinical Nurse Specialist: Gap Analysis and Recommendations. CLIN NURSE SPEC 2021. [PMID: 34843197 PMCID: PMC8614195 DOI: 10.1097/nur.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yedulla NR, Faraj MT, Koolmees DS, Battista EB, Montgomery ZA, Day CS. Assessing Orthopedic Patient Preferences for Mandated Virtual Care During the COVID-19 Pandemic and Elective Virtual Care in Non-Pandemic Circumstances. Orthopedics 2021; 44:e471-e476. [PMID: 34292825 DOI: 10.3928/01477447-20210618-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare orthopedic patient preferences for mandated virtual care during the coronavirus disease 2019 (COVID-19) pandemic and elective virtual care during non-pandemic circumstances. An orthopedic virtual care questionnaire was administered to adult orthopedic patients undergoing their first orthopedic virtual visit between March 15, 2020, and May 18, 2020. The questionnaire had 13 items rated on a 1-to-5 Likert scale ("strongly agree" to "strongly disagree"). Responses were compared using Kruskal-Wallis and nonparametric Wilcoxon rank-sum tests. Patients showed higher preferences for mandated virtual care during the pandemic when compared with elective virtual care during non-pandemic circumstances (2.25±1.31 vs 4.10±1.25, P<.0001) and also preferred virtual visits in other specialties compared with orthopedics (2.17±1.35 vs 2.79±1.42, P<.0001). Patients older than 50 years were more likely to view virtual care as the best option during the pandemic (2.06±1.25 vs 2.48±1.35, P<.0165) and equally as effective as in-person visits in non-pandemic circumstances (2.45±1.36 vs 2.83±1.18, P<.0150). Female patients were more likely to pursue future orthopedic virtual visits (2.61±1.37 vs 3.07±1.45, P<.0203) and view their virtual visit as equally effective as an in-person visit (2.47±1.33 vs 2.87±1.18, P<.0181). Orthopedic patient preference for mandated virtual care during the COVID-19 pandemic seems to be higher than for elective virtual care during non-pandemic circumstances, and older and female patients appear to favor virtual care. [Orthopedics. 2021;44(4):e471-e476.].
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Hasson RM, Fay KA, Phillips JD, Millington TM, Finley DJ. Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont. Am J Surg 2021; 221:725-730. [PMID: 32829909 PMCID: PMC10750228 DOI: 10.1016/j.amjsurg.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rural populations face many health disadvantages compared to urban areas. There is a critical need to better understand the current lung cancer screening landscape in these communities to identify targeted areas to improve the impact of this proven tool. METHODS Data from the County Health Rankings of New Hampshire and Vermont was reviewed for population density, distribution of adult smokers, and level of education compared to the distribution of Lung Cancer Screening Facilities throughout these two states. RESULTS Screening programs in southern counties of Vermont with lower levels of education have decreased access. In New Hampshire, there are no programs within 30 miles of the areas with the largest distribution of smokers, and decreased access in some areas with the lowest levels of education. CONCLUSIONS Improving equitable access to high-quality screening services in rural regions and the creation of targeted interventions to address decreased access in areas of high tobacco use and low education is vital to decreasing the incidence of latestage presentations of lung cancer within these populations.
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Affiliation(s)
- Rian M Hasson
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Kayla A Fay
- The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Joseph D Phillips
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Timothy M Millington
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - David J Finley
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
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Salwen-Deremer JK, Lauretti JM, Aschbrenner KA, Heinberg L, Ritz SJ, Sogg S. Remote unaffiliated presurgical psychosocial evaluations: a qualitative assessment of the attitudes of ASMBS members. Surg Obes Relat Dis 2021; 17:1182-1189. [PMID: 33753010 DOI: 10.1016/j.soard.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A psychosocial evaluation is an important component of the preoperative assessment process for people seeking metabolic and bariatric surgery (MBS), and is required for accreditation of MBS programs. Recently, independent companies without affiliations with MBS programs have been marketing remotely administered, unaffiliated psychosocial evaluations for MBS (RUS), and American Society for Metabolic and Bariatric Surgery (ASMBS) members have raised concerns about these evaluations. OBJECTIVES To explore ASMBS members' beliefs about RUS. SETTING Online survey. METHODS We developed a survey to evaluate ASMBS members' opinions, experiences, and/or concerns about in-person and RUS psychosocial evaluations for MBS. RESULTS In total, 635 ASMBS members responded to the online survey and 156 responded to an open-ended question on RUS. Responses were coded based on a manual developed for this study, yielding themes of concerns about the quality of RUS, lack of ongoing relationships in RUS, and conditions under which/reasons why RUS evaluations could be acceptable. CONCLUSION Respondents expressed both interest in and concerns about RUS in pre-MBS psychosocial evaluations. Use of RUS has the potential to improve access to MBS by providing a convenient and efficient means of completing the psychosocial evaluation. Conversely, respondents expressed concerns about the background and training of RUS providers, the quality of the reports, and the limited relationships between the RUS provider and both the MBS patient and the MBS team. We discuss the clinical and research implications of response themes, particularly for patients in rural areas or those who have other barriers to care.
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Affiliation(s)
| | - Jennifer M Lauretti
- UMass Memorial Medical Center, UMass Medical School, Worcester, Massachusetts
| | | | - Leslie Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | | | - Stephanie Sogg
- Massachusetts General Hospital Weight Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Cruz C, Orchard K, Shoemaker EZ, Hilty DM. A Survey of Residents/Fellows, Program Directors, and Faculty About Telepsychiatry: Clinical Experience, Interest, and Views/Concerns. ACTA ACUST UNITED AC 2021; 6:327-337. [PMID: 33585672 PMCID: PMC7870779 DOI: 10.1007/s41347-020-00164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
The effectiveness of telepsychiatry video for clinical care is well established, and clinician and psychiatry resident interest in it is growing—particularly in light of the COVID-19 impact. Still, few residency programs in the United States have core curricula, rotations/electives available, and competencies, and many faculty have no experience. A survey was sent via national organization listserves for residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience and interest, and views/concerns, using Likert-like and yes/no questions. Descriptive statistics and other analyses compared the groups to assess impact of clinical experience on interest and views/concerns. Respondents (N = 270) have limited clinical experience with telepsychiatry (46% none), with trainees having less than others, and yet, most were very interested or interested in it (68%). Trainees (N = 123) have concerns about being prepared for future practice. Clinical experience with video in the range of 6–20 h appears to dramatically increase interest and reduce concerns, though less time has a positive effect. Respondents have concerns about connectivity, medico-legal issues, and clinical effectiveness (e.g., diverse populations, psychosis, and emergencies) with telepsychiatry. More research is needed to assess current clinical and curricular experience, interest, and concerns. Additional curricular interventions during residency and fellowship training could build skills and confidence, if this is feasible, and the benefits outweigh the costs.
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Affiliation(s)
- Cesar Cruz
- Child and Adolescent Psychiatry, USC Institute of Psychiatry & Law, Los Angeles, CA USA
| | - Kali Orchard
- Yellowknife Adult and Child Psychiatry, Yellowknife, Canada
| | - Erica Z Shoemaker
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, USC and LAC+USC Medical Center, Los Angeles, CA USA
| | - Donald M Hilty
- Northern California Veterans Administration Health Care System, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Davis, CA USA
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A Survey Comparing Adult and Child Psychiatry Trainees, Faculty, and Program Directors' Perspectives About Telepsychiatry: Implications for Clinical Care and Training. ACTA ACUST UNITED AC 2021; 6:338-347. [PMID: 33501373 PMCID: PMC7820828 DOI: 10.1007/s41347-020-00187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
Telepsychiatry’s effectiveness is well established, and interest in it is growing, despite few residency/fellowship core curricula and rotations. A link to a cross-sectional survey was sent via national organization listservs for psychiatry residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience, and views/concerns about telepsychiatry. Descriptive statistics and other analyses compared groups to assess the impact of amount clinical experience and psychiatric specialty (general vs. child and adolescent psychiatry), on interest, and views/concerns about the practice of telepsychiatry. All respondents (N = 270; child psychiatry N = 89) have limited clinical experience with telepsychiatry (46% overall; 49% of non-child had none versus 40% child). Trainees (N = 123; child N = 43) expressed less interest than others. All respondents expressed worry about ability to do a physical exam, connectivity, medico-legal issues, and fit for diverse populations. Child respondents expressed less concern than others, but they reported more worry about loss of nonverbal cues. Clinical experience with telepsychiatry in the range of 6–20 h appears to build interest and allay concerns, though 1–5 h also may have a positive impact. More research is needed to assess clinical experience, interest, and concerns for adult and child psychiatry trainees and clinicians. Replicable, curricular interventions appear to be indicated.
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Hilty DM, Armstrong CM, Edwards-Stewart A, Gentry MT, Luxton DD, Krupinski EA. Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:252-277. [PMID: 33501372 PMCID: PMC7819828 DOI: 10.1007/s41347-020-00190-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023]
Abstract
Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.
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Affiliation(s)
- Donald M. Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, Washington, DC USA
| | | | - Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN US
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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Disney L, Mowbray O, Evans D. Telemental Health Use and Refugee Mental Health Providers Following COVID-19 Pandemic. CLINICAL SOCIAL WORK JOURNAL 2021; 49:463-470. [PMID: 33967352 PMCID: PMC8090514 DOI: 10.1007/s10615-021-00808-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 05/07/2023]
Abstract
The outbreak of COVID-19 has increased stress, fear, and anxiety for many people. At the same time, social isolation restrictions have disrupted most in-person mental health services. Many mental health providers are adapting to the crisis by utilizing telemental health. However, the literature is scant about how to most effectively utilize telemental health practices with refugee clients, many of whom do not speak English and require an interpreter, may have limited technological proficiency or access, and/or have additional case management needs and coordination as part of their treatment plan. The purpose of this study is to understand how mental health clinicians and case workers at a refugee-serving mental health clinic are successfully shifting their face-to-face practice to telemental health, the obstacles they encounter, and what resources they have found to be helpful. Two main themes emerged from the data: (1) refugee mental health providers display initiative and flexibility in their adaptation to telemental health and (2) providers reported numerous obstacles to effective telemental health, including client barriers, tech barriers, communication issues, and the challenge of reading nonverbal cues virtually. By better understanding telemental health when working with refugees, clinical social workers will be more effective in meeting the needs of a population with significant mental health needs and limited mental healthcare access.
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Affiliation(s)
- Lindsey Disney
- School of Social Welfare, University at Albany, Albany, NY USA
| | - Orion Mowbray
- School of Social Work, University of Georgia, Athens, GA USA
| | - Dana Evans
- Positive Growth, Inc., Clarkston, GA USA
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