1
|
Agbali RA, Balas EA, Beltrame F, Heboyan V, De Leo G. A review of questionnaires used for the assessment of telemedicine. J Telemed Telecare 2024; 30:1636-1666. [PMID: 37032470 DOI: 10.1177/1357633x231166161] [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: 04/11/2023]
Abstract
INTRODUCTION Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
Collapse
Affiliation(s)
- Raphael A Agbali
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - E Andrew Balas
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Francesco Beltrame
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genova, Italy
| | - Vahe Heboyan
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| |
Collapse
|
2
|
Hochfelder CG, Shuman AG. Ethics and Palliation in Head and Neck Surgery. Surg Oncol Clin N Am 2024; 33:683-695. [PMID: 39244287 DOI: 10.1016/j.soc.2024.04.005] [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: 09/09/2024]
Abstract
Head and neck cancer is a potentially traumatizing disease with the potential to impact many of the functions which are core to human life: eating, drinking, breathing, and speaking. Patients with head and neck cancer are disproportionately impacted by socioeconomic challenges, social stigma, and difficult decisions about treatment approaches. Herein, the authors review foundational ethical principles and frameworks to guide care of these patients. The authors discuss specific challenges including shared decision-making and advance care planning. The authors further discuss palliative care with a discussion of the role of surgery as a component of palliation.
Collapse
Affiliation(s)
- Colleen G Hochfelder
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1903 Taubman Center, SPC 5312, Ann Arbor, MI 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1903 Taubman Center, SPC 5312, Ann Arbor, MI 48109-5312, USA.
| |
Collapse
|
3
|
Ferguson JM, Van Campen J, Slightam C, Greene L, Heyworth L, Zulman DM. Evaluation of the Veterans Health Administration's Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study. J Med Internet Res 2024; 26:e59089. [PMID: 39250183 PMCID: PMC11420580 DOI: 10.2196/59089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/22/2024] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. OBJECTIVE We sought to evaluate the reach and impact of VHA's Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. METHODS We examined the reach of VHA's Connected Device Program using national secondary data from VHA's electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients' demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. RESULTS Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. CONCLUSIONS This evaluation of VHA's Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention.
Collapse
Affiliation(s)
- Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, United States
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, United States
- Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Leonie Heyworth
- Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Veterans Health Administration, Washington, DC, United States
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, United States
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, United States
- Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| |
Collapse
|
4
|
Bell J, Gottlieb LM, Lyles CR, Nguyen OK, Ackerman SL, De Marchis EH. Provision of digital devices and internet connectivity to improve synchronous telemedicine access in the U.S.: a systematic scoping review. Front Digit Health 2024; 6:1408170. [PMID: 39135634 PMCID: PMC11317370 DOI: 10.3389/fdgth.2024.1408170] [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: 03/27/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction The COVID-19 pandemic led to a dramatic increase in telemedicine use for direct patient care. Inequities in device/internet access can limit the extent to which patients can engage with telemedicine care and exacerbate health disparities. In this review, we examined existing literature on interventions designed to improve patient telemedicine access by providing digital devices including tablets, smartphones, and computers and/or internet connectivity. Methods In this systematic scoping review, we searched four databases for peer-reviewed studies published 1/1/2000-10/19/2021 that described healthcare interventions that provided patients with devices and/or internet connectivity and reported outcomes related to telemedicine access and/or usage. Data extraction elements included: study population, setting, intervention design, details on device/connectivity provision, and outcomes evaluated. Results Twelve articles reflecting seven unique interventions met inclusion criteria. Ten articles examined telemedicine utilization (83%) and reported improved patient show rates/utilization. Seven articles examined patient satisfaction with the interventions (58%) and reported positive experiences. Fewer articles examined health outcomes (17%; 2/12) though these also demonstrated positive results. Across included studies, study quality was low. There were no controlled trials, and the most rigorously designed studies (n = 4) involved pre/post-intervention assessments. Discussion Findings from this review indicate that providing material technology supports to patients can facilitate telemedicine access, is acceptable to patients and clinicians, and can contribute to improved health outcomes. The low number and quality of existing studies limits the strength of this evidence. Future research should explore interventions that can increase equitable access to telemedicine services. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=183442, identifier, PROSPERO: CRD42020183442.
Collapse
Affiliation(s)
- Joshua Bell
- Department of Pediatrics, University of California, San Francisco, CA, United States
| | - Laura M. Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
- Social Interventions Research and Evaluation Network (SIREN), Center for Health and Community, University of California, San Francisco, CA, United States
| | - Courtney R. Lyles
- Center for Healthcare Policy and Research, University of California, Sacramento, CA, United States
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA, United States
| | - Oanh Kieu Nguyen
- UCSF Center for Vulnerable Populations, University of California, San Francisco, CA, United States
- Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Sara L. Ackerman
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, United States
| | - Emilia H. De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| |
Collapse
|
5
|
Sachs BC, Latham LA, Bateman JR, Cleveland MJ, Espeland MA, Fischer E, Gaussoin SA, Leng I, Rapp SR, Rogers S, Shappell HM, Williams BJ, Yang M, Craft S. Feasibility of Remote Administration of the Uniform Data Set-Version 3 for Assessment of Older Adults With Mild Cognitive Impairment and Alzheimer's Disease. Arch Clin Neuropsychol 2024; 39:635-643. [PMID: 38291734 PMCID: PMC11447737 DOI: 10.1093/arclin/acae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Assess the feasibility and concurrent validity of a modified Uniform Data Set version 3 (UDSv3) for remote administration for individuals with normal cognition (NC), mild cognitive impairment (MCI), and early dementia. METHOD Participants (N = 93) (age: 72.8 [8.9] years; education: 15.6 [2.5] years; 72% female; 84% White) were enrolled from the Wake Forest ADRC. Portions of the UDSv3 cognitive battery, plus the Rey Auditory Verbal Learning Test, were completed by telephone or video within ~6 months of participant's in-person visit. Adaptations for phone administration (e.g., Oral Trails for Trail Making Test [TMT] and Blind Montreal Cognitive Assessment [MoCA] for MoCA) were made. Participants reported on the pleasantness, difficulty, and preference for each modality. Staff provided validity ratings for assessments. Participants' remote data were adjudicated by cognitive experts blinded to the in person-diagnosis (NC [N = 44], MCI [N = 35], Dementia [N = 11], or other [N = 3]). RESULTS Remote assessments were rated as pleasant as in-person assessments by 74% of participants and equally difficult by 75%. Staff validity rating (video = 92%; phone = 87.5%) was good. Concordance between remote/in-person scores was generally moderate to good (r = .3 -.8; p < .05) except for TMT-A/OTMT-A (r = .3; p > .05). Agreement between remote/in-person adjudicated cognitive status was good (k = .61-.64). CONCLUSIONS We found preliminary evidence that older adults, including those with cognitive impairment, can be assessed remotely using a modified UDSv3 research battery. Adjudication of cognitive status that relies on remotely collected data is comparable to classifications using in-person assessments.
Collapse
Affiliation(s)
- Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren A Latham
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James R Bateman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary Jo Cleveland
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark A Espeland
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eric Fischer
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sarah A Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Iris Leng
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samantha Rogers
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heather M Shappell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Benjamin J Williams
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mia Yang
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suzanne Craft
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
6
|
Tsai J, Lampros A, Blue-Howells J. Digital access among a national sample of currently and formerly homeless veterans in 2022. Health Informatics J 2024; 30:14604582241276974. [PMID: 39167203 DOI: 10.1177/14604582241276974] [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: 08/23/2024]
Abstract
Background: Digital technologies are essential for connecting to the Internet and communicating with others. Methods: This study used data from the 2022 Project Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) survey, which surveyed a national sample of 1992 homeless-experienced veterans (HEV) about use of cell phones, smart phones, computers, laptops, and the Internet. Data were analyzed to compare currently and formerly homeless veterans on digital access and to identify characteristics associated with never using the Internet. Results: Over 75% of HEV reported having a cellphone and over 65% reported having a smartphone. Internet use was common among HEV as 74% of currently homeless veterans and 77% of formerly homeless veterans reported using the Internet. Among HEV who used the Internet, over 70% used the Internet at least weekly. There was no significant difference between currently and formerly homeless veterans on their Internet use in the total sample and subsamples of only black and only Hispanic veterans. Overall, HEV who were older, black non-Hispanic, and living in the Southeast were more likely to never use the Internet. Conclusions: These findings highlight the potential for technology-based interventions among HEV, and suggest a digital divide based on age, race, and geography.
Collapse
Affiliation(s)
- Jack Tsai
- National Center on Homelessness among Veterans, U.S. Department of Veterans Affairs, Homeless Programs Office, Washington, DC, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Austin Lampros
- National Center on Homelessness among Veterans, U.S. Department of Veterans Affairs, Homeless Programs Office, Washington, DC, USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, U.S. Department of Veterans Affairs, Homeless Programs Office, Washington, DC, USA
| |
Collapse
|
7
|
Green G, Barragan NC, Abraham J, Chen S, Kuo T. Delivery of Comprehensive Medication Management and Other Clinical Services via Telehealth by Pharmacy Type. J Pharm Pract 2024; 37:625-631. [PMID: 36803060 DOI: 10.1177/08971900231158934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background: The recent coronavirus pandemic accelerated the need to deliver pharmacy-related services remotely. Objective: To describe experiences with providing comprehensive medication management (CMM) and other clinical services via telehealth by pharmacy type, before and during the COVID-19 pandemic. Methods: An online survey of pharmacists, representing 27 pharmacies, was conducted to capture telehealth usage in three pharmacy types: independently owned, integrated into a clinical setting, and retail chain. A sub-analysis was performed to assess if providing CMM services via telehealth helped, resulted in no change, or worsened the care of different patient groups (e.g., those with diabetes, were low-income, aged 65+ years). Results: During the pandemic, telehealth usage among independently owned pharmacies and those integrated into a clinical setting increased, but no change occurred among retail chain pharmacies. This usage increase in the first two pharmacy types occurred despite limited investments in connectivity-related resources to support telehealth services. Pharmacists from both independently owned pharmacies (63%) and those integrated into a clinical setting (89%) reported CMM via telehealth reached patients they would not otherwise have been able to reach during the pandemic. Most pharmacists/pharmacies found telehealth to be a feasible and acceptable method of delivering CMM. Conclusion: Pharmacists and pharmacies are now experienced with and have interest in continuing CMM via telehealth, even as the pandemic recedes. However, investments in telecommunications resources, training support, technical assistance, and continued telehealth reimbursement from health plans are needed to sustain this service delivery model.
Collapse
Affiliation(s)
- Gabrielle Green
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jessica Abraham
- University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA
| | - Steven Chen
- University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Family Medicine, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
- Population Health Program, University of California, Los Angeles Clinical and Translational Science Institute, Los Angeles, CA, USA
| |
Collapse
|
8
|
Wiley K, Johnson J, Coleman C, Olson C, Chuo J, McSwain D. Translating Value Across Telehealth Stakeholders: A Rapid Review of Telehealth Measurement Evidence and a New Policy Framework to Guide Telehealth Researchers. Telemed J E Health 2024; 30:1559-1573. [PMID: 38563764 DOI: 10.1089/tmj.2023.0211] [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: 04/04/2024] Open
Abstract
Introduction: The surge in virtual care during the pandemic was accompanied by an increase in telehealth data of interest to policy stakeholders and other health care decision makers. However, these data often require substantial preprocessing and targeted analyses to be usable. By deliberately evaluating telehealth services with stakeholder perspectives in mind, telehealth researchers can more effectively inform clinical and policy decision making. Objective: To examine existing literature on telehealth measurement and evaluation and develop a new policy-oriented framework to guide telehealth researchers. Materials and Methods: A systematic rapid review of literature on telehealth measurement and evaluation was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The findings were analyzed and applied to the Supporting Pediatric Research on Outcomes and Utilization of Telehealth Evaluation and Measurement (STEM) Framework through the lens of key health care delivery decision makers to create a STEM Policy Framework Results: An initial search yielded 2,324 peer-reviewed articles and gray literatyre from 2012 to 2022, of which 56 met inclusion criteria. These measured and evaluated telehealth access (41.5%), quality (32.1%), cost (15.1%), experience (5.7%), and utilization (5.7%), consistent with the STEM Framework domains, but there was no universal approach. The STEM Policy Framework focuses this literature by describing data measures for each domain from the perspectives of five stakeholders. Conclusions: Literature describing measurement and evaluation approaches for telehealth is limited and not standardized, with few considering policy stakeholder perspectives. With this proposed STEM Policy Framework, we aim to improve this body of literature and support researchers seeking to inform telehealth policy through their work.
Collapse
Affiliation(s)
- Kevin Wiley
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jada Johnson
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christina Coleman
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christina Olson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - John Chuo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David McSwain
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
9
|
Karachaliou E, Douzenis P, Chatzinikolaou F, Pantazis N, Martinaki S, Bali P, Tasios K, Douzenis A. Prisoners' Perceptions and Satisfaction with Telepsychiatry Services in Greece and the Effects of Its Use on the Coercion of Mental Healthcare. Healthcare (Basel) 2024; 12:1044. [PMID: 38786454 PMCID: PMC11121354 DOI: 10.3390/healthcare12101044] [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: 03/31/2024] [Revised: 05/04/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). METHOD The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. RESULTS Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). CONCLUSION According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices.
Collapse
Affiliation(s)
| | - Phoebe Douzenis
- University Hospitals of Derby and Burton, Derby DE22 3NE, UK;
| | - Fotios Chatzinikolaou
- Department of Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Sophia Martinaki
- Department of Social Work, University of West Attica, 12241 Athens, Greece;
| | - Panagiota Bali
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece;
| | | | - Athanasios Douzenis
- Department of Psychiatry, School of Medicine, National & Kapodistrian University of Athens, 15772 Athens, Greece;
| |
Collapse
|
10
|
Slightam C, SooHoo S, Greene L, Zulman DM, Kimerling R. Development and Validation of a Measure to Assess Patient Experiences With Video Care Encounters. JAMA Netw Open 2024; 7:e245277. [PMID: 38578639 PMCID: PMC10998154 DOI: 10.1001/jamanetworkopen.2024.5277] [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] [Received: 09/28/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Importance As video-based care expands in many clinical settings, assessing patient experiences with this care modality will help optimize health care quality, safety, and communication. Objective To develop and assess the psychometric properties of the video visit user experience (VVUE) measure, a patient-reported measure of experiences with video-based technology. Design, Setting, and Participants In this survey study, veterans completed a web-based, mail, or telephone survey about their use of Veterans Healthcare Administration (VHA) virtual care between September 2021 and January 2022. The survey was completed by patients who reported having a VHA video visit on their own device or a VHA-issued device and linked to VHA utilization data for the 6 months following the survey. Data analysis was performed from March 2022 to February 2023. Main Outcomes and Measures The survey included 19 items about experiences with video visits that were rated using a 4-point Likert-type scale (strongly disagree to strongly agree). First, an exploratory factor analysis was conducted to determine the factor structure and parsimonious set of items, using the McDonald Omega test to assess internal consistency reliability. Then, a confirmatory factor analysis was conducted to test structural validity, and bivariate correlations between VVUE and VHA health care engagement were calculated to test concurrent validity. Finally, predictive validity was assessed using logistic regression to determine whether VVUE was associated with future VHA video visit use. Results Among 1887 respondents included in the analyses, 83.2% (95% CI, 81.5%-84.8%) were male, 41.0% (95% CI, 38.8%-43.1%) were aged 65 years or older, and the majority had multiple chronic medical and mental health conditions. The exploratory factor analysis identified a 10-item single-factor VVUE measure (including questions about satisfaction, user-centeredness, technical quality, usefulness, and appropriateness), explaining 96% of the total variance, with acceptable internal consistency reliability (ω = 0.95). The confirmatory factor analysis results confirmed a single-factor solution (standardized root mean squared residual = 0.04). VVUE was positively associated with VHA health care engagement (ρ = 0.47; P < .001). Predictive validity models demonstrated that higher VVUE measure scores were associated with future use of video visits, where each 1-point increase on VVUE was associated with greater likelihood of having a video visit in subsequent 6 months (adjusted odds ratio, 1.04; 95% CI, 1.02-1.06). Conclusions and Relevance The findings of this study of veterans using video visits suggest that a brief measure is valid to capture veterans' experiences receiving VHA virtual care.
Collapse
Affiliation(s)
- Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Sonya SooHoo
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Donna M. Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Rachel Kimerling
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| |
Collapse
|
11
|
Alfaro AJ, Greene L, Van Campen J, Zulman DM, Gould CE, Blonigen DM. Patterns and predictors of mental health service use among older veterans with alcohol use disorder who received a video-enabled tablet. Aging Ment Health 2024; 28:604-610. [PMID: 37723897 DOI: 10.1080/13607863.2023.2253448] [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: 02/27/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
Objectives: Video-based telehealth may expand access to mental health services among older veterans with alcohol use disorder (AUD). We examined the modalities through which mental health services were rendered, and predictors of video visits before and after video-enabled tablet receipt from the Veterans Health Administration. Method: 11,210 veterans aged 60 or older with a diagnosis of AUD who received a tablet between 1 April 2020 and 25 October 2021 were identified. The electronic health record was used to characterized encounters by modality of mental health care delivery in the six months pre/post tablet receipt. Logistic regression examined predictors of a video visit for mental health. Results: Phone was the most common modality; however, the proportion of video encounters increased from 8.7% to 26.2% after tablet receipt. Individuals who were older, male, and had more physical health conditions, were less likely to have a video visit. Individuals who were married, resided in urban areas, had a history of housing instability, and had more mental health conditions, were more likely to have a video visit. Conclusion: Video-enabled tablets may help older adults with AUD overcome access barriers to mental health services, although targeted support for certain groups may be necessary.
Collapse
Affiliation(s)
- Ana J Alfaro
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Liberty Greene
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - James Van Campen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christine E Gould
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel M Blonigen
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, CA, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| |
Collapse
|
12
|
Wells SY, Knopp K, Ponzini GT, Kehle-Forbes SM, Gomez RM, Morland LA, Dedert E, Jackson GL, Grubbs KM. Examining veterans' preferences for how to deliver couples-based treatments for posttraumatic stress disorder: Home-based telehealth or in-person? Psychol Serv 2024:2024-56635-001. [PMID: 38407069 PMCID: PMC11345872 DOI: 10.1037/ser0000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Understanding the modality by which veterans prefer to receive couples-based posttraumatic stress disorder (PTSD) treatment (i.e., home-based telehealth, in-person) may increase engagement in PTSD psychotherapy. This study aimed to understand veterans' preferred modality for couples-based PTSD treatments, individual factors associated with preference, and reasons for their preference. One hundred sixty-six veterans completed a baseline assessment as part of a clinical trial. Measures included a closed- and open-ended treatment preference questionnaire, as well as demographics, clinical symptoms, functioning, and relational measures, such as relationship satisfaction. Descriptive statistics and correlations examined factors associated with preference. An open-ended question querying veterans' reasons for their preferred modality was coded to identify themes. Though veterans as a group had no clear modality preference (51% preferring home-based telehealth and 49% preferring in-person treatment), veterans consistently expressed high levels of preference strength in the modality they chose. The presence of children in the home was associated with stronger preference for home-based telehealth. Veterans who preferred in-person care found it to be more credible and had more positive treatment expectancies. Veterans who preferred home-based telehealth believed it was flexible and increased access to care. For both preference groups, veterans' preferred modality was viewed as facilitating interpersonal relations and being more comfortable than the alternative modality. Veterans expressed strong preference for receiving their desired treatment modality for couples-based PTSD treatment. Results suggest that it is important to offer multiple treatment delivery options in couples-based PTSD treatment and matching couples to their preferred modality supports individualized, patient-centered care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Stephanie Y Wells
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System
| | - Gabriella T Ponzini
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
| | - Shannon M Kehle-Forbes
- Center for Care Deliver and Outcomes Research, Minneapolis Veterans Affairs Healthcare System
| | | | | | - Eric Dedert
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center
| | - George L Jackson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
| | | |
Collapse
|
13
|
Lum J, Sadej I, Pizer SD, Yee C. Telehealth Access and Substitution in the VHA. J Gen Intern Med 2024; 39:44-52. [PMID: 38393611 PMCID: PMC10937886 DOI: 10.1007/s11606-023-08465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/06/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND In response to COVID-19, the Veterans Health Administration (VHA) expanded telehealth availability, allowing veterans to receive care at home. We explore the extent of substitution of telehealth for in-person care among medical centers (facilities), providers, and patients. We explore the extent to which patient preferences drive telehealth utilization, and compare access to care (as measured by waiting times) for telehealth and in-person visits. METHODS We use VHA electronic health records to identify scheduled outpatient mental health (MH) appointments from January 2019 through February 2023 focusing on care delivered by social workers, psychologists, and psychiatrists. For each quarter, we compute the proportion of completed appointments that were delivered via phone or video by each facility, provider, and patient and show the changes in these proportions before, during, and after the onset of COVID-19. To explore patient preferences, we match providers of patients with high rates of telehealth utilization and examine the extent to which those providers deliver in-person care. To examine access to care, we compute waiting times for in-person, video, and phone new patient appointments. We investigate differences between urban and rural patients, and patients of different ages. KEY RESULTS Telehealth for MH grew dramatically in the VHA after the onset of COVID-19. While some facilities provided more telehealth than others, all facilities (as of early 2023) provided some telehealth MH services. Approximately 86% of individual providers provided telehealth, with 27% scheduling MH appointments almost exclusively as telehealth appointments and 59% providing a mix. Patients exhibited more polarization, with 36% scheduling only in-person visits for almost all their MH visits and 56% of them scheduling exclusively telehealth, and only 8% of them utilizing a mix of modalities. Of those who exclusively received telehealth care, a majority of them utilized video (80%) over phone (20%). Take-up of MH among younger patients was higher relative to older patients. Urban patients used telehealth more than rural patients. Patient preferences rather than provider preferences drove utilization of patients who almost exclusively utilized telehealth. Between April 2021 and February 2023, the average difference in waiting time for in-person and video appointments was less than 1 day, with comparable appointment volumes, suggesting that the supply of and demand for in-person and video were not different enough to merit waiting longer. Telehealth was chosen over in-person more among urban and younger patients, as older and rural patients exhibited higher willingness to wait for in-person over video appointments. By contrast, appointment volumes and waiting times for phone appointments were lower across all groups, suggesting that phone may not be as substitutable for in-person visits in MH. CONCLUSIONS We find that the VHA has made telehealth widely available, providing access to many veterans. While telehealth utilization has increased, face-to-face care persists for MH services, suggesting that one modality may not serve all purposes and preferences for care. Patient preferences drive the modality decision among those who exclusively use MH care via telehealth. For those who persist in mostly utilizing in-person care, there may be various factors influencing those preferences such as issues with limited internet connectivity, language barriers, and digital literacy, especially for older and rural patients who utilize in-person care more than those who are younger and more urban. Further investigation is required to investigate the optimal mix of modalities which may allow for potential increases in patient satisfaction, quality of care, and clinic efficiency.
Collapse
Affiliation(s)
- Jessica Lum
- VA Boston Healthcare System, Boston, MA, USA.
| | - Izabela Sadej
- VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
| | - Steven D Pizer
- VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
| | - Christine Yee
- VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA
| |
Collapse
|
14
|
Heyworth L, Shah N, Galpin K. 20 Years of Telehealth in the Veterans Health Administration: Taking Stock of Our Past and Charting Our Future. J Gen Intern Med 2024; 39:5-8. [PMID: 38378981 PMCID: PMC10937874 DOI: 10.1007/s11606-024-08617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA.
| | - Nilesh Shah
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA
| | - Kevin Galpin
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, 810 Vermont Avenue, Washington, NW, DC 20420, USA
| |
Collapse
|
15
|
Kinney RL, Copeland LA, Tsai J, Abbott AA, Wallace K, Walker LA, Weber J, Katsos S, McInnes DK. A mixed-methods study of VA video connect utilization among veterans with diabetes experiencing housing instability during the pandemic. Digit Health 2024; 10:20552076241282629. [PMID: 39381825 PMCID: PMC11459566 DOI: 10.1177/20552076241282629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/20/2024] [Indexed: 10/10/2024] Open
Abstract
Introduction Prior to the coronavirus disease-2019 (COVID-19) pandemic the U.S. Department of Veterans Affairs (VA) had the largest telehealth program in the United States. The pandemic motivated providers within the VA to expand telehealth in effort to reduce disrupted care while mitigating risks. The pandemic provides a rare opportunity to examine how to better engage veterans experiencing housing instability (HI) in telehealth diabetes care. Methods Mixed methods design to examine VA video connect (VVC) diabetes care utilization among veterans experiencing HI from March 1, 2019, to March 1, 2022, combining multivariable regression analyses of VA administrative data with semi-structured interviews. Study aims included: (a) examine changes in diabetes care delivery mode over the peri-pandemic timeframe; (b) identify sociodemographic and clinical characteristics associated with VVC care among veterans with HI; and (c) understand the facilitators and barriers of VVC utilization. Results Totally, 5904 veterans were eligible for study analysis. Veterans who are female (OR: 1.63; 95% CI: 1.3, 2.0; p < 0.0001), self-identify as Hispanic (OR: 1.44; 95% CI: 1.1, 1.9; p = 0.02), are married (OR: 1.39; 95% CI: 1.2, 1.6; p < 0.0001), and are in VA priority group 1 (OR: 1.21; 95% CI 1.1, 1.4; p = 0.004) were more likely to use VVC the pandemic. Veterans of older age (OR: 0.97; 95% CI: 0.97, 0.98; p < .0001) and rural dwelling (OR: 0.85; 95% CI: 0.7, 1.2; p = 0.04), were less likely to use VVC. Thirteen VA providers and 15 veterans were interviewed. Veterans reported that decisions about using VVC were driven by limitations in in-person care availability, safety, and convenience. Discussion Telehealth played an important role in providing veterans with HI access to diabetes care during the pandemic. Future interventions should seek to increase education and technology in effort to increase VVC uptake into routine diabetes care to ensure veterans' optimal and equitable access.
Collapse
Affiliation(s)
- Rebecca L Kinney
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC, USA
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Jack Tsai
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Alice A Abbott
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Kate Wallace
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Lorrie A Walker
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Jillian Weber
- VHA Homeless Programs Office, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Shara Katsos
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Donald K McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
16
|
Bjork JM, Sadicario JS, Jahan NF, Curiel E, Thumma L, Reisweber J. Virtual Hybrid Versus In-Person Administration of Transcending Self Therapy for Veterans with Substance Use Disorders. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241255437. [PMID: 38803614 PMCID: PMC11129570 DOI: 10.1177/29768357241255437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
Objectives Veterans with substance use disorder (SUD) can show high severity and are at high risk of relapse due to trauma histories and other comorbid conditions. However, evidence-based SUD therapies may not be available to many veterans due to geographic or transportation constraints. Telehealth approaches have shown promise to improve access to different SUD therapy formats but have not been well-studied in open (rolling-admission) group therapy of in-person patients as administered by a single on-screen therapist. Methods Social distancing required by the COVID-19 pandemic forced the transition of delivery of Transcending Self Therapy (TST) from an in-person therapist to a single remote (on-screen) therapist. In this virtual model, veterans continued to receive TST but the therapist was off site and provided therapy to veterans who were together in the same room during a 28 day residential Veterans Affairs treatment program. In a program evaluation, we compared their changes in quality of life (QoL), treatment satisfaction ratings and group therapy treatment outcomes with those of Veterans who received TST from an in-person therapist. Results In both groups, there was a significant increase in QoL Inventory scores from baseline to post-treatment, with no difference in improvement between treatment modalities (i.e., in-person group vs telehealth-delivered group). Veterans professed knowledge of therapy-driven skills at the end of treatment in both groups and overwhelmingly rated TST as helpful and understandable. Conclusions These data extend previous findings of patient acceptability of remotely-delivered SUD treatment, here with a remote therapist administering open group therapy, as evidenced by improvement in QoL and positive patient feedback about the remote intervention.
Collapse
Affiliation(s)
- James M. Bjork
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Insitute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaclyn S. Sadicario
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nabila F. Jahan
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Espn Curiel
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
| | - Lillia Thumma
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Insitute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | | |
Collapse
|
17
|
Newmark RL, Allison TA, Smith AK, Perissinotto CM, Tha SH, Kotwal AA. The Role of Digital Technologies in Facilitating Psychosocial Resilience to Sudden Social Isolation Among Older Adults: Lessons Learned from the COVID-19 Pandemic. J Appl Gerontol 2023; 42:2348-2359. [PMID: 37536316 PMCID: PMC11056268 DOI: 10.1177/07334648231190228] [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: 08/05/2023] Open
Abstract
This study investigated how older adults adopted new technologies in response to sudden social isolation caused by the COVID-19 pandemic and how this adoption was related to their long-term psychosocial well-being. The study involved a 6-month longitudinal survey of 151 older adults and two phone-based focus groups, which informed a semi-structured interview guide and purposive sampling of diverse community-dwelling older adults. We then conducted twenty qualitative interviews and thematic analysis and mapped themes to 6-month quantitative trajectories of psychosocial health. Three themes emerged: first, most participants adopted multiple technologies to maintain social connection and psychosocial well-being. Second, participants felt left behind by certain technologies due to complicated systems or ageist societal norms. Third, pandemic-related community resources promoted technology independence among isolated older adults and those wanting to avoid "burdening" family. Results challenge ageist stereotypes and provide a framework for encouraging access and comfort with multiple technologies to adapt to sudden health crises or disruptive events.
Collapse
Affiliation(s)
- Rebecca L Newmark
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carla M Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Soe Han Tha
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| |
Collapse
|
18
|
Cigolle C, Phillips K. Telepharmacy Model of Care. Clin Ther 2023; 45:935-940. [PMID: 37775470 DOI: 10.1016/j.clinthera.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE This study assessed the feasibility of the Telepharmacy Model of Care, a medication review and deprescribing model for use in older adults, with innovations in cognitive and functional evaluation, in telemedicine delivery, and in the use of a pharmacy technician. METHODS This retrospective medical record review/abstraction analyzed (from March 1, 2022, to December 31, 2022) data from US veteran participants in a pilot implementation (April 13, 2021, to May 20, 2022) of the Telepharmacy Model of Care at the Veterans Affairs Ann Arbor Healthcare System (Ann Arbor, Michigan). The project team assessed and made recommendations about multiple factors in medication management: medication list accuracy; safety of medications and their combinations; older adults' cognition, health literacy, and physical abilities and impairments in self-managing medications; and caregivers' ability to compensate for those impairments. FINDINGS The pilot included 60 US veterans (mean age, 75 years [range, 59-93 years]; 97% were men). Overall, participants were successful in using telemedicine (98%). Encounters required 30 to 45 minutes for the visit and 20 minutes for follow-up and documentation (P = 0.14 pharmacist vs pharmacy technician). The median number of medications per patient was 18. A total of 57% of patients had four or more medication-related discrepancies; fewer patients experienced medication-adherence problems, drug-drug interactions, problematic medication combinations, and untreated/undertreated conditions. Using the Safe Medication Algorithm for Older Adults tool, 35% were identified as taking a Red Flag medication (contraindicated in older adults), and 74%, a High Risk medication (eg, an anticoagulant). A total of 37% had cognitive and health literacy impairments, and 45%, physical impairments, interfering with the ability to self-manage medications. Recommendations on deprescribing were made in 98% of patients. IMPLICATION The telemedicine-based and pharmacist/pharmacy technician-delivered model was a feasible method for addressing comprehensive medication review and deprescribing in these cognitively and functionally impaired US veterans.
Collapse
Affiliation(s)
- Christine Cigolle
- Veterans Affairs Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA; Division of Geriatric and Palliative Medicine, Department of Internal Medicine.
| | - Kristin Phillips
- Veterans Affairs Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Ann Arbor, Michigan
| |
Collapse
|
19
|
Gately ME, Metcalf EE, Waller DE, McLaren JE, Chamberlin ES, Hawley CE, Venegas M, Dryden EM, O’Connor MK, Moo LR. Caregiver Support Role in Occupational Therapy Video Telehealth: A Scoping Review. TOPICS IN GERIATRIC REHABILITATION 2023; 39:253-265. [PMID: 37901356 PMCID: PMC10601380 DOI: 10.1097/tgr.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Caregiver involvement may facilitate patient participation in occupational therapy (OT) video telehealth. However, little is known about the extent to which caregivers participate and what they do. This scoping review aims to, 1) describe the caregiver role supporting patient participation in OT video telehealth, and, 2) identify barriers and facilitators to caregiver involvement. Findings reveal caregiver involvement in a range of OT evaluation and intervention processes, with details on what caregivers did overall lacking. Barriers and facilitators are also described. This study underscores the need for clear and robust descriptions of caregiver participation to increase best practices in video telehealth.
Collapse
Affiliation(s)
- Megan E. Gately
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Boston University School of Medicine, Department of Medicine, Division of Geriatrics, Boston, MA, USA
| | - Emily E. Metcalf
- VA Palo Alto Health Care System, National Center for PTSD, Dissemination and Training Division, Menlo Park, CA, USA
| | - Dylan E. Waller
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Jaye E. McLaren
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
| | - Elizabeth S. Chamberlin
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- VA Bedford Health Care System, VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), Bedford, MA, USA
| | - Chelsea E. Hawley
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Boston University School of Medicine, Department of Medicine, Division of Geriatrics, Boston, MA, USA
| | - Maria Venegas
- Boston University School of Medicine, Department of Medicine, Division of Geriatrics, Boston, MA, USA
- VA Bedford Health Care System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Eileen M. Dryden
- VA Bedford Health Care System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Maureen K. O’Connor
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Boston University School of Medicine, Neurology Department, Boston, MA, USA
| | - Lauren R. Moo
- VA Bedford Health Care System, New England Geriatric Research Education and Clinical Center (GRECC), Bedford, MA, USA
- Massachusetts General Hospital, Cognitive Behavioral Neurology Unit, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
20
|
Chang CH, Lien WC, Chiu TP, Yang TH, Wei CC, Kuo YL, Yeh CH, Liu B, Chen PJ, Lin YC. A novel smart somatosensory wearable assistive device for older adults' home rehabilitation during the COVID-19 pandemic. Front Public Health 2023; 11:1026662. [PMID: 37790724 PMCID: PMC10544986 DOI: 10.3389/fpubh.2023.1026662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Background Due to the Coronavirus disease 19 (COVID-19) related social distancing measures and health service suspension, physical activity has declined, leading to increased falling risk and disability, and consequently, compromising the older adult health. How to improve the quality of older adult life has become a crucial social issue. Objective In traditional rehabilitation, manual and repetitive muscle training cannot identify the patient's rehabilitation effect, and increasing the willingness to use it is not easy. Therefore, based on the usability perspective, this study aims to develop a novel smart somatosensory wearable assistive device (called SSWAD) combined with wireless surface electromyography (sEMG) and exergame software and hardware technology. The older adult can do knee extension, ankle dorsiflexion, and ankle plantar flexion rehabilitation exercises at home. Meanwhile, sEMG values can be digitally recorded to assist physicians (or professionals) in judgment, treatment, or diagnosis. Methods To explore whether the novel SSWAD could improve the older adult willingness to use and motivation for home rehabilitation, 25 frail older adult (12 males and 13 females with an average age of 69.3) perform the rehabilitation program with the SSWAD, followed by completing the system usability scale (SUS) questionnaire and the semi-structured interview for the quantitative and qualitative analyses. In addition, we further investigate whether the factor of gender or prior rehabilitation experience would affect the home rehabilitation willingness or not. Results According to the overall SUS score, the novel SSWAD has good overall usability performance (77.70), meaning that the SSWAD makes older adult feel interested and improves their willingness for continuous rehabilitation at home. In addition, the individual item scores of SUS are shown that female older adult with prior rehabilitation experience perform better in "Learnability" (t = 2.35, p = 0.03) and "Confidence" (t = -3.24, p = 0.01). On the contrary, male older adult without rehabilitation experience are more willing to adopt new technologies (t = -2.73, p = 0.02), and perform better in "Learnability" (t = 2.18, p = 0.04) and "Confidence" (t = -3.75, p < 0.001) with the SSWAD. In addition, the result of the semi-structured interview shows that the operation of the SSWAD is highly flexible, thus reducing older adult burden during the rehabilitation exercise and using them long-term. Conclusion This novel SSWAD receives consistently positive feedback regardless of the gender or prior rehabilitation experience of elders. The SSWAD could be used as a novel way of home rehabilitation for elders, especially during the COVID-19 pandemic. Older adult can do rehabilitation exercises at home, and physicians could make proper judgments or adjust suitable treatments online according to the sEMG data, which older adult can know their rehabilitation progress at the same time. Most importantly, older adult do not have to go to the hospital every time for rehabilitation, which significantly reduces time and the risk of infection.
Collapse
Affiliation(s)
- Chien-Hsiang Chang
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tseng-Ping Chiu
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Hua Yang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Chun Wei
- Department of Digital Multimedia Design, National Taipei University of Business, Taipei, Taiwan
| | - Yu-Liang Kuo
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Hsing Yeh
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Bo Liu
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Pin-Jun Chen
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Yang-Cheng Lin
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
21
|
Shoemaker HE, Thorpe A, Stevens V, Butler JM, Drews FA, Burpo N, Scherer LD, Fagerlin A. Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study. JMIR Form Res 2023; 7:e42217. [PMID: 37527547 PMCID: PMC10494868 DOI: 10.2196/42217] [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: 08/30/2022] [Revised: 03/15/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. OBJECTIVE This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. METHODS A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. RESULTS There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). CONCLUSIONS Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all.
Collapse
Affiliation(s)
- Holly E Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Vanessa Stevens
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jorie M Butler
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Geriatrics Research, Education, and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Psychology, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
| | - Nicole Burpo
- Research Operations, American Heart Association, Dallas, TX, United States
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, CO, United States
- VA Denver Center for Innovation, Denver, CO, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
| |
Collapse
|
22
|
Ginzberg SP, Soegaard Ballester JM, Wirtalla CJ, Pryma DA, Mandel SJ, Kelz RR, Wachtel H. Insurance-Based Disparities in Guideline-Concordant Thyroid Cancer Care in the Era of De-escalation. J Surg Res 2023; 289:211-219. [PMID: 37141704 PMCID: PMC10229451 DOI: 10.1016/j.jss.2023.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Prior studies have demonstrated insurance-based disparities in the treatment of well-differentiated thyroid cancer. However, it remains unclear whether these disparities have persisted in the era of the 2015 American Thyroid Association (ATA) management guidelines. The goal of this study was to assess whether insurance type is associated with the receipt of guideline-concordant and timely thyroid cancer treatment in a modern cohort. METHODS Patients diagnosed with well-differentiated thyroid cancer between 2016 and 2019 were identified from the National Cancer Database. Appropriateness of surgical and radioactive iodine treatment (RAI) was determined based on the 2015 ATA guidelines. Multivariable logistic regression and Cox proportional hazard regression analyses, stratified at age 65, were used to evaluate the associations between insurance type and appropriateness and timeliness of the treatment. RESULTS 125,827 patients were included (private = 71%, Medicare = 19%, Medicaid = 10%). Compared to privately insured patients, patients with Medicaid more frequently presented with tumors >4 cm in size (11% versus 8%, P < 0.001) and regional metastases (29% versus 27%, P < 0.001). However, patients with Medicaid were also less likely to undergo appropriate surgical treatment (odds ratio 0.69, P < 0.001), less likely to undergo surgery within 90 d of diagnosis (hazard ratio 0.80, P < 0.001), and more likely to be undertreated with RAI (odds ratio 1.29, P < 0.001). There were no differences in the likelihood of guideline-concordant surgical or medical treatment by insurance type in patients ≥65 y old. CONCLUSIONS In the era of the 2015 ATA guidelines, patients with Medicaid remain less likely to receive guideline-concordant, timely surgery and more likely to be undertreated with RAI compared to privately insured patients.
Collapse
Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Chris J Wirtalla
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel A Pryma
- Department of Radiology, Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan J Mandel
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
23
|
Spiess ST, Gardner E, Turner C, Galt A, Fortenberry K, Ho T, Knox J, Ose D. We Cannot Put This Genie Back in the Bottle: Qualitative Interview Study Among Family Medicine Providers About Their Experiences With Virtual Visits During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e43877. [PMID: 37651162 PMCID: PMC10502598 DOI: 10.2196/43877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND When a genie is freed from its bottle, things cannot be restored to the way they were before. At the beginning of the global COVID-19 pandemic, health care systems adjusted how they delivered care overnight. Primary care practices switched from seeing patients in person to virtual care applications, including video and phone visits, e-visits, e-consults, and messaging with clinicians. Prior to the pandemic, these applications were not as widely used, but discussions around their advantages and disadvantages in some settings were being explored. Emergency regulatory changes spurred by the pandemic freed this virtual care "genie" from its bottle. Wide-scale adoption of virtual care in family medicine has much potential, as primary care services are often a patient's first point of contact with the health care system. OBJECTIVE This study aims to analyze family medicine providers' experiences using virtual visits during the pandemic, perceived outcomes of the shift to virtual visits, and discusses its implications for the future of family medicine. METHODS This qualitative study took place at 3 academic primary care clinics between June and December 2020. Data were collected through one-on-one Zoom (version 5.2.1) interviews with family medicine clinical faculty who experienced the rapid transition of in-person visits to mostly "virtual" visits. The interviews were recorded, deidentified, and transcribed. We adopted a constructivist approach to qualitative content analysis to evaluate the results. RESULTS In total, 25 participants were eligible, and 20 individuals participated in this study (80% participation rate). The mean age was 43.4 years, and 85% (17/20) of the participants were female. We identified 3 main themes: the care process, patient engagement, and team-based care. CONCLUSIONS This study highlights the transition from in-person to virtual visits during the pandemic from the perspective of family medicine providers. Generally, family medicine providers' perceptions of the shift to virtual visits were positive, especially regarding team-based care. Challenges involved virtual inhibition, particularly for providers. Providers described ways they integrated virtual care with aspects of in-person care, creating a hybrid environment. The genie is out of the bottle-things will not be the same-but family medicine now has the opportunity to evolve.
Collapse
Affiliation(s)
- Saskia T Spiess
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Elena Gardner
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Cindy Turner
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Annie Galt
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Katherine Fortenberry
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Tiffany Ho
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Jordan Knox
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Dominik Ose
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| |
Collapse
|
24
|
Taylor E, Patel D, Marconi V, Whitmire A, Hansen N, Kershaw T, Fiellin D, Lauckner C. Pilot Trial of a Smartphone-Based Intervention to Reduce Alcohol Consumption among Veterans with HIV. MILITARY BEHAVIORAL HEALTH 2023; 11:66-77. [PMID: 38405355 PMCID: PMC10888529 DOI: 10.1080/21635781.2023.2221465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Veterans engage in disproportionate levels of alcohol use, which can impact treatment outcomes among veterans with HIV. The TRAC (Tracking and Reducing Alcohol Consumption) intervention, which combines smartphones, mobile breathalyzers, and motivational interviewing (MI), was developed to help reduce alcohol use among this population. This study reports results of an 8-week pilot trial of TRAC among veterans with HIV (N = 10). Participants attended weekly MI sessions conducted via videoconferencing or phone and completed twice-daily self-monitoring of alcohol consumption using breathalyzers and surveys. They also completed pre- and post-intervention questionnaires and a qualitative interview. Analyses explored adherence to self-monitoring tasks, perceptions of the intervention, and preliminary effects of TRAC on alcohol use and readiness to change drinking behavior. Participants completed 76% of breathalyzer readings and 73% of surveys and completed more daytime than evening monitoring tasks. AUDIT hazardous drinking scores significantly decreased between baseline and post-test. Qualitative interviews revealed positive attitudes toward the technologies and MI sessions. Overall, this pilot demonstrated that the TRAC intervention has potential to reduce alcohol use among veterans with HIV, though additional effort is needed to improve adherence to mobile monitoring. Results were used to refine the intervention in preparation for a randomized controlled trial.
Collapse
Affiliation(s)
- Erica Taylor
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Darshti Patel
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Vincent Marconi
- Atlanta VAMC, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David Fiellin
- Program in Addiction Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Medicine, Yale School of Public Health, New Haven, Connecticut, USA
| | - Carolyn Lauckner
- Center for Health Equity Transformation, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| |
Collapse
|
25
|
Haimi M. The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review. BMC Med Inform Decis Mak 2023; 23:95. [PMID: 37193960 PMCID: PMC10186294 DOI: 10.1186/s12911-023-02194-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Telemedicine has become more convenient and advantageous due to the rapid development of the internet and telecommunications. A growing number of patients are turning to telemedicine for health consultations and health-related information. Telemedicine can increase access to medical care by removing geographical and other barriers. In most nations, the COVID-19 pandemic imposed social isolation. This has accelerated the transition to telemedicine, which has become the most commonly utilized method of outpatient care in many places. Telehealth can assist resolve gaps in access to healthcare services and health outcomes, in addition to its primary function of boosting accessibility to remote health services. However, as the benefits of telemedicine become more apparent, so do the limitations of serving vulnerable groups. Some populations may lack digital literacy or internet access. Homeless persons, the elderly, and people with inadequate language skills are also affected. In such circumstances, telemedicine has the potential to exacerbate health inequities. AIM AND METHODS In this narrative review (using the PubMed and Google scholar database), the different benefits and drawbacks of telemedicine are discussed, both globally and in Israel, with particular focus paid to special populations and to the telehealth usage during the Covid-19 period. FINDINGS The contradiction and paradox of using telemedicine to address health inequities yet sometimes making them worse is highlighted. The effectiveness of telemedicine in bridging access to healthcare inequities is explored along with a number of potential solutions. CONCLUSIONS Policy makers should identify barriers among special populations to using telemedicine. They should initiate interventions to overcome these barriers, while adapting them to the needs of these groups.
Collapse
Affiliation(s)
- Motti Haimi
- Clalit Health Services, Tel Aviv, Israel.
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel.
- Health Disparities Working Group, International Society for Telemedicine and E-Health (ISfTeH), Basel, Switzerland.
| |
Collapse
|
26
|
Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
Collapse
Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| |
Collapse
|
27
|
Wiener AA, Neuman HB. Improving shared decision making in virtual breast cancer surgery consultations. Am J Surg 2023; 225:645-649. [PMID: 38577977 PMCID: PMC9579141 DOI: 10.1016/j.amjsurg.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
With the COVID19 pandemic, use of telehealth has expanded rapidly in subspecialties with limited prior telehealth experience. While telehealth offers many opportunities to improve patient convenience, access, and comfort, the virtual platform poses unique challenges for shared decision making. In this review article, we describe what occurs within a standard in-person breast surgery consult and propose a model for an ideal virtual breast surgery consult, including strategies to foster patient engagement and shared decision making. Our model incorporates pre-visit preparation, deliberate pauses, and targeted engagement as ways to encourage patients to integrate information and actively participate in treatment decisions. Intentional strategies such as these must be adopted to improve shared decision making on the virtual platform.
Collapse
Affiliation(s)
- Alyssa A Wiener
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| |
Collapse
|
28
|
Ferguson JM, Wray CM, Jacobs J, Greene L, Wagner TH, Odden MC, Freese J, Van Campen J, Asch SM, Heyworth L, Zulman DM. Variation in initial and continued use of primary, mental health, and specialty video care among Veterans. Health Serv Res 2023; 58:402-414. [PMID: 36345235 PMCID: PMC10012228 DOI: 10.1111/1475-6773.14098] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify which Veteran populations are routinely accessing video-based care. DATA SOURCES AND STUDY SETTING National, secondary administrative data from electronic health records at the Veterans Health Administration (VHA), 2019-2021. STUDY DESIGN This retrospective cohort analysis identified patient characteristics associated with the odds of using any video care; and then, among those with a previous video visit, the annual rate of video care utilization. Video care use was reported overall and stratified into care type (e.g., primary, mental health, and specialty video care) between March 10, 2020 and February 28, 2021. DATA COLLECTION Veterans active in VA health care (>1 outpatient visit between March 11, 2019 and March 10, 2020) were included in this study. PRINCIPAL FINDINGS Among 5,389,129 Veterans in this evaluation, approximately 27.4% of Veterans had at least one video visit. We found differences in video care utilization by type of video care: 14.7% of Veterans had at least one primary care video visit, 10.6% a mental health video visit, and 5.9% a specialty care video visit. Veterans with a history of housing instability had a higher overall rate of video care driven by their higher usage of video for mental health care compared with Veterans in stable housing. American Indian/Alaska Native Veterans had reduced odds of video visits, yet similar rates of video care when compared to White Veterans. Low-income Veterans had lower odds of using primary video care yet slightly elevated rates of primary video care among those with at least one video visit when compared to Veterans enrolled at VA without special considerations. CONCLUSIONS Variation in video care utilization patterns by type of care identified Veteran populations that might require greater resources and support to initiate and sustain video care use. Our data support service specific outreach to homeless and American Indian/Alaska Native Veterans.
Collapse
Affiliation(s)
- Jacqueline M. Ferguson
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Charlie M. Wray
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Section of Hospital MedicineVeterans Affairs San Francisco Health Care SystemSan FranciscoCaliforniaUSA
| | - Josephine Jacobs
- Health Economics Resource CenterVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Liberty Greene
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Todd H. Wagner
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Health Economics Resource CenterVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Michelle C. Odden
- Geriatric Research, Education, and Clinical CenterVeterans Affairs Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Jeremy Freese
- Department of SociologyStanford UniversityStanfordCaliforniaUSA
| | - James Van Campen
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Steven M. Asch
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Leonie Heyworth
- Office of Connected Care/TelehealthDepartment of Veterans Affairs Central OfficeWashingtonDCUSA
- Department of MedicineUniversity of California, San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Donna M. Zulman
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| |
Collapse
|
29
|
Siddiqui S, Farr E, Dusto N, Chen L, Kocherginsky M, Skelton F, Verduzco-Gutierrez M, Lee S. Telemedicine Use Among Physiatrists During the Early Phase of the COVID-19 Pandemic and Potential for Future Use. Telemed J E Health 2023; 29:242-252. [PMID: 35833791 PMCID: PMC10081713 DOI: 10.1089/tmj.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/20/2022] [Accepted: 03/28/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: With the coronavirus disease 2019 (COVID-19) pandemic causing the need for social distancing, telemedicine saw a significant increase in use to provide routine medical care. As a field, physiatry had already been implementing telemedicine prior to the pandemic. In this study, we characterized the use of telemedicine among physiatrists during the early phase of the COVID-19 pandemic to understand the barriers and facilitators to implementing telemedicine use in the field of physiatry in the future. Methods: Online survey of a cross-sectional sample of physiatrists. Analysis was conducted using logistic regression. Results: One hundred seventy one (n = 171) participants completed the survey. Before the pandemic, only 17.5% of respondents used telemedicine. In the logistic regression, physicians who used a hospital-provided platform were more likely to use telemedicine in the future compared with those who used their own secure platform, conducted a phone visit, and used a non-secure platform or other platforms. The three most popular barriers identified were "inability to complete the physical examination," "patients lack of access to technology," and "patients lack of familiarity with the technology." Discussion: Focus on education on telemedicine functional examination strategies and technology strategies for patients and providers (including addressing the digital divide and hospital-provided secure platforms) are potential targets of implementation strategies for greater telemedicine uptake for physiatrists in the future.
Collapse
Affiliation(s)
- Sameer Siddiqui
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth System, Cleveland, Ohio, USA
| | - Ellen Farr
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
| | - Nathaniel Dusto
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California, USA
| | - Liqi Chen
- Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Masha Kocherginsky
- Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Felicia Skelton
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - Sujin Lee
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California, USA
- Rehabilitation Institute, MemorialCare Long Beach Medical Center, Long Beach, California, USA
| |
Collapse
|
30
|
Garvin LA, Greenan MA, Edelman EJ, Slightam C, McInnes DK, Zulman DM. Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-12. [PMID: 36573210 PMCID: PMC9769469 DOI: 10.1007/s41347-022-00290-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Telehealth offers promising opportunities, but also challenges, for veterans experiencing homelessness - during the COVID-19 pandemic and beyond. Recent research found low utilization of clinical video visits among homeless veterans receiving a VA tablet, and having a substance use disorder (SUD) further reduced visit likelihood. Hence, this study sought to identify unique barriers to telehealth use among veterans experiencing homelessness with a SUD and design an intervention to promote adoption. This qualitative study was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The study's three phases included veteran interviews (N = 28) to identify barriers and facilitators to video telehealth use and propose intervention candidates, a provider expert panel to obtain feedback on interventions, and a focus group with veterans to complete the intervention. Finally, a prototype was designed using the intervention mapping approach. Veteran interviews revealed that barriers to video telehealth included complex physical and mental health issues, lack of digital literacy, and insufficient technical support. Together, veterans and experts proposed five intervention candidates. In the end, a veteran focus group combined two candidates, peer-led digital training and motivational interviewing. Intervention mapping was used to design a "stepped care" intervention that trains and activates veterans at all skill levels. This study demonstrates how inclusion of expert and veteran views led to development of a novel intervention to support and sustain video telehealth use among veterans experiencing homeless with SUD.
Collapse
Affiliation(s)
- Lynn A. Garvin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA USA
| | - Mary Alexis Greenan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
| | - Cindie Slightam
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA USA
| | - D. Keith McInnes
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA USA
| | - Donna M. Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA USA
| |
Collapse
|
31
|
Sine K, Appaneal H, Dosa D, LaPlante KL. Antimicrobial Prescribing in the Telehealth Setting: Framework for Stewardship During a Period of Rapid Acceleration Within Primary Care. Clin Infect Dis 2022; 75:2260-2265. [PMID: 35906829 PMCID: PMC9384578 DOI: 10.1093/cid/ciac598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 01/19/2023] Open
Abstract
Antibiotic resistance is a global public health threat. The use of telehealth in primary care presents unique barriers to antimicrobial stewardship, including limited physical examination and changes to the patient-provider relationship. Since the coronavirus disease 2019 (COVID-19) pandemic, there is a need to identify novel antimicrobial stewardship strategies with an explosion in the use of telehealth within primary care. Our review proposes a tailored, sustainable approach to antimicrobial prescribing in the telehealth setting based on the Centers for Disease Control and Prevention's Core Elements of Outpatient Antibiotic Stewardship: commitment, action for policy and practice; tracking and reporting; and education and expertise. The rapid growth of telehealth for all types of primary care visits (not just antibiotic use) is outpacing knowledge associated with strategies for antimicrobial stewardship. Improving antibiotic use within primary care settings is critical as telehealth will remain a priority whether the COVID-19 pandemic recedes, particularly within patient populations with limited access to healthcare.
Collapse
Affiliation(s)
- Kathryn Sine
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Haley Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department is College of pharmacy, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - David Dosa
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department is College of pharmacy, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI School of Public Health, Brown University, Providence, RI, USA
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department is College of pharmacy, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI School of Public Health, Brown University, Providence, RI, USA
| |
Collapse
|
32
|
Griffin AC, Troszak LK, Van Campen J, Midboe AM, Zulman DM. Tablet distribution to veterans: an opportunity to increase patient portal adoption and use. J Am Med Inform Assoc 2022; 30:73-82. [PMID: 36269168 PMCID: PMC9748532 DOI: 10.1093/jamia/ocac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Examine whether distribution of tablets to patients with access barriers influences their adoption and use of patient portals. MATERIALS AND METHODS This retrospective cohort study included Veterans Affairs (VA) patients (n = 28 659) who received a VA-issued tablet between November 1, 2020 and April 30, 2021. Tablets included an app for VA's My HealtheVet (MHV) portal. Veterans were grouped into 3 MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Three multivariable models were estimated to examine the factors predicting (1) MHV registration among non-users, (2) any MHV feature use among inactive users, and (3) more MHV use among active users post-tablet receipt. Differences in feature use during the 6 months pre-/post-tablet were examined with McNemar chi-squared tests of proportions. RESULTS In the 6 months post-tablet, 1298 (8%) non-users registered for MHV, 525 (24%) inactive users used at least one MHV feature, and 4234 (46%) active users increased feature use. Across veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (P < .01). Among active users, use of all features increased during the 6 months post-tablet, with the greatest differences in viewing prescription refills and scheduling appointments (P < .01). CONCLUSION Providing patients who experience barriers to in-person care with a portal-enabled device supports engagement in health information and management tasks. Additional strategies are needed to promote registration and digital inclusion among inactive and non-users of portals.
Collapse
Affiliation(s)
- Ashley C Griffin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Lara K Troszak
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amanda M Midboe
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Donna M Zulman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
33
|
Subramaniam S, Chen J, Wilkerson TL, Stevenson L, Kincaid C, Firestone C, Ball SL. Refining the Implementation of a Hub-and-Spoke Model for TelePain Through Qualitative Inquiry. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-11. [PMID: 36530381 PMCID: PMC9734451 DOI: 10.1007/s41347-022-00288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
The hub-and-spoke telehealth model leverages centrally located providers who utilize telehealth technology to bring specialized care to medically underserved areas. This model has the potential to promote equitable access to healthcare. However, few studies address how to facilitate the adoption and implementation of hub-and-spoke telehealth. We examined spoke site providers' experiences with TelePain, a national hub-and-spoke model of interdisciplinary chronic pain care, with a focus on improving future implementation. We conducted semi-structured individual interviews (20-45 min) with 27 VA spoke site providers via teleconferencing between August 2020 and February 2021. Interview transcripts were coded in Atlas.ti 8.0 using deductive (identified a priori and used to build the interview guide) and inductive (emerging) codes. Our analysis identified the following themes stressed by the spoke sites: (1) spoke sites needed to envision how TelePain services would work at their site before deciding to adopt; (2) TelePain implementation needed to fit into local existing care processes; (3) hub sites needed to understand spoke sites' context (e.g., via needs assessment) to tailor the services accordingly, and (4) hub-and-spoke sites needed to establish bidirectional communication. Our findings provide a practical guide to improve future rollout of hub-and-spoke telehealth models. Recommendations focus on the role of the hub site in promoting program adoption by (1) developing a clear and detailed marketing plan and (2) considering how the program can be adapted to fit the local spoke site context. To improve implementation, hub-and-spoke sites must establish ongoing and consistent bidirectional communication; this is particularly critical in the everchanging post-peak pandemic healthcare system. An important next step is the development of recommendations and guidelines for implementing hub-and-spoke telehealth, as well as examining pain outcomes for patients touched by this program.
Collapse
Affiliation(s)
- Soumya Subramaniam
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Jessica Chen
- Puget Sound VA Healthcare System, 1660 S, Columbian Way, Seattle, WA 98108 USA
| | - Tai-Lyn Wilkerson
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Lauren Stevenson
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Carrie Kincaid
- Puget Sound VA Healthcare System, 1660 S, Columbian Way, Seattle, WA 98108 USA
| | - Christine Firestone
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| | - Sherry L. Ball
- VA Northeast Ohio Healthcare System, 10701 East Blvd, Cleveland, OH 44106 USA
| |
Collapse
|
34
|
Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic. BMC PRIMARY CARE 2022; 23:155. [PMID: 35717159 PMCID: PMC9206131 DOI: 10.1186/s12875-022-01738-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/17/2022] [Indexed: 01/19/2023]
Abstract
Abstract
Background
At the onset of COVID-19, there was a rapid expansion of telehealth (video/telephone) visits to maintain delivery of primary care (PC) services at the Veterans Health Administration (VA). This study examines patient, provider, and site-level characteristics of any virtual and video-based care in PC.
Methods
Interrupted time series (ITS) design was conducted using VA administrative/clinical, electronic healthcare data, 12-months before and 12-months after COVID-19 onset (set at March 2020) at the VA Greater Los Angeles Healthcare System (GLA), between 2019 and 2021. Patients with at least one visit to a VA PC clinic at GLA (n = 547,730 visits) were included in the analysis. The two main outcomes for this study were 1) any telehealth (versus in-person), as well as 2) video-based care (versus telephone). For the ITS analysis, segmented logistic regression on repeated monthly observations of any telehealth and video-based care was used.
Results
Percent telehealth and video use increased from 13.9 to 63.1%, and 0.3 to 11.3%, respectively, before to after COVID-19 onset. According to adjusted percentages, GLA community-based clinics (37.7%, versus 29.8% in hospital-based clinics, p < .001), social workers/pharmacists/dietitians (53.7%, versus 34.0% for PC clinicians, p < .001), and minority groups, non-Hispanic African Americans (36.3%) and Hispanics (34.4%, versus 35.3% for Whites, p < .001) were more likely to use telephone than video. Conversely, mental health providers (43.3%) compared to PC clinicians (15.3%), and women (for all age groups, except 75+) compared to men, were more likely to use video than telephone (all p’s < .001).
Conclusions
Since telehealth care provision is likely to continue after COVID-19, additional research is needed to identify which PC outpatient services are better suited for telephone (e.g., case management) versus video-based care (e.g., integrated mental health visits). Additionally, it is important to understand how all clinics can systematically increase access to both telephone- and video-based PC services, while ensuring equitable care for all patient populations.
Collapse
|
35
|
Kelley ML, Strowger M, Chentsova VO, Bravo AJ, Gaylord SA, Burgin EE, Vinci C, Ayers KL, Agha E. Mindfulness to Manage Moral Injury: Rationale and development of a live online 7-week group intervention for veterans with moral injury. Contemp Clin Trials Commun 2022; 30:101011. [PMID: 36340697 PMCID: PMC9626875 DOI: 10.1016/j.conctc.2022.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/27/2022] [Accepted: 10/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Military service puts service members at risk for moral injury. Moral injury is an array of symptoms (e.g., guilt, shame, anger) that develop from events that violate or transgress one's moral code. Objective We describe adaption of in-person mindfulness training program, Mindfulness to Manage Chronic Pain (MMCP), to address symptoms of moral injury to be delivered live via the web. We discuss how we will assess benchmarks (i.e., recruitment, credibility and acceptability, completion rates, and adherence) of the Mindfulness to Manage Moral Injury (MMMI) program. Methods Aim 1: To develop and then adapt the MMCP program based on feedback from experts and veterans who took part in Study 1. Aim 2: To develop an equally intensive facilitator-led online Educational Support (ES) program to serve as a comparison intervention and conduct a run-through of each program with 20 veterans (10 MMMI; 10 ES). Aim 3: To conduct a small-scale randomized controlled trial (N = 42 veterans; 21 MMMI; 21 ES) in which we will collect pre-post-test and weekly benchmark data for both refined intervention arms. Results Study 1 and 2 are completed. Data collection for Study 3 will be completed in 2022. Conclusion MMMI is designed to provide a live facilitated mindfulness program to address symptoms of moral injury. If Study 3 demonstrates good benchmarks, with additional large-scale testing, MMMI may be a promising treatment that can reach veterans who may not seek traditional VAMC care and/or who prefer a web-based program.
Collapse
Affiliation(s)
- Michelle L. Kelley
- Old Dominion University, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Megan Strowger
- Old Dominion University, Old Dominion University, Norfolk, VA, USA
| | | | - Adrian J. Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E. Burgin
- School Psychology and Counselor Education, William & Mary, Williamsburg, VA, USA
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth L. Ayers
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Erum Agha
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
36
|
Patients' Perspectives on the Shift to Telemedicine in Primary and Behavioral Health Care during the COVID-19 Pandemic. J Gen Intern Med 2022; 37:4248-4256. [PMID: 36167954 PMCID: PMC9514672 DOI: 10.1007/s11606-022-07827-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Studies specifically focused on patients' perspectives on telemedicine visits in primary and behavioral health care are fairly limited and have often focused on highly selected populations or used overall satisfaction surveys. OBJECTIVE To examine patient perspectives on the shift to telemedicine, the remote delivery of health care via the use of electronic information and communications technology, in primary and behavioral health care in Federally Qualified Health Centers (FQHCs) during COVID-19. DESIGN Semi-structured interviews were conducted using video conference with patients and caregivers between October and December 2020. PARTICIPANTS Providers from 6 FQHCs nominated participants. Eighteen patients and caregivers were interviewed: 6 patients with only primary care visits; 5 with only behavioral health visits; 3 with both primary care and behavioral health visits; and 4 caregivers of children with pediatric visits. APPROACH Using a protocol-driven, rapid qualitative methodology, we analyzed the interview data and assessed the quality of care, benefits and challenges of telemedicine, and use of telemedicine post-pandemic. KEY RESULTS Respondents broadly supported the option of home-based synchronous telemedicine visits in primary and behavioral health care. Nearly all respondents appreciated remote visits, largely because such visits provided a safe option during the pandemic. Patients were generally satisfied with telemedicine and believed the quality of visits to be similar to in-person visits, especially when delivered by a provider with whom they had established rapport. Although most respondents planned to return to mostly in-person visits when considered safe to do so, they remained supportive of the continued option for remote visits as remote care addresses some of the typical barriers faced by low-income patients. CONCLUSIONS Addressing digital literacy challenges, enhancing remote visit privacy, and improving practice workflows will help ensure equitable access to all patients as we move to a new post-COVID-19 "normal" marked by increased reliance on telemedicine and technology.
Collapse
|
37
|
Campbell IM, Crowley TB, Keena B, Donoghue S, McManus ML, Zackai EH. The experience of one pediatric geneticist with telemedicine-based clinical diagnosis. Am J Med Genet A 2022; 188:3416-3422. [PMID: 35906847 DOI: 10.1002/ajmg.a.62920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
Telemedicine has long been considered as an attractive alternative methodology in clinical genetics to improve patient access and convenience. Given the importance of the dysmorphology physical examination and anthropometric measurement in clinical genetics, many have wondered if lost information would hamper diagnosis. We previously addressed this question by analyzing thousands of diagnostic encounters in a single practice involving multiple practitioners and found no evidence for a difference in new molecular diagnosis rates. However, our previous study design resulted in variability in providers between in-person and telemedicine evaluation groups. To address this in our present study, we expanded our analysis to 1104 new patient evaluations seen by one highly experienced clinical geneticist across two 10-month periods before and after the start of the COVID-19 pandemic. Comparing patients seen in-person to those seen by telemedicine, we found significant differences in race and ethnicity, preferred language, and home zip code median income. The clinical geneticist intended to send more genetic testing for those patients seen by telemedicine, but due to issues with test authorization and sample collection, there was no difference in ultimate completion rate between groups. We found no significant difference in new molecular diagnosis rate. Overall, we find telemedicine to be an acceptable alternative to in-person evaluation for routine pediatric clinical genetics care.
Collapse
Affiliation(s)
- Ian M Campbell
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - T Blaine Crowley
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Beth Keena
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah Donoghue
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Morgan L McManus
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
38
|
Tisdale RL, Ferguson J, Van Campen J, Greene L, Sandhu AT, Heidenreich PA, Zulman DM. Disparities in virtual cardiology visits among Veterans Health Administration patients during the COVID-19 pandemic. JAMIA Open 2022; 5:ooac103. [PMID: 36531138 PMCID: PMC9754629 DOI: 10.1093/jamiaopen/ooac103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objective In response to the coronavirus disease 2019 (COVID-19) pandemic, the Veterans Health Administration (VA) rapidly expanded virtual care (defined as care delivered by video and phone), raising concerns about technology access disparities (ie, the digital divide). Virtual care was somewhat established in primary care and mental health care prepandemic, but video telehealth implementation was new for most subspecialties, including cardiology. We sought to identify patient characteristics of virtual and video-based care users in VA cardiology clinics nationally during the first year of the COVID-19 pandemic. Materials and Methods Cohort study of Veteran patients across all VA facilities with a cardiology visit January 1, 2019-March 10, 2020, with follow-up January 1, 2019-March 10, 2021. Main measures included cardiology visits by visit type and likelihood of receiving cardiology-related virtual care, calculated with a repeated event survival model. Results 416 587 Veterans with 1 689 595 total cardiology visits were analyzed; average patient age was 69.6 years and 4.3% were female. Virtual cardiology care expanded dramatically early in the COVID-19 pandemic from 5% to 70% of encounters. Older, lower-income, and rural-dwelling Veterans and those experiencing homelessness were less likely to use video care (adjusted hazard ratio for ages 75 and older 0.80, 95% confidence interval (CI) 0.75-0.86; for highly rural residents 0.77, 95% CI 0.68-0.87; for low-income status 0.94, 95% CI 0.89-0.98; for homeless Veterans 0.85, 95% CI 0.80-0.92). Conclusion The pandemic worsened the digital divide for cardiology care for many vulnerable patients to the extent that video visits represent added value over phone visits. Targeted interventions may be necessary for equity in COVID-19-era access to virtual cardiology care.
Collapse
Affiliation(s)
- Rebecca L Tisdale
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Jacqueline Ferguson
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - James Van Campen
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Liberty Greene
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Donna M Zulman
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
39
|
Davis CN, O’Neill SE. Treatment of Alcohol Use Problems Among Rural Populations: a Review of Barriers and Considerations for Increasing Access to Quality Care. CURRENT ADDICTION REPORTS 2022; 9:432-444. [DOI: 10.1007/s40429-022-00454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
|
40
|
Hise N, Buckner J, Ince S, Quint C. Telemedicine at the VA: Examining Smartphone Connectivity Rates to VA Video Connect and Doximity Dialer Video. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2022; 2:100147. [PMCID: PMC9647012 DOI: 10.1016/j.avsurg.2022.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022]
Abstract
Background Telemedicine usage has accelerated as a result of the COVID-19 pandemic, raising concerns those without the necessary technology and digital literacy to participate may face increasing health disparities. In this study, we examined the rates at which veterans are able to connect to two common telemedicine applications: VA Video Connect (VVC) and Doximity Dialer Video (DV). Methods Participants were selected from a pool of vascular surgery patients seen from August 2020 to October 2021 at a single Veterans Affairs medical center. Participants had to be >50 years old and not previously participated in a video visit. Eligible veterans were asked their interest participating in video visits and if they owned a smartphone. Those who met the eligibility requirements were tested on their ability to connect to both VVC and DV with minimal assistance. The connectivity rate for both platforms was recorded, and basic demographic and medical history information was collected. Results One-hundred-four veterans participated in the study, with an average age of 70±7 years. Seventy-four participants (71%) expressed interest in video visits, and 52 (70%) owned a smartphone. Forty-five smartphone owners (87%) successfully connected to DV, whereas 19 (37%) successfully connected to VVC (p<0.001). VVC connectivity decreased with increasing age-group: 50-59=80%, 60-69=44%, ≥70=18% (p=0.02). Conclusions Older veterans demonstrate difficulty connecting to VVC. The VHA is taking important steps to streamline usability of VVC, however continued expansion of support programs is necessary to improve access and reduce healthcare disparities in this population.
Collapse
|
41
|
Chen PV, Helm A, Caloudas SG, Ecker A, Day G, Hogan J, Lindsay J. Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature. Curr Psychiatry Rep 2022; 24:529-539. [PMID: 36053400 PMCID: PMC9437398 DOI: 10.1007/s11920-022-01359-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper is to provide a comparative review of using phone (audio-only) or video for mental health treatments. Our review includes evidence of phone and video's effectiveness in terms of reduced symptomology, retention, satisfaction, therapeutic alliance, and other outcomes of interest. This review also discusses how patients and providers' experiences and attitudes differ between these two modalities. Finally, we present information on different usage rates of phone and video across patient populations and mental health provider types, and different implementation strategies. RECENT FINDINGS Treatments through phone and video are both able to reduce symptoms related to mental health conditions and have both been found to be non-inferior to in-person care. Both phone and video are more convenient to patients. Video offers important visual information that can be important to diagnosing mental health conditions. Phone, however, is more broadly accessible and may come with fewer technological issues. In the context of mental health care, where non-verbal cues are tied to symptomology and diagnosing, and a strong relationship between patient and provider can enhance treatment, we encourage the use of video, especially for psychotherapeutic services. However, as phone is more accessible, we ultimately recommend an accommodating approach, one that flexibly makes use of both phone and video. Future studies on telehealth should focus on direct, head-to-head comparisons between phone and video and conduct more rigorous testing on whether clinical differences exist.
Collapse
Affiliation(s)
- Patricia V Chen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
- Margaret M. and Albert B Alkek Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Ashley Helm
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Steve G Caloudas
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Anthony Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Giselle Day
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Julianna Hogan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Jan Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| |
Collapse
|
42
|
Singh G, DeWalle J, Tanriover B, Singh N, Chang AR, Anand PM. Effect of age and rural residency on perceptions about SARS-CoV-2 pandemic and vaccination in kidney transplant recipients. Transpl Infect Dis 2022; 24:e13943. [PMID: 36169231 PMCID: PMC9539214 DOI: 10.1111/tid.13943] [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: 03/23/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transplant patients have poor outcomes in coronavirus-disease 2019 (COVID-19). The pandemic's effects on rural patients' overall care experience, attitudes to telemedicine, and vaccination are poorly understood. METHODS We administered a cross-sectional survey to adult kidney transplant recipients in central Pennsylvania across four clinical sites between March 29, 2021 and June 2, 2021. We assessed the pandemic's impact on care access, telemedicine experience, attitudes toward preventive measures, vaccination, and variation by sociodemographic variables. RESULTS Survey completion rate was 51% (303/594). Of these, 52.8% were rural residents. The most common impact was use of telemedicine (79.2%). Predominant barriers to telemedicine were lack of video devices (10.9%), perceived complexity (5.6%), and technical issues (5.3%). On a 0-10 Likert scale, the mean positive impression for telemedicine was 7.7; lower for patients with telephone-only versus video visits (7.0 vs. 8.2; p < .001), and age ≥60 years (7.4 vs. 8.1; p = .01) on univariate analyses. Time/travel savings were commonly identified (115/241, 47.7%) best parts of telemedicine and lack of personal connection (70/166, 42.2%) the worst. Only 68.9% had received any dose of COVID vaccination. The vaccinated group members were older (58.4 vs. 53.5 years; p = .007), and less likely rural (47.8% vs. 65.2%; p = .005). Common themes associated with vaccine hesitancy included concerns about safety (27/59, 46%), perceived lack of data (19/59, 32%), and distrust (17/59, 29%). At least one misconception about the vaccines or COVID-19 was quoted by 29% of vaccine-hesitant patients. CONCLUSIONS Among respondents, the pandemic significantly impacted healthcare experience, especially in older patients in underserved communities. COVID-19 vaccination rate was relatively low, driven by misconceptions and lack of trust.
Collapse
Affiliation(s)
- Gurmukteshwar Singh
- Department of NephrologyGeisinger HealthDanvillePennsylvaniaUSA,Kidney Health Research InstituteGeisinger HealthDanvillePennsylvaniaUSA
| | - Joseph DeWalle
- Department of Population Health SciencesGeisinger HealthDanvillePennsylvaniaUSA
| | - Bekir Tanriover
- Division of NephrologyUniversity of Arizona College of MedicineTusconArizonaUSA
| | - Neeraj Singh
- John C. McDonald Regional Transplant CenterLouisiana State UniversityShreveportLouisianaUSA
| | - Alex R. Chang
- Department of NephrologyGeisinger HealthDanvillePennsylvaniaUSA,Kidney Health Research InstituteGeisinger HealthDanvillePennsylvaniaUSA
| | - Prince M. Anand
- Division of NephrologyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| |
Collapse
|
43
|
Schwartz AW, Driver JA, Pollara LM, Roefaro J, Harrington MB, Charness ME, Skarf LM. Increasing Telehealth Visits for Older Veterans Associated with Decreased No-Show Rate in a Geriatrics Consultation Clinic. J Gen Intern Med 2022; 37:3217-3219. [PMID: 35476240 PMCID: PMC9045203 DOI: 10.1007/s11606-022-07598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Wershof Schwartz
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA. .,New England Geriatrics Research Education and Clinical Center, Boston, USA. .,Harvard Medical School, Boston, USA. .,Brigham and Women's Hospital Division of Aging, Boston, USA.
| | - Jane A Driver
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,New England Geriatrics Research Education and Clinical Center, Boston, USA.,Harvard Medical School, Boston, USA.,Brigham and Women's Hospital Division of Aging, Boston, USA
| | - Lisa M Pollara
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA
| | - John Roefaro
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA
| | - Mary Beth Harrington
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,New England Geriatrics Research Education and Clinical Center, Boston, USA
| | - Michael E Charness
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,Harvard Medical School, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Lara Michal Skarf
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,Harvard Medical School, Boston, USA
| |
Collapse
|
44
|
Waldman CE, Min JH, Wassif H, Freeman AM, Rzeszut AK, Reilly J, Theriot P, Soliman AM, Thamman R, Bhatt A, Bhavnani SP. COVID-19 telehealth preparedness: a cross-sectional assessment of cardiology practices in the USA. Per Med 2022; 19:411-422. [PMID: 35912812 DOI: 10.2217/pme-2021-0179] [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: 11/21/2022]
Abstract
Aim: The COVID-19 pandemic forced medical practices to augment healthcare delivery to remote and virtual services. We describe the results of a nationwide survey of cardiovascular professionals regarding telehealth perspectives. Materials & methods: A 31-question survey was sent early in the pandemic to assess the impact of COVID-19 on telehealth adoption & reimbursement. Results: A total of 342 clinicians across 42 states participated. 77% were using telehealth, with the majority initiating usage 2 months after the COVID-19 shutdown. A variety of video-based systems were used. Telehealth integration requirements differed, with electronic medical record integration being mandated in more urban than rural practices (70 vs 59%; p < 0.005). Many implementation barriers surfaced, with over 75% of respondents emphasizing reimbursement uncertainty and concerns for telehealth generalizability given the complexity of cardiovascular diseases. Conclusion: Substantial variation exists in telehealth practices. Further studies and legislation are needed to improve access, reimbursement and the quality of telehealth-based cardiovascular care.
Collapse
Affiliation(s)
- Carly E Waldman
- Department of Internal Medicine, Scripps Clinic, San Diego, CA, USA.,Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| | - Jean H Min
- Department of Internal Medicine, Scripps Clinic, San Diego, CA, USA.,Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Section of Clinical Cardiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44103, USA
| | - Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, CO 80206, USA
| | - Anne K Rzeszut
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Jack Reilly
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Paul Theriot
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Ahmed M Soliman
- Division of Cardiology, Houston Methodist DeBakey Cardiology Associates, Houston, TX 77030, USA
| | - Ritu Thamman
- Division of Medicine, University of Pittsburg School of Medicine, Pittsburg, PA 15213, USA
| | - Ami Bhatt
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sanjeev P Bhavnani
- Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| |
Collapse
|
45
|
Der-Martirosian C, Shin M, Upham ML, Douglas JH, Zeliadt SB, Taylor SL. Telehealth Complementary and Integrative Health Therapies During COVID-19 at the U.S. Department of Veterans Affairs. Telemed J E Health 2022; 29:576-583. [PMID: 35867052 DOI: 10.1089/tmj.2022.0209] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Complementary and integrative health (CIH) therapies, such as in-person acupuncture, chiropractic care, and meditation, are evidence-based nonpharmaceutical treatment options for pain. During COVID-19, the Veterans Health Administration (VA) delivered several CIH therapies virtually. This study explores veterans' utilization, advantages/disadvantages, and delivery issues of yoga, Tai Chi, meditation/mindfulness (self-care), and massage, chiropractic, and acupuncture (practitioner-delivered care), using telephone/video at 18 VA sites during COVID-19. Methods: Use of virtual care was examined quantitatively with VA administrative data for six CIH therapies before and after COVID-19 onset (2019-2021). Advantages/disadvantages and health care delivery issues of these CIH therapies through virtual care were examined qualitatively using interview data (2020-2021). Results: Overall, televisits represented a substantial portion of all CIH self-care therapies delivered by VA in 2020 (53.7%) and 2021 (82.1%), as sites developed virtual group classes using VA secure online video platforms in response to COVID-19. In contrast, a small proportion of all encounters with acupuncturists, chiropractors, and massage therapists was telephone/video encounters in 2020 (17.3%) and in 2021 (5.4%). These were predominantly one-on-one care in the form of education, follow-ups, home exercises, assessments/evaluations, or acupressure. Delivery issues included technical difficulties, lack of access to needed technology, difficulty tracking virtual visits, and capacity restrictions. Advantages included increased access to self-care, increased patient receptivity to engaging in self-care, and flexibility in staffing online group classes. Disadvantages included patient preference, patient safety, and strain on staffing. Conclusion: Despite delivery issues or disadvantages of tele-CIH self-care, veterans' use of teleself-care CIH therapies grew substantially during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Claudia Der-Martirosian
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Veterans Emergency Management Evaluation Center, Office of Patient Care Services, North Hills, California, USA
| | - Marlena Shin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Michelle L Upham
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Jamie H Douglas
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Steven B Zeliadt
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA.,Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine and Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
46
|
Waite MR, Diab S, Adefisoye J. Virtual Behavioral Health Treatment Satisfaction and Outcomes Across Time. J Patient Cent Res Rev 2022; 9:158-165. [PMID: 35935523 PMCID: PMC9302910 DOI: 10.17294/2330-0698.1918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Purpose The COVID-19 pandemic continues to have major and long-lasting impacts on health care delivery and mental health. As health care shifted to telehealth, legislation was adjusted to expand telehealth allowances, creating a unique opportunity to elucidate outcomes. The aim of this study was to assess long-term patient and clinician satisfaction and outcomes with virtual behavioral health. Methods Data were obtained over 16 months from surveys to patients and clinicians receiving/providing virtual treatment. Outcomes data also were collected from medical records of adults receiving in-person and virtual behavioral health treatment. Data were summarized using descriptive statistics. Groups were compared using various chi-squared tests for categorical variables, Likert response trends over time, and conditional independence, with Wilcoxon rank-sum or Jonckheere trend test used to assess continuous variables. P-values of ≤0.05 were considered statistically significant. Results Patients gave high ratings to virtual treatment and indicated a preference for virtual formats. Both patient and clinician preference for virtual visits increased significantly with time, and many clinicians perceived virtual services to be equally effective to in-person. Virtual programs had higher completion rates, attendance rates, and number of treatment visits, suggesting that virtual behavioral health had equivalent or better outcomes to in-person treatment and that attitudes toward telehealth changed over time. Conclusions If trends found in this study continue, telehealth may emerge as a preferred option long term This is important considering the increase in mental health needs associated with the COVID-19 pandemic and the eventuality that in-person restrictions ease as the pandemic subsides.
Collapse
Affiliation(s)
- Mindy R. Waite
- Aurora Behavioral Health Services, Advocate Aurora Health, Wauwatosa, WI
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Sara Diab
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - James Adefisoye
- Aurora University of Wisconsin Medical Group, Advocate Aurora Health, Milwaukee, WI
| |
Collapse
|
47
|
Gately ME, Tickle-Degnen L, McLaren JE, Ward N, Ladin K, Moo LR. Factors Influencing Barriers and Facilitators to In-home Video Telehealth for Dementia Management. Clin Gerontol 2022; 45:1020-1033. [PMID: 34096477 DOI: 10.1080/07317115.2021.1930316] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Quality dementia care, which recognizes caregivers as vital care partners, is a scarce resource. Innovative solutions like video telehealth may increase the reach of extant clinicians; however, little is known about perceived barriers and facilitators to in-home video telehealth for dementia management from the perspectives of caregivers. METHODS Twenty-four caregivers of community-dwelling Veterans with dementia participated in semi-structured interviews. Questions gathered perceived facilitators and barriers to in-home video telehealth for dementia management through experience with related technology. Transcripts were analyzed using directed content analysis which was guided by factors previously identified as influencing older adults' adoption of technology. RESULTS Caregiver experience with related technology was mostly facilitative to video telehealth, which was thought best suited for follow-up care. Increased access and decreased patient-caregiver stress were potential benefits. Barriers included perceived limitations of video and the belief that persons with dementia would have limited ability to manage technological aspects and to engage in video telehealth on their own. CONCLUSIONS This study improves our understanding of the factors that caregivers perceive as barriers and facilitators to in-home video telehealth for dementia management. CLINICAL IMPLICATIONS Strategies to optimize video telehealth include capitalizing on caregivers' social network and providing targeted training.
Collapse
Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Tickle-Degnen
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Jaye E McLaren
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Nathan Ward
- Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Lauren R Moo
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
48
|
Gately ME, Quach ED, Shirk SD, Trudeau SA. Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems. MEDICAL RESEARCH ARCHIVES 2022; 10:10.18103/mra.v10i5.2751. [PMID: 36405543 PMCID: PMC9670247 DOI: 10.18103/mra.v10i5.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Telehealth has rapidly expanded since COVID-19. Veterans Health Administration (VHA), the largest integrated health care system in the United States, was well-positioned to incorporate telehealth across specialties due to existing policies and infrastructure. OBJECTIVES The objective of this study is to investigate predictors of occupational therapy (OT) practitioners' adoption of video telehealth. METHODS This study presents data from a convenience sample of VHA occupational therapy (OT) practitioners administered pre-pandemic, in fall 2019. Survey development was guided by the Promoting Action on Research Implementation in Health Services framework, and gathered clinician attitudes, experiences, and perspectives about video telehealth to deliver OT services. Items included telehealth usage, perceived effectiveness of specific OT interventions, and perceptions about evidence. Our outcome variable denoted practitioners' level of adoption of video telehealth: telehealth users (adopters), non-users who want to use telehealth (potential adopters and reference group), and non-users who do not want to use telehealth (non-adopters). In multiple multinomial logistic regressions, we tested whether level of adoption was associated with years of VHA work experience and perceived strength of evidence. RESULTS Of approximately 1455 eligible practitioners, 305 VHA occupational therapy practitioners participated in the survey (21% response rate). One hundred and twenty-five (41%) reported using video telehealth, whereas 180 (59%) reported not using video telehealth. Among non-users, 107 (59%) indicated willingness to adopt telehealth whereas 73 (41%) were not willing. More VHA work experience predicted higher odds of being an adopter than a potential adopter; perceptions of stronger evidence regarding video telehealth predicted higher odds of being a potential adopter than a non-adopter. CONCLUSION Clinician beliefs and years of experience exerted an influence on clinicians' use or willingness to use video telehealth. Efforts to enhance adoption of video telehealth should address clinicians' beliefs regarding the innovative nature of and organizational resources necessary to foster utilization.
Collapse
Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
| | - Emma D Quach
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Department of Gerontology, University of Massachusetts Boston
| | - Steven D Shirk
- VA Bedford Healthcare System, Bedford, MA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Scott A Trudeau
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
- American Occupational Therapy Association, Bethesda, MD
| |
Collapse
|
49
|
Connecting Older Veterans with Mental Health Mobile Apps: a Survey of Provider and Staff Use of Apps and Patient Education Materials. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 7:192-197. [PMID: 34841046 PMCID: PMC8610440 DOI: 10.1007/s41347-021-00236-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
|
50
|
Leclercq C, Witt H, Hindricks G, Katra RP, Albert D, Belliger A, Cowie MR, Deneke T, Friedman P, Haschemi M, Lobban T, Lordereau I, McConnell MV, Rapallini L, Samset E, Turakhia MP, Singh JP, Svennberg E, Wadhwa M, Weidinger F. Wearables, telemedicine, and artificial intelligence in arrhythmias and heart failure: Proceedings of the European Society of Cardiology: Cardiovascular Round Table. Europace 2022; 24:1372-1383. [PMID: 35640917 DOI: 10.1093/europace/euac052] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 12/31/2022] Open
Abstract
Digital technology is now an integral part of medicine. Tools for detecting, screening, diagnosis, and monitoring health-related parameters have improved patient care and enabled individuals to identify issues leading to better management of their own health. Wearable technologies have integrated sensors and can measure physical activity, heart rate and rhythm, and glucose and electrolytes. For individuals at risk, wearables or other devices may be useful for early detection of atrial fibrillation or sub-clinical states of cardiovascular disease, disease management of cardiovascular diseases such as hypertension and heart failure, and lifestyle modification. Health data are available from a multitude of sources, namely clinical, laboratory and imaging data, genetic profiles, wearables, implantable devices, patient-generated measurements, and social and environmental data. Artificial intelligence is needed to efficiently extract value from this constantly increasing volume and variety of data and to help in its interpretation. Indeed, it is not the acquisition of digital information, but rather the smart handling and analysis that is challenging. There are multiple stakeholder groups involved in the development and effective implementation of digital tools. While the needs of these groups may vary, they also have many commonalities, including the following: a desire for data privacy and security; the need for understandable, trustworthy, and transparent systems; standardized processes for regulatory and reimbursement assessments; and better ways of rapidly assessing value.
Collapse
Affiliation(s)
- Christophe Leclercq
- Department of Cardiology, CHU Rennes and Inserm, LTSI, University of Rennes, Centre Cardio-Pneumologique, CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, 2 Rue Henri le Guilloux, 35000, Rennes, France
| | - Henning Witt
- Department of Internal Medicine, Pfizer, Berlin, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, Leipzig Heart Institute, Leipzig, Germany
| | - Rodolphe P Katra
- Cardiac Rhythm Management, Research & Technology, Medtronic, Minneapolis, MN, USA
| | | | - Andrea Belliger
- Institute for Communication and Leadership, and Lucerne University of Education, Lucerne, Switzerland
| | - Martin R Cowie
- Royal Brompton Hospital & School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology and Arrhythmology Heart Center, Bad Neustadt, Germany
| | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mehdiyar Haschemi
- Siemens Healthineers, Segment Advanced Therapies, Clinical Segment Cardiovascular Care, Forchheim, Bavaria, Germany
| | - Trudie Lobban
- Atrial Fibrillation Association (AF Association), Arrhythmia Alliance (A-A), and STARS (Syncope Trust And Reflex anoxic Seizures), UK & International
| | | | - Michael V McConnell
- Fitbit/Google; Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Leonardo Rapallini
- Research and Development, Cardiac Diagnostics and Services Business, Medtronic, Minneapolis, MN, USA
| | - Eigil Samset
- GE Healthcare Cardiology Solutions, Chicago, IL, USA
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emma Svennberg
- Department Electrophysiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| |
Collapse
|