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O'Shea AMJ, Gibson M, Merchant J, Rewerts K, Miell K, Kaboli PJ, Shimada SL. Understanding rural-urban differences in veterans' internet access, use and patient preferences for telemedicine. J Rural Health 2024; 40:438-445. [PMID: 37935649 DOI: 10.1111/jrh.12805] [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: 06/08/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans. PURPOSE To examine veteran-reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality. METHODS Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30-min computer-assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in-person or by video). Counts and weighted percentages are reported. FINDINGS After accounting for survey weights, 96.2% of respondents had in-home internet access and 89.5% reported functional connection speeds. However, rural- compared to urban-residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in-person visits, rural versus urban-residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet-enabled device (25.9%). CONCLUSIONS Though rural-residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.
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Affiliation(s)
- Amy M J O'Shea
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mikayla Gibson
- Department of Human Physiology, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA
| | - James Merchant
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Kelby Rewerts
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Kelly Miell
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Peter J Kaboli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), The Bedford VA Medical Center, Bedford, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Nakamoto CH, Cutler DM, Beaulieu ND, Uscher-Pines L, Mehrotra A. The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22. Health Aff (Millwood) 2024; 43:691-700. [PMID: 38630943 DOI: 10.1377/hlthaff.2023.01142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use. In 2021-22, relative to those in the lowest quartile, Medicare patients of health systems in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease), a $248 increase in per patient per year spending (1.6 percent relative increase), and increased adherence for metformin and statins. There were no clear differential changes in hospitalizations or receipt of preventive care.
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Affiliation(s)
| | - David M Cutler
- David M. Cutler, Harvard University and National Bureau of Economic Research, Cambridge, Massachusetts
| | | | | | - Ateev Mehrotra
- Ateev Mehrotra , Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Neufeld A, Babenko O, Bhella V. Family Physician Motivation and Well-Being in the Digital Era. Ann Fam Med 2023; 21:496-501. [PMID: 38012032 PMCID: PMC10681703 DOI: 10.1370/afm.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Family physicians rapidly shifted to using virtual care during the COVID-19 pandemic, yet it is largely unknown if this change has impacted their workplace motivation. A better understanding of this matter is essential for optimizing the integration of virtual care into standard practice and for supporting family physician well-being. Using a self-determination theory lens, we examined if family physicians experienced autonomous (vs controlled) motivation toward using virtual care, how this related to their subjective well-being, and whether satisfaction (vs frustration) of their basic psychological needs at work mediated that relationship. METHODS Using cross-sectional survey methodology, quantitative data was collected from 156 family physicians in Alberta, Canada. The questionnaire contained validated scales for measuring motivational quality, workplace need fulfillment, and subjective well-being. Descriptive, correlational, and mediation analyses were performed. RESULTS Family physicians varied significantly in their quality of motivation towards using virtual care. Controlled motivation toward using virtual care was associated with lower well-being, and workplace need frustration fully mediated that relationship. Conversely, workplace need satisfaction, but not autonomous motivation toward using virtual care, was associated with higher well-being. CONCLUSIONS In line with self-determination theory, findings suggest that when family physicians' motivation toward using virtual care is less self-determined, it will lead to poorer subjective well-being, because of basic psychological need frustration. Potential implications of the findings are discussed within the contexts of virtual health and primary care.
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Affiliation(s)
- Adam Neufeld
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oksana Babenko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vishal Bhella
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leong R, Sanderson KE, Klassen AF, Ratcliffe EM, Zuniga-Villanueva G. Comparing the suitability of virtual versus in-person care: Perceptions from pediatricians. J Telemed Telecare 2023:1357633X231205329. [PMID: 37904516 DOI: 10.1177/1357633x231205329] [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: 11/01/2023]
Abstract
OBJECTIVES The COVID-19 pandemic compelled a portion of healthcare to be delivered virtually. As the pandemic waned, health systems strived to find a balance between re-incorporating in-person care while maintaining virtual care. To find when virtual or in-person encounters are more appropriate, we surveyed pediatricians' perceptions when comparing the suitability of virtual care to in-person care. METHODS We surveyed a Canadian tertiary-level pediatric hospital where pediatricians assessed whether specific clinical encounters or tasks were more or less effective virtually than when performed in person. Pediatricians also rated the importance of clinical and patient factors when deciding if a patient needs to be seen in person. RESULTS Of 160 pediatrics faculty members, 56 (35%) responded to the survey. When assessing different types of clinical encounters, triage, multidisciplinary meetings, discharge, and follow ups were more likely to favor virtual encounters. However, first consultations and family meetings were more likely to favor in-person encounters. Regarding clinical tasks, pediatricians were more likely to endorse explaining test results, offering treatment recommendations, and obtaining patient histories virtually. On the contrary, there was a preference for physical examinations, assessing patients visually, and assessing developmental milestones to be performed in person. When deciding if a patient should be seen in person versus virtual, pediatricians rated the patient's condition and communication barriers as the most important factors favoring an in-person appointment. DISCUSSION These results offer an initial framework for pediatricians when choosing which encounter type may be most appropriate for their patients between virtual or in-person appointments.
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Affiliation(s)
- Russell Leong
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kate E Sanderson
- Hamilton Health Sciences Centre for Evidence-Based Implementation, McMaster University, Hamilton, ON, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Gregorio Zuniga-Villanueva
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, Tecnológico de Monterrey, Monterrey, NL, Mexico
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Babenko O, Neufeld A. Profiles of physician motivation towards using virtual care: differences in workplace need fulfillment. BMC Health Serv Res 2023; 23:1101. [PMID: 37845679 PMCID: PMC10580539 DOI: 10.1186/s12913-023-10057-x] [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: 05/23/2023] [Accepted: 09/24/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Physicians appear to vary in their motivation towards using virtual care, but to what extent is unclear. To better understand this variance, which is important for supporting physician wellbeing and therefore patient care, the authors used self-determination theory's (SDT) framework. According to SDT, different types of motivation exist, ranging from controlled to autonomous, that lend to differences in engagement, performance, and wellbeing. The authors aimed to determine: (a) if there were distinct groups of physicians based on their quality of motivation towards using virtual care, and if so, (b) how these groups varied in fulfillment of basic psychological needs (autonomy, competence, and relatedness) in the workplace. METHODS In March-August 2022, the authors collected quantitative, survey-based data from a cross-section of 156 family physicians in Alberta, Canada. The survey contained existing scales that measure types of motivation (autonomous vs. controlled) and basic psychological need satisfaction/frustration at work. Cluster analysis was used to explore profiles of physician motivation towards using virtual care, and analysis of variance was used to determine how each profile differed with respect to workplace need fulfillment. RESULTS With motivation towards using virtual care, three higher-order profiles of physician motivation were identified: autonomous (19% family physicians), controlled (16% of family physicians), and ambivalent (66% of family physicians). The three profiles differed significantly in terms of psychological need fulfillment at work. CONCLUSIONS This study identifies specific profiles that family physicians currently fall into when it comes to motivation towards using virtual care. In line with SDT, findings suggest that basic psychological needs are fundamental nutrients for physicians to internalize and endorse the value of using virtual care in their practices. Implications for physician wellbeing are discussed.
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Affiliation(s)
- Oksana Babenko
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Adam Neufeld
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Castaldelli-Maia JM, Gimenes GK, Perrotte G, Gonzalez S, Okassova A, Malvido K, Torales J. BRAF-testing medical education needs in Latin America. CANCER PATHOGENESIS AND THERAPY 2023; 1:295-298. [PMID: 38327604 PMCID: PMC10846295 DOI: 10.1016/j.cpt.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 02/09/2024]
Affiliation(s)
- João Mauricio Castaldelli-Maia
- Clima Clinic, São Paulo, SP 01422-000, Brazil
- Medical School, FMABC University Center Brazil, Santo André, SP 09060-870, Brazil
- School of Medical Sciences, National University of Asunción, San Lorenzo 1120, Paraguay
| | - Gislaine Koch Gimenes
- Clinics Hospital, Medical School, University of São Paulo (USP), São Paulo, SP 05403-010, Brazil
| | - Giuliana Perrotte
- Medical School, FMABC University Center Brazil, Santo André, SP 09060-870, Brazil
| | - Stefani Gonzalez
- Medical School, FMABC University Center Brazil, Santo André, SP 09060-870, Brazil
| | - Ainur Okassova
- Medical Education and Clinical Research Center (CEMIC), Buenos Aires C1425ASG, Argentina
| | - Karina Malvido
- Medical Education and Clinical Research Center (CEMIC), Buenos Aires C1425ASG, Argentina
| | - Julio Torales
- School of Medical Sciences, National University of Asunción, San Lorenzo 1120, Paraguay
- Regional Institute for Health Research, National University of Caaguazú, Coronel Oviedo, 3300, Paraguay
- School of Medical Sciences, Universidad Sudamericana, Pedro Juan Caballero, 130110, Paraguay
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Ashley C, Williams A, Dennis S, McInnes S, Zwar NA, Morgan M, Halcomb E. Telehealth's future in Australian primary health care: a qualitative study exploring lessons learnt from the COVID-19 pandemic. BJGP Open 2023:BJGPO.2022.0117. [PMID: 36750374 DOI: 10.3399/bjgpo.2022.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telehealth emerged as a means of safely providing primary healthcare (PHC) consultations. In Australia, changes to telehealth funding led to the reconsideration of the role of telehealth in the ongoing provision of PHC services. AIM To investigate GPs', registered nurses' (RNs), nurse practitioners' (NPs), and allied health (AH) clinicians perceptions of the sustainability of telehealth in PHC post-pandemic. DESIGN & SETTING Semi-structured interviews were undertaken with 33 purposively selected clinicians, including GPs (n = 13), RNs (n = 5), NPs (n = 9), and AH clinicians (n = 6) working in PHC settings across Australia. Participants were drawn from responders to a national survey of PHC providers (n = 217). METHOD The thematic analysis approach reported by Braun and Clarke was used to analyse the interview data. RESULTS Data analysis revealed that the perception of providers was represented by the following two themes: lessons learnt; and the sustainability of telehealth. Lessons learnt included the need for rapid adaptation to telehealth, use of technology, and the pandemic being a catalyst for long-term change. The sustainability of telehealth in PHC comprised four subthemes around challenges: the funding model, maintaining patient and provider safety, hybrid service models, and access to support. CONCLUSION Providers required resilience and flexibility to adapt to telehealth. Funding models must reward providers from an outcome focus, rather than placing limits on telehealth's use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for PHC professionals.
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Affiliation(s)
- Christine Ashley
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- School of Nursing and Midwifery, University of Notre Dame Australia, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Susan McInnes
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Nicholas A Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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Blood AJ, Cannon CP, Gordon WJ, Mailly C, MacLean T, Subramaniam S, Tucci M, Crossen J, Nichols H, Wagholikar KB, Zelle D, McPartlin M, Matta LS, Oates M, Aronson S, Murphy S, Landman A, Fisher NDL, Gaziano TA, Plutzky J, Scirica BM. Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network. JAMA Cardiol 2023; 8:12-21. [PMID: 36350612 PMCID: PMC9647559 DOI: 10.1001/jamacardio.2022.4018] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022]
Abstract
Importance Blood pressure (BP) and cholesterol control remain challenging. Remote care can deliver more effective care outside of traditional clinician-patient settings but scaling and ensuring access to care among diverse populations remains elusive. Objective To implement and evaluate a remote hypertension and cholesterol management program across a diverse health care network. Design, Setting, and Participants Between January 2018 and July 2021, 20 454 patients in a large integrated health network were screened; 18 444 were approached, and 10 803 were enrolled in a comprehensive remote hypertension and cholesterol program (3658 patients with hypertension, 8103 patients with cholesterol, and 958 patients with both). A total of 1266 patients requested education only without medication titration. Enrolled patients received education, home BP device integration, and medication titration. Nonlicensed navigators and pharmacists, supported by cardiovascular clinicians, coordinated care using standardized algorithms, task management and automation software, and omnichannel communication. BP and laboratory test results were actively monitored. Main Outcomes and Measures Changes in BP and low-density lipoprotein cholesterol (LDL-C). Results The mean (SD) age among 10 803 patients was 65 (11.4) years; 6009 participants (56%) were female; 1321 (12%) identified as Black, 1190 (11%) as Hispanic, 7758 (72%) as White, and 1727 (16%) as another or multiple races (including American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, unknown, other, and declined to respond; consolidated owing to small numbers); and 142 (11%) reported a preferred language other than English. A total of 424 482 BP readings and 139 263 laboratory reports were collected. In the hypertension program, the mean (SD) office BP prior to enrollment was 150/83 (18/10) mm Hg, and the mean (SD) home BP was 145/83 (20/12) mm Hg. For those engaged in remote medication management, the mean (SD) clinic BP 6 and 12 months after enrollment decreased by 8.7/3.8 (21.4/12.4) and 9.7/5.2 (22.2/12.6) mm Hg, respectively. In the education-only cohort, BP changed by a mean (SD) -1.5/-0.7 (23.0/11.1) and by +0.2/-1.9 (30.3/11.2) mm Hg, respectively (P < .001 for between cohort difference). In the lipids program, patients in remote medication management experienced a reduction in LDL-C by a mean (SD) 35.4 (43.1) and 37.5 (43.9) mg/dL at 6 and 12 months, respectively, while the education-only cohort experienced a mean (SD) reduction in LDL-C of 9.3 (34.3) and 10.2 (35.5) mg/dL at 6 and 12 months, respectively (P < .001). Similar rates of enrollment and reductions in BP and lipids were observed across different racial, ethnic, and primary language groups. Conclusions and Relevance The results of this study indicate that a standardized remote BP and cholesterol management program may help optimize guideline-directed therapy at scale, reduce cardiovascular risk, and minimize the need for in-person visits among diverse populations.
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Affiliation(s)
- Alexander J. Blood
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Christopher P. Cannon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - William J. Gordon
- Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Mass General Brigham Personalized Medicine, Boston, Massachusetts
| | - Charlotte Mailly
- Mass General Brigham Personalized Medicine, Boston, Massachusetts
| | - Taylor MacLean
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Samantha Subramaniam
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michela Tucci
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jennifer Crossen
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Hunter Nichols
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - David Zelle
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marian McPartlin
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lina S. Matta
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michael Oates
- Mass General Brigham Personalized Medicine, Boston, Massachusetts
| | - Samuel Aronson
- Mass General Brigham Personalized Medicine, Boston, Massachusetts
| | - Shawn Murphy
- Harvard Medical School, Boston, Massachusetts
- Laboratory of Computer Science, Massachusetts General Hospital, Boston
- Department of Neurology, Massachusetts General Hospital, Boston
- Research Information Science and Computing, Mass General Brigham, Boston, Massachusetts
| | - Adam Landman
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Naomi D. L. Fisher
- Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Thomas A. Gaziano
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin M. Scirica
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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A
3‐D
approach to personalised nutrition. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1002/fsat.3602_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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A Call-to-Action for Clinicians to Implement Evidence-Based Best Practices When Caring for Women with Uterine Fibroids. Reprod Sci 2022; 29:1188-1196. [PMID: 35178678 PMCID: PMC8853611 DOI: 10.1007/s43032-022-00877-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/06/2022] [Indexed: 11/12/2022]
Abstract
Uterine fibroids are common benign tumors that occur in up to 80% of women. Approximately half of the women affected experience considerable physical, psychological, and economic burdens and impact on quality of life due to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Several medical and surgical options are available to treat uterine fibroids; however, healthcare providers may benefit from practical guidance in the development of individualized treatment plans based on a personalized approach. Medical treatments and minimally invasive procedures are generally preferred by most patients before considering more invasive, higher risk surgical interventions. In general, patient-centered, uterine-preserving procedures may be prioritized based on the patient’s goals and the clinical scenario. Occasionally, hysterectomy may be the preferred treatment option for some patients who require definitive treatment. This call-to-action highlights recent challenges to patient care, including radical shifts in physician–patient interactions due to the COVID-19 pandemic and recent changes to evidence-based, clinically approved therapies. This report also reviews contemporary recommendations for women’s health providers in the diagnosis and medical and surgical management of uterine fibroids. This call-to-action aims to empower healthcare providers to optimize the quality of care for women with uterine fibroids utilizing the best available evidence and best practices.
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Berg J, Carlson K, Richards S. Providers at a Midwestern Academic System Report a Positive Experience with Telehealth During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1379-1385. [PMID: 35007435 DOI: 10.1089/tmj.2021.0410] [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: 11/12/2022] Open
Abstract
Introduction: Since the onset of the COVID-19 pandemic, there has been rapid expansion in the use of telehealth. As a result, many providers who had no prior experience using telehealth are now using it to provide patient care. The goal of this study was to survey health care providers on a wide range of telehealth topics including their experiences examining and connecting with patients digitally, identifying which types of patients may be best suited to telehealth, and identifying technical and logistical areas for improvement when using telehealth. Methods: Physicians and advanced practice providers (n = 944) at a large midwestern academic system were invited to complete an anonymous online survey during a 2-week period in October 2020. Results: Surveys, completed and analyzed (n = 178), indicated 86.6% of respondents felt confident in their clinical assessment, and 86.1% felt they formed an adequate personal connection with the patient in the majority of telehealth visits. A majority (58.5%) of providers felt telehealth was not effective for new patients, but 83% of providers felt it was effective for providing care to established patients. Respondents identified several areas for technological improvement including issues with video (27.5%) and audio (16.8%) quality. In 24.4% of visits, these technology issues were severe enough providers needed to convert an audiovisual appointment to telephone. Conclusions: Provider experience with telehealth has largely been positive at our institution. Although telehealth may not be appropriate for new patients, providers did feel it was an effective means of providing care for established patients. To continue improving the quality of telehealth, a multiteam approach should be considered, including members of technology and clinical operations teams working closely with those providers experienced in telehealth.
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Affiliation(s)
- Jenna Berg
- Department of Otolaryngology, Head & Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.,This study was presented as a poster at the American Academy of Otolaryngology Head and Neck Surgery Conference in Los Angeles, CA, October 2021
| | - Kristy Carlson
- Department of Otolaryngology, Head & Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.,This study was presented as a poster at the American Academy of Otolaryngology Head and Neck Surgery Conference in Los Angeles, CA, October 2021
| | - Sarah Richards
- Department of Internal Medicine, Division of Hospital Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.,This study was presented as a poster at the American Academy of Otolaryngology Head and Neck Surgery Conference in Los Angeles, CA, October 2021
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Althobiani M, Alqahtani JS, Hurst JR, Russell AM, Porter J. Telehealth for patients with interstitial lung diseases (ILD): results of an international survey of clinicians. BMJ Open Respir Res 2022; 8:8/1/e001088. [PMID: 34969772 PMCID: PMC8718433 DOI: 10.1136/bmjresp-2021-001088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinicians and policymakers are promoting widespread use of home technology including spirometry to detect disease progression for patients with interstitial lung disease (ILD); the COVID-19 pandemic has accelerated this. Data collating clinicians' views on the potential utility of telehealth in ILD are limited. AIM This survey investigated clinicians' opinions about contemporary methods and practices used to monitor disease progression in patients with ILD using telehealth. METHODS Clinicians were invited to participate in a cross-sectional survey (SurveyMonkey) of 13 questions designed by an expert panel. Telehealth was defined as home monitoring of symptoms and physiological parameters with regular automatic transmission of data from the patient's home to the clinician. Data are presented as percentages of respondents. RESULTS A total of 207 clinicians from 23 countries participated in the survey. A minority (81, 39%) reported using telehealth. 50% (n=41) of these respondents completed a further question about the effectiveness of telehealth. A majority of respondents (32, 70%) rated it to be quite or more effective than face-to-face visit. There were a greater number of respondents using telehealth from Europe (94, 45%) than Asia (51, 25%) and America (24%). Clinicians reported the most useful telehealth monitoring technologies as smartphone apps (59%) and wearable sensors (30%). Telehealth was most frequently used for monitoring disease progression (70%), quality of life (63%), medication use (63%) and reducing the need for in-person visits (63%). Clinicians most often monitored symptoms (93%), oxygen saturation (74%) and physical activity (72%). The equipment perceived to be most effective were spirometers (43%) and pulse oximeters (33%). The primary barriers to clinicians' participation in telehealth were organisational structure (80%), technical challenges (63%) and lack of time and/or workload (63%). Clinicians considered patients' barriers to participation might include lack of awareness (76%), lack of knowledge using smartphones (60%) and lack of confidence in telehealth (56%). CONCLUSION The ILD clinicians completing this survey who used telehealth to monitor patients (n=81) supported its' clinical utility. Our findings emphasise the need for robust research in telehealth as a mode for the delivery of cost-effective healthcare services in ILD and highlight the need to assess patients' perspectives to improve telehealth utility in patients with ILD.
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Affiliation(s)
- Malik Althobiani
- UCL Respiratory, University College London, London, UK.,Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Joanna Porter
- UCL Respiratory, University College London, London, UK
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Gangamma R, Walia B, Luke M, Lucena C. Continuation of teletherapy post COVID-19: Survey data from licensed mental health professionals (Preprint). JMIR Form Res 2021; 6:e32419. [PMID: 35584317 PMCID: PMC9162131 DOI: 10.2196/32419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/02/2023] Open
Abstract
Background The use of teletherapy has exponentially increased in the context of the ongoing COVID-19 pandemic. Studies on teletherapy documented substantial benefits of accessibility and convenience even before the start of the pandemic. Although recent studies show that this modality of therapy delivery is here to stay, few have studied who will most benefit from this trend. Objective In this paper, we report predictors of continued teletherapy usage in a sample of licensed mental health professionals in the United States during a time period when pandemic-related restrictions began diminishing. As such, it is one of the first studies to examine factors related to continued benefits of teletherapy postpandemic. Methods Participation from licensed mental health professionals was sought on listservs of national organizations of multiple mental health organizations. Data were collected via an anonymous link to a survey on Qualtrics between January 2021 and April 2021. Participants responded to questions on therapist demographics, practice setting, experiences of shifting to teletherapy, perspectives on continued use of teletherapy, and their client characteristics. Findings related to client characteristics that predicted continued teletherapy usage are presented here. Results A total of 186 individuals consented to participate in the survey, with a final sample of 114 with complete data. A majority of participants identified as female (92/114, 80.7%), White (94/114, 82.5%), and having a master's degree (75/114, 65.5%) from a nationally accredited program (106/114, 93%). Data were analyzed using heteroskedastic regression modeling with client-related factors as predictors. Two models were run with and without distance travelled by clients as a control variable. Model estimates from both models showed that continued use of teletherapy postpandemic was predicted by the following factors: higher percentage of clients from rural areas, younger and older adult clients, clients with Medicare, and clients with marginalized gender and religious/spiritual identities. Significantly, having a higher percentage of clients from lower socioeconomic status, a higher percentage of those with Medicaid coverage, and a higher percentage of couples and families as clients predicted decreased use of teletherapy postpandemic. Conclusions Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries, and those who seek couple and family therapy may be less likely to be served by it. These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing, and childcare issues, as well as the need for continued training for licensed professionals.
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Affiliation(s)
- Rashmi Gangamma
- Department of Marriage and Family Therapy, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Bhavneet Walia
- Department of Public Health, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Melissa Luke
- Department of Counseling & Human Services, School of Education, Syracuse University, Syracuse, NY, United States
| | - Claudine Lucena
- Department of Marriage and Family Therapy, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
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