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Yang KWK, Rattsev I, Lkhagvajav Z, Flaks-Manov N, Gorman K, Epstein JA, Crainiceanu CM, Taylor CO. Patterns of healthcare utilization according to health equity determinants during the first year of the pandemic at Johns Hopkins Medicine. JAMIA Open 2024; 7:ooae093. [PMID: 39386066 PMCID: PMC11458551 DOI: 10.1093/jamiaopen/ooae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/23/2024] [Accepted: 09/20/2024] [Indexed: 10/12/2024] Open
Abstract
Objectives Rapid telehealth adoption happened at the onset of the coronavirus disease 2019 (COVID-19) pandemic, resulting in a move from in-person predominant to telehealth predominant care delivery. Later, in person visits rebounded with telehealth options remaining. This study aimed to assess differences in healthcare utilization during this changing landscape in terms of health equity determinants. Materials and Methods This was an observational cohort study of Johns Hopkins Medicine (JHM) patients. We analyzed utilization of video, telephone, and in-person patient-provider visits by eligible patients between March 16, 2019 and December 31, 2020. Percent changes in average weekly patient-provider visits from pre-pandemic (March 16, 2019-June 30, 2019) to early 2020 pandemic (March 16, 2020-June 30, 2020) and from pre-pandemic (July 1, 2019-December 31, 2019) to late 2020 pandemic (July 1, 2020-December 31, 2020). We used a quantile cut off technique to describe disproportionately smaller or greater drops in visits during the first year of the pandemic among health equity determinant groups and according to visit specialty, when compared to the total population. Results There was a 39% drop in patient-provider visits from the pre-pandemic to the early 2020 pandemic period, and a 24% drop from pre-pandemic to the late 2020 pandemic period. We discovered 21 groups according to health equity determinates and visit departments with patterns of disproportionately smaller or greater drops in visits during the first year of the pandemic, when compared to the total population: Pattern 1 -smaller drop in visits early and late 2020 (age 45-64, Medicare insurance, high poverty and high unemployment; mental health and medical specialty visits -P < .001); Pattern 2 -greater drop in visits early 2020 only (age 65-84; OB/GYN and surgical specialty visits-P < .001); Pattern 3 -greater drop in visits early and late 2020 (age 0-5, age 6-17, age 85+, Asian race, Hispanic or Latino ethnicity, private insurance-P < .001); and Pattern 4-smaller drop in visits in early 2020 when compared to late 2020. The age 18-44 group showed a smaller drop in visits early 2020 and then visit levels similar to the total population late 2020. Primary care visits were similar to the total population early 2020 and then a smaller drop in visits late 2020 (P < .001). Discussion Our study provides evidence of health equity determinant groups having disproportionally smaller or greater drops in visits during the first year of the pandemic. The observed differences may have been influenced by changing telehealth offerings during the first year of the pandemic. Groups with disproportionately smaller drops in visits early 2020 (Pattern #1 and age 18-44 group in Pattern #4), suggests more success with adopting telehealth among those groups. Whereas groups with disproportionately greater drops in visits early 2020 (Pattern #2 and Pattern #3), suggests less success with telehealth adoption. For Pattern #4, more clarification is needed on how changes in telehealth offerings contributed to the downward trend in visits observed from early to late 2020. Conclusion We describe 4 main patterns to characterize groups with disproportionately smaller or greater drops in visits during the first year of the pandemic. While this work did not specifically study vulnerable populations, these patterns set the stage for further studies of such groups.
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Affiliation(s)
- Kai-Wen K Yang
- Johns Hopkins Whiting School of Engineering, Institute for Computational Medicine, Baltimore, MD 21218, United States
| | - Ilia Rattsev
- Johns Hopkins Whiting School of Engineering, Institute for Computational Medicine, Baltimore, MD 21218, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Zoljargal Lkhagvajav
- Johns Hopkins Whiting School of Engineering, Institute for Computational Medicine, Baltimore, MD 21218, United States
| | - Natalie Flaks-Manov
- Johns Hopkins Whiting School of Engineering, Institute for Computational Medicine, Baltimore, MD 21218, United States
| | - Kevin Gorman
- Johns Hopkins Whiting School of Engineering, Institute for Computational Medicine, Baltimore, MD 21218, United States
| | - Jeremy Aaron Epstein
- Division of Hospital Medicine, Johns Hopkins Hospital, Baltimore, MD 21224, United States
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Casey O Taylor
- Johns Hopkins Whiting School of Engineering, Institute for Computational Medicine, Baltimore, MD 21218, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
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2
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Klein KG, Tucker CM, Mejia J, Folsom K, Kolli S, Anton S, Stewart E, Knight AM, Miles Hamilton J, Belcher M. Motivators of and barriers to in-person health care and video telehealth utilization among older black adults: a qualitative study. ETHNICITY & HEALTH 2024:1-23. [PMID: 39382515 DOI: 10.1080/13557858.2024.2412848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE Older Black adults continue to experience heightened rates of chronic illness and poor health outcomes. Further, older Black adults must navigate interlocking systems of oppression (e.g. racism, ageism, ableism, and classism etc.) that impact their healthcare utilization. Telehealth has emerged as a common health care modality, which presents unique concerns for aging populations. DESIGN The present study explored the motivators of and barriers to in-person healthcare and video telehealth use among a sample of predominantly lower-income, older Black adults. The researchers collaborated with community scientists to recruit, facilitate focus groups and provide technological support for participants. Sixteen virtual focus groups were conducted (n = 147) with older Black adults aged 55-84 years. The researchers utilized a thematic analysis approach to identify twelve distinct themes. RESULTS Participants identified the following as motivators to using in-person health care: improved patient-provider relationships, increased community support, and more culturally sensitive resources. Limited accessibility, discrimination and resulting distrust, and poor patient-provider communication were identified as barriers to in-person health care use. E-health literacy and accessibility both emerged as motivators of and barriers to using telehealth, while disinterest in telehealth and impersonal patient-provider relationships were noted as additional barriers. CONCLUSION These findings provide key implications for reducing the burden of health care inequity for older Black adults. Future implementation research should use equity-focused frameworks such as the patient-centered culturally sensitive health care (PC-CSHC) model. Additionally, collaboration with the community is necessary to create and implement the necessary culturally sensitive health interventions.
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Affiliation(s)
- Kirsten G Klein
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Carolyn M Tucker
- Department of Health Disparities, University of Florida, Gainesville, FL, United States
| | - Jeannette Mejia
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Kelly Folsom
- Department of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Shruti Kolli
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Stephen Anton
- Department of Physiology and Aging, University of Florida, Gainesville, FL, United States
| | - Eric Stewart
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | - Ann-Marie Knight
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | | | - Marjorie Belcher
- Department of Health Disparities, University of Florida, Gainesville, FL, United States
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Oh KM, Cieslowski B, Beran K, Elnahas NH, Steves SL, Sutter RE. Nurse-led telehealth and mobile health care models for type 2 diabetes and hypertension in low-income US populations: A scoping review. J Am Assoc Nurse Pract 2024; 36:565-575. [PMID: 39042268 DOI: 10.1097/jxx.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/12/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Increasing numbers of underserved people with chronic diseases and decreasing providers in rural areas have contributed to the care shortage in the United States. Nurse-led telehealth/mobile care models have potential benefits for this population. However, there is a substantial gap in the literature regarding this topic. PURPOSE To examine the available literature on nurse-led telehealth/mobile health care models with a particular focus on care model settings, nursing roles, care components, achieved outcomes, and the identification of both facilitative factors and encountered challenges. The ultimate goal is to offer recommendations based on these findings, thereby aiding the development or refinement of evidence-based care models that meet to the unique needs of low-income populations. METHODOLOGY Literature published from 2010 to 2023 was searched in six electronic databases (Cumulative Index to Nursing and Allied Health Literature, Communication and Mass Media Complete, Medline, APA PsycINFO, Social Sciences Index, and Web of Science databases). RESULTS Commonalities identified among included studies with significant improvements were the provision of home monitors and education to participants, multiple engagements, and extensive community and/or family involvement. CONCLUSIONS Nurse-led telehealth/mobile health care models for chronic diseases are an emerging approach. Nurse educators must ensure that future nurses are adept in diverse telehealth modes, collaborating across disciplines. Leveraging advanced practice registered nurses and interdisciplinary teams provides holistic care. IMPLICATIONS Our review outlined recent research findings that suggest enhanced patient outcomes through technology, communication, and community support. In addition, we offered suggestions for future research and practice, emphasizing the importance of exploring the requirements of diverse and underserved communities.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, Virginia
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4
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McConnell KJ, Edelstein S, Wolk CB, Lindner S, Zhu JM. Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae104. [PMID: 39220582 PMCID: PMC11363869 DOI: 10.1093/haschl/qxae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/09/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
The COVID-19 public health emergency (PHE) caused significant disruptions in the delivery of care, with in-person visits decreasing and telehealth use increasing. We investigated the impact of these changes on mental health services for Medicaid-enrolled adults and youth in Washington State. Among enrollees with existing mental health conditions, the first year of the PHE was associated with a surge in specialty outpatient mental health visits (13% higher for adults and 7% higher for youth), returning to pre-PHE levels in the second year. Conversely, youth with new mental health needs experienced a decline in specialty outpatient visit rates by ∼15% and 37% in the first and second years of the PHE, respectively. These findings indicate that while mental health service use was maintained or improved for established patients, these patterns did not extend to Medicaid-enrolled youth with new mental health needs, potentially due to barriers such as difficulty in finding providers and establishing new patient-provider relationships remotely. To bridge this gap, there is a need for a multi-faceted approach that includes improving service accessibility, enhancing provider availability, and optimizing initial care encounters, whether in-person or virtual, to better support new patients.
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Affiliation(s)
- K John McConnell
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR 97239, United States
| | - Sara Edelstein
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR 97239, United States
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Stephan Lindner
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR 97239, United States
| | - Jane M Zhu
- Division of General Internal Medicine, Oregon Health and Science University, Portland, OR, 97239, United States
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Amagai S, Vonesh E, Adams J, Luo Y. Closing the gap: addressing telehealth disparities across specialties in the sustained pandemic era. NPJ Digit Med 2024; 7:217. [PMID: 39164391 PMCID: PMC11335954 DOI: 10.1038/s41746-024-01201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
Missed appointments, or no-shows, disrupt healthcare delivery, exacerbating chronic disease management and leading to worse health outcomes. Telehealth has surged as a viable solution to reduce no-shows and improve healthcare accessibility, especially during the COVID-19 pandemic. However, telehealth disparities and its long-term efficacy across various medical specialties remain understudied. To address this, we performed a retrospective analysis of electronic health records from a heterogenous network of hospitals in Illinois, examining telehealth use and no-shows across among 444,752 adult patients with 1,973,098 outpatient encounters across nine specialties during the sustained pandemic phase (i.e., January 1, 2021 to July 1, 2022). Among them, 84,290 (4.27%) were no-shows, and telehealth constituted 202,933 (10.3%) of the total encounters. Telehealth use during the sustained phase varied significantly by specialty type. Overall, telehealth encounters were associated with reduced no-show odds compared to in-person encounters (OR, 0.28; 95% CI, 0.26-0.29). Black and Hispanic patients, as well as those with Medicaid, had higher no-show odds relative to their counterparts, even when using telehealth. Mental health specialty had the highest telehealth usage rate and the highest no-show odds (OR, 2.99; 95% CI, 2.84-3.14) relative to other specialties included in the study. Moreover, specialty type had differential effects on no-shows for telehealth. These results underscore the variability in telehealth use by specialty type and pervasive disparities telehealth use and no-shows. As we move beyond the pandemic, our findings can inform policymakers to tailor policies and incentives to reach different patient groups as well as specialties, with varying needs, to promote equitable telehealth utilization.
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Affiliation(s)
- Saki Amagai
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edward Vonesh
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James Adams
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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6
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Lynette Ejezie C, Cuccaro P, Savas LS, Shegog R. Regional differences in provider recommendation of HPV vaccines among 13-to-17 year old adolescents from 2019 to 2021. Vaccine 2024; 42:125974. [PMID: 38796327 DOI: 10.1016/j.vaccine.2024.05.022] [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: 02/28/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE The prevalence of recommendation of human papillomavirus (HPV) vaccination by health care providers has improved over the last decade. However, research to determine whether the COVID-19 pandemic affected the progress in recommendation among adolescents across the U.S. regions has been limited. Therefore, the present study was conducted to determine if region was associated with provider recommendation of HPV vaccines in 2019-2021 and whether changes in recommendations varied by region. METHOD Using a cross-sectional design to examine National Immunization Survey-Teen (2019-2021) data, logistic regression and moderation analyses were performed to model region variation in HPV vaccine recommendations (n = 50,739 respondents). RESULTS The odds of recommendation were higher in the Midwest (aOR, 1.17 [95% CI, 1.06-1.29]), and Northeast (aOR, 1.38 [95% CI, 1.23-1.56]) regions than in the South region. Also, the odds of provider recommendation were higher in 2020 (aOR,1.16 [95% CI, 1.03-1.30]) than in 2019. Other variables-sex, age, race/ethnicity, health insurance status, and poverty status-were associated with recommendation of HPV vaccination. CONCLUSION Although the improvement in recommendation from 2019 to 2020 is an important public health gain, recommendation in the South still lags behind that in other regions. More efforts are needed to improve HPV vaccination recommendations in this region.
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Affiliation(s)
- Chinenye Lynette Ejezie
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Lara S Savas
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX 77030, USA
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7
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Wang RC, Lipin DI, Swoboda TK, Sambamoorthi U. A Comparative Analysis of Healthcare Quality Perception Among Different Vulnerable Populations with and without Telehealth Utilization: A Cross-Sectional Study from the Health Information National Trends Survey. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02116-8. [PMID: 39102175 DOI: 10.1007/s40615-024-02116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The COVID-19 pandemic led to a rapid expansion of telehealth utilization in medicine. However, the quality measures associated with telehealth use remain unclear, particularly among vulnerable populations. This study aims to investigate the impact of telehealth on individuals' perception of overall quality care among vulnerable patient populations. METHODS This cross-sectional study utilized Health Information National Trends Survey data. The individuals' overall perception of healthcare quality was compared between populations that had at least one telehealth visit and non-telehealth users, who all had the option of utilizing telehealth. This comparison focused on vulnerable populations, considering differences in race and ethnicity (non-Hispanic white vs. non-Hispanic black/Hispanic individuals) and socioeconomic status (high vs. low). Multivariable logistic regressions were employed to ascertain the association between individuals' overall perceptions of quality care with and without telehealth utilization. RESULTS A total of 2920 participants, representing an unweighted population of 114,608,302, were analyzed. The adjusted odds ratio (AOR) for at least one telehealth visit associated with individuals' overall perception of quality care among the entire survey population was 0.76 with a 95% CI of 0.51-1.13 (p = 0.173). The AOR was 0.83 (95% CI 0.39-1.77, p = 0.618) among the non-White population, and the AOR was 0.71 (95% CI 0.29-1.78, p = 0.462) among individuals with low SES. CONCLUSIONS Although telehealth utilization has both its limitations and advantages compared to traditional clinical visits, no statistically significant differences in individuals' overall perception of quality care were identified among telehealth and non-telehealth users. These findings were also consistent across various vulnerable populations.
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Affiliation(s)
- Richard C Wang
- St. Mark's School of Texas, 10600 Preston Rd, Dallas, TX, 75230, USA.
| | - Daniel I Lipin
- St. Mark's School of Texas, 10600 Preston Rd, Dallas, TX, 75230, USA
| | - Thomas K Swoboda
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, 657 N. Town Center Drive, Las Vegas, NV, 89144, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, Texas Center for Health Disparity, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Hartman-Munick SM, Allen S, Powell A. Disordered Eating/Eating Disorders in Adolescents. Pediatr Clin North Am 2024; 71:631-643. [PMID: 39003006 DOI: 10.1016/j.pcl.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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
The coronavirus disease 2019 pandemic was as tressful time for adolescents, with increased isolation, loss of routines, and changes in access to medical care. In this setting, the medical system saw a significant rise in the number of adolescents seeking care for eating disorders, as well as increased severity of patient presentation. Telehealth treatment for eating disorders was a unique shift during the pandemic, with some benefits but not universally positive experiences among patients, families and providers.
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Affiliation(s)
- Sydney M Hartman-Munick
- University of Massachusetts Memorial Children's Medical Center, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Suzanne Allen
- University of Massachusetts Memorial Children's Medical Center, UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Anne Powell
- University of Massachusetts Memorial Children's Medical Center, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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Zheng D, Shang Y, Ni J, Peng L, Tan X, Dai Z, Zhao Y, Gu A, Wang J, Song Y, Li X, Zhang J, Heng W, Zhang C, Liu C, Li H, Du Y, Xu J, Wu D, Cai X, Meng R, Dong X, Ruan Y, Jiang L. Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study. JMIR Cancer 2024; 10:e45331. [PMID: 38838304 PMCID: PMC11187506 DOI: 10.2196/45331] [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: 12/28/2022] [Revised: 05/18/2023] [Accepted: 12/05/2023] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. OBJECTIVE The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician's perspective. METHODS A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform's registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. RESULTS Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. CONCLUSIONS This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions.
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Affiliation(s)
- Di Zheng
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanhong Shang
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Jian Ni
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ling Peng
- Department of Respiratory Disease, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiaoming Tan
- Department of Respiratory and Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoxia Dai
- Department of Thoracic Medical Oncology II, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yizhuo Zhao
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiqin Gu
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiying Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanyan Song
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Li
- Internal Medicine of Thoracic Oncology, Baotou Tumor Hospital, Baotou, China
| | - Junping Zhang
- Department of Thoracic Oncology, The Affiliated Bethune Hospital of Shaanxi Medical University, Taiyuan, China
| | - Wei Heng
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cuiying Zhang
- Cancer Center, Inner Mongolia Autonomous Region People's Hospital, Huhehot, China
| | - Chunling Liu
- The Second Ward, Department of Pulmonary Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Hui Li
- Cancer Center, Inner Mongolia Autonomous Region People's Hospital, Huhehot, China
| | - Yingying Du
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianfang Xu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dan Wu
- Department of Thoracic Surgery, Cixi People's Hospital, Ningbo, China
| | - Xuwei Cai
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Meng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaorong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaoping Ruan
- College of Mathematics and Computer Science, Zhejiang A&F University, Hangzhou, China
- Metafame Technologies Inc, Shanghai, China
| | - Liyan Jiang
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Daniels B, McGinnis C, Topaz LS, Greenwald P, Turchioe MR, Creber RMM, Sharma R. Bridging the digital health divide-patient experiences with mobile integrated health and facilitated telehealth by community-level indicators of health disparity. J Am Med Inform Assoc 2024; 31:875-883. [PMID: 38269583 PMCID: PMC10990509 DOI: 10.1093/jamia/ocae007] [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: 10/09/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Evaluate the impact of community tele-paramedicine (CTP) on patient experience and satisfaction relative to community-level indicators of health disparity. MATERIALS AND METHODS This mixed-methods study evaluates patient-reported satisfaction and experience with CTP, a facilitated telehealth program combining in-home paramedic visits with video visits by emergency physicians. Anonymous post-CTP visit survey responses and themes derived from directed content analysis of in-depth interviews from participants of a randomized clinical trial of mobile integrated health and telehealth were stratified into high, moderate, and low health disparity Community Health Districts (CHD) according to the 2018 New York City (NYC) Community Health Survey. RESULTS Among 232 CTP patients, 55% resided in high or moderate disparity CHDs but accounted for 66% of visits between April 2019 and October 2021. CHDs with the highest proportion of CTP visits were more adversely impacted by social determinants of health relative to the NYC average. Satisfaction surveys were completed in 37% of 2078 CTP visits between February 2021 and March 2023 demonstrating high patient satisfaction that did not vary by community-level health disparity. Qualitative interviews conducted with 19 patients identified differing perspectives on the value of CTP: patients in high-disparity CHDs expressed themes aligned with improved health literacy, self-efficacy, and a more engaged health system, whereas those from low-disparity CHDs focused on convenience and uniquely identified redundancies in at-home services. CONCLUSIONS This mixed-methods analysis suggests CTP bridges the digital health divide by facilitating telehealth in communities negatively impacted by health disparities.
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Affiliation(s)
- Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Christina McGinnis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Peter Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | | | | | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
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Linggonegoro D, Williams K, Hlobik M, Huang J. Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey. JMIR DERMATOLOGY 2024; 7:e51511. [PMID: 38517468 PMCID: PMC10998172 DOI: 10.2196/51511] [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: 08/03/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024] Open
Abstract
Certain sociodemographic factors are associated with low technology access and digital healthy literacy.
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Affiliation(s)
- Danny Linggonegoro
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kathryn Williams
- Biostatistics and Research Design Center, ICCTR, Boston Children's Hospital, Boston, MA, United States
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
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12
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Marcondes FO, Normand SLT, Le Cook B, Huskamp HA, Rodriguez JA, Barnett ML, Uscher-Pines L, Busch AB, Mehrotra A. Racial and Ethnic Differences in Telemedicine Use. JAMA HEALTH FORUM 2024; 5:e240131. [PMID: 38517424 PMCID: PMC10960201 DOI: 10.1001/jamahealthforum.2024.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/24/2024] [Indexed: 03/23/2024] Open
Abstract
Importance Individuals of racial and ethnic minority groups may be less likely to use telemedicine in part due to lack of access to technology (ie, digital divide). To date, some studies have found less telemedicine use by individuals of racial and ethnic minority groups compared with White individuals, and others have found the opposite. What explains these different findings is unclear. Objective To quantify racial and ethnic differences in the receipt of telemedicine and total visits with and without accounting for demographic and clinical characteristics and geography. Design, Setting, and Participants This cross-sectional study included individuals who were continuously enrolled in traditional Medicare from March 2020 to February 2022 or until death. Exposure Race and ethnicity, which was categorized as Black non-Hispanic, Hispanic, White non-Hispanic, other (defined as American Indian/Pacific Islander, Alaska Native, and Asian), and unknown/missing. Main Outcomes and Measures Total telemedicine visits (audio-video or audio); total visits (telemedicine or in-person) per individual during the study period. Multivariable models were used that sequentially adjusted for demographic and clinical characteristics and geographic area to examine their association with differences in telemedicine and total visit utilization by documented race and ethnicity. Results In this national sample of 14 305 819 individuals, 7.4% reported that they were Black, 5.6% Hispanic, and 4.2% other race. In unadjusted results, compared with White individuals, Black individuals, Hispanic individuals, and individuals of other racial groups had 16.7 (95% CI, 16.1-17.3), 32.9 (95% CI, 32.3-33.6), and 20.9 (95% CI, 20.2-21.7) more telemedicine visits per 100 beneficiaries, respectively. After adjustment for clinical and demographic characteristics and geography, compared with White individuals, Black individuals, Hispanic individuals, and individuals of other racial groups had 7.9 (95% CI, -8.5 to -7.3), 13.2 (95% CI, -13.9 to -12.6), and 9.2 (95% CI, -10.0 to -8.5) fewer telemedicine visits per 100 beneficiaries, respectively. In unadjusted and fully adjusted models, and in 2019 and the second year of the COVID-19 pandemic, Black individuals, Hispanic individuals, and individuals of other racial groups continued to have fewer total visits than White individuals. Conclusions and Relevance The results of this cross-sectional study of US Medicare enrollees suggest that although nationally, Black individuals, Hispanic individuals, and individuals of other racial groups received more telemedicine visits during the pandemic and disproportionately lived in geographic regions with higher telemedicine use, after controlling for geographic region, Black individuals, Hispanic individuals, and individuals of other racial groups received fewer telemedicine visits than White individuals.
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Affiliation(s)
| | - Sharon-Lise T. Normand
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Benjamin Le Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jorge A. Rodriguez
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Alisa B. Busch
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- McLean Hospital, Belmont, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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13
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Qian L, Sy LS, Hong V, Glenn SC, Ryan DS, Nelson JC, Hambidge SJ, Crane B, Zerbo O, DeSilva MB, Glanz JM, Donahue JG, Liles E, Duffy J, Xu S. Impact of the COVID-19 Pandemic on Health Care Utilization in the Vaccine Safety Datalink: Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e48159. [PMID: 38091476 PMCID: PMC10807656 DOI: 10.2196/48159] [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: 04/13/2023] [Revised: 08/02/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers for strategic planning, as well as to researchers when designing studies that use observational electronic health record data during the pandemic period. OBJECTIVE This study aimed to evaluate the changes in health care utilization across all care settings among a large, diverse, and insured population in the United States during the COVID-19 pandemic. METHODS We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages from January 1, 2017, to December 31, 2021. The visit rates per person-year were calculated monthly during the study period for 4 health care settings combined as well as by inpatient, emergency department (ED), outpatient, and telehealth settings, both among all members and members without COVID-19. Difference-in-difference analysis and interrupted time series analysis were performed to assess the changes in visit rates from the prepandemic period (January 2017 to February 2020) to the early pandemic period (April-December 2020) and the later pandemic period (July-December 2021), respectively. An exploratory analysis was also conducted to assess trends through June 2023 at one of the largest sites, Kaiser Permanente Southern California. RESULTS The study included more than 11 million members from 2017 to 2021. Compared with the prepandemic period, we found reductions in visit rates during the early pandemic period for all in-person care settings. During the later pandemic period, overall use reached 8.36 visits per person-year, exceeding the prepandemic level of 7.49 visits per person-year in 2019 (adjusted percent change 5.1%, 95% CI 0.6%-9.9%); inpatient and ED visits returned to prepandemic levels among all members, although they remained low at 0.095 and 0.241 visits per person-year, indicating a 7.5% and 8% decrease compared to pre-pandemic levels among members without COVID-19, respectively. Telehealth visits, which were approximately 42% of the volume of outpatient visits during the later pandemic period, were increased by 97.5% (95% CI 86.0%-109.7%) from 0.865 visits per person-year in 2019 to 2.35 visits per person-year in the later pandemic period. The trends in Kaiser Permanente Southern California were similar to those of the entire study population. Visit rates from January 2022 to June 2023 were stable and appeared to be a continuation of the use levels observed at the end of 2021. CONCLUSIONS Telehealth services became a mainstay of the health care system during the late COVID-19 pandemic period. Inpatient and ED visits returned to prepandemic levels, although they remained low among members without evidence of COVID-19. Our findings provide valuable information for strategic resource allocation for postpandemic patient care and for designing observational studies involving the pandemic period.
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Affiliation(s)
- Lei Qian
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lina S Sy
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Vennis Hong
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Sungching C Glenn
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Denison S Ryan
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jennifer C Nelson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Simon J Hambidge
- Denver Health Ambulatory Care Services, Denver, CO, United States
| | - Bradley Crane
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | | | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - James G Donahue
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Elizabeth Liles
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Jonathan Duffy
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stanley Xu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
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14
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Bhuyan SS, Kalra S, Mahmood A, Rai A, Bordoloi K, Basu U, O'Callaghan E, Gardner M. Motivation and Use of Telehealth Among People with Depression in the United States. J Prim Care Community Health 2024; 15:21501319241266515. [PMID: 39279333 PMCID: PMC11409303 DOI: 10.1177/21501319241266515] [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: 09/18/2024] Open
Abstract
INTRODUCTION The global mental health crisis, compounded by the challenges of the COVID-19 pandemic, underscores the urgent need for accessible mental health care solutions. Telehealth services have emerged as a promising technology to address barriers to access mental health services. However, population-based studies examining telehealth utilization among individuals with depression are limited. METHODS Using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) of 2022 (n = 4502), we investigated telehealth utilization among individuals diagnosed with depression in the United States. We employed multivariable logistic regression analysis to assess the association, adjusting for demographics, health behaviors, health status, trust in the medical system, and access to transportation. We also studied the factors that motivated the use of telehealth among individuals diagnosed with depression. RESULTS In the multivariable adjusted logistic regression models, individuals diagnosed with depression (AOR 2.59, 95% CI 1.96-3.42) were significantly more likely to use telehealth services relative to individuals with no depression diagnosis. Other factors associated with increased telehealth use included women (AOR 1.36, 95% CI 1.07-1.72), Hispanic ethnicity (AOR 1.78, 95% CI 1.28-2.48), being married or living with a partner (AOR 1.30, 95% CI 1.05-1.62), frequent healthcare visits (AOR 2.31, 95% CI 1.71-3.11), health insurance coverage (AOR 1.86, 95% CI 1.04-3.34), confidence in self-care (AOR 1.38, 95% CI 1.07-1.78), and lack of reliable transportation (AOR 1.57, 95% CI 1.01-2.42). Major motivation factors that influenced telehealth use among individuals with depression primarily included convenience, such as reduced travel times, as well as clinicians' recommendations. CONCLUSION Telehealth is a promising option for accessing mental health care, particularly for those with depression. Further research is needed to understand how well telehealth works and how it can be combined with traditional care, ensuring fair costs and keeping information safe.
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Affiliation(s)
| | - Saurabh Kalra
- The State University of New Jersey, New Brunswick, NJ, USA
| | - Asos Mahmood
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Akasha Rai
- The State University of New Jersey, New Brunswick, NJ, USA
| | | | - Urmi Basu
- Insight Biopharma, Princeton, NJ, USA
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15
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Kim J, Kelley J, Choi S, Weir P. Impact of Transportation Barriers on Telehealth Use During the COVID-19 Pandemic. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241266345. [PMID: 39129323 PMCID: PMC11320394 DOI: 10.1177/00469580241266345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/17/2024] [Accepted: 06/10/2024] [Indexed: 08/13/2024]
Abstract
Telehealth use among individuals with and without transportation challenges remains understudied. This study aims to compare telehealth utilization and types of healthcare services between subjects with and without transportation challenges. Using data from the 2021 Medical Expenditure Panel Survey (MEPS), we identified telehealth use for office visits by adults (≥18 years old) in 2021, categorizing the type of healthcare services received, such as checkups and mental health counseling. Weighted logistic regression was employed to identify factors associated with telehealth usage. The total population analyzed was 204 621 985 (unweighted n = 17 674). The average (SD) age of the subjects was 49 (18) years old, and 53% were female. On average, individuals with transportation challenges had 1.40 telehealth visits, while those without such challenges had 0.87 visits (P = .03). Additionally, individuals with transportation challenges had more visits related to behavioral health compared to those without transportation challenges (22% vs 11%, P < .01). Those facing transportation challenges were 40% more likely to use telehealth compared to those without transportation challenges (OR = 1.40, P = .01). The findings suggest that telehealth could serve as a viable solution to overcome transportation barriers and improve access to care. However, it is crucial to assess access to care through telehealth to enhance the health outcomes for individuals facing transportation challenges.
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Affiliation(s)
| | | | | | - Peter Weir
- University of Utah Medical Group Population Health, Salt Lake City, UT, USA
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16
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Mojtahedi Z, Sun I, Shen JJ. Telehealth Utilization and Good Care among Informal Caregivers: Health Information National Trends Survey, 2022. Healthcare (Basel) 2023; 11:3193. [PMID: 38132083 PMCID: PMC10742888 DOI: 10.3390/healthcare11243193] [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: 11/18/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the adoption of telehealth services. Informal caregivers provide vital support to family and friends. Studying telehealth among informal caregivers is crucial to understanding how technology can support and enhance their caregiving responsibilities, potentially enhancing telehealth services for them as well as their patients. The present study aims to nationally investigate telehealth utilization and quality among informal caregivers. METHODS This cross-sectional investigation employed the 2022 Health Information National Trends Survey (HINTS) dataset. Informal caregivers, telehealth variables (utilization, good care, technical problems, convenience, and concerns about infection exposure), and sociodemographic factors (age, gender, race/ethnicity, income, education, health insurance, and census regions) were identified based on questions in the survey. Weighted multivariable logistic regression models were employed to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. RESULTS Significant disparities in telehealth utilization were detected among informal caregivers (N = 831), when telehealth users were compared to non-users. Those aged 50-64 (OR = 0.36, 95% CI = 0.20-0.65) and 65+ (OR = 0.40, 95% CI = 0.21-0.74) had significantly lower odds of using telehealth than those aged 35-49. Men had significantly lower odds of telehealth utilization (OR = 0.47, 95% CI = 0.25-0.87). Black caregivers compared to Whites had significantly lower odds (OR = 0.49, 95% CI = 0.24-0.99), while health insurance increased odds (OR = 5.31, 95% CI = 1.67-16.86) of telehealth utilization. Informal caregivers who used telehealth were more likely to be perceived as good telehealth caregivers if they had no telehealth technical issues compared to caregivers who had (OR = 4.61, CI = 1.61-13.16; p-value = 0.0051) and if they were from the South compared to the West (OR = 2.95, CI = 1.18-7.37, p-value = 0.0213). CONCLUSIONS For the first time, to the best of our knowledge, we have nationally investigated telehealth utilization and quality among informal caregivers. Disparities in telehealth utilization among informal caregivers are evident, with age, gender, race, and health insurance being significant determinants. Telehealth quality is significantly influenced by technical problems and census regions, emphasizing the importance of addressing these aspects in telehealth service development for informal caregivers.
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Affiliation(s)
- Zahra Mojtahedi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA; (Z.M.); (I.S.)
| | - Ivan Sun
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA; (Z.M.); (I.S.)
- UNLV Brookings Mountain West, University of Nevada, Las Vegas, NV 89154, USA
| | - Jay J. Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA; (Z.M.); (I.S.)
- Center for Health Disparities and Research, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
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17
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Aldzhyan V, Tamamian C, Tabibian JH. Leveraging telemedicine in gastroenterology and hepatology: a narrative review. Mhealth 2023; 9:36. [PMID: 38023778 PMCID: PMC10643195 DOI: 10.21037/mhealth-23-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objective Over the years, telemedicine has played a prominent role in delivering healthcare to patients. Due to its flexibility and many benefits, telemedicine confers physicians the ability to guide and promote medical care remotely. The advent of the coronavirus disease 2019 (COVID-19) pandemic has changed the landscape of medicine and has accelerated the usage of digital and remote healthcare systems for clinical care. Herein, we provide an overview of telemedicine, its applications in managing inflammatory bowel disease (IBD), celiac disease (CD), and liver diseases, its advantages and limitations, and its use in educating the next generation of gastroenterologists. Methods We conducted a review of scientific articles published in PubMed and Google Scholar. Articles were selected based on the search terms included in the search strategy summary. The language of the articles was restricted to English only. Key Content and Findings We report that telemedicine has the potential to streamline and improve patient care in gastroenterology (GI) and hepatology while also limiting health care expenses. Additionally, we noted the importance of tele-education for training the next generation of physicians who intend on practicing in rural settings. Furthermore, we identified barriers to telemedicine care that exacerbate health inequities and potential solutions to achieving digital health equity. Lastly, we briefly discuss the role of artificial intelligence (AI) in remote patient monitoring. Conclusions Although telemedicine has existed for many decades, over the past decade there have been many advancements in telemedicine applications in GI and hepatology. Despite its broad benefits, further research needs to be done to alleviate barriers to telemedicine care.
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Affiliation(s)
- Vahagn Aldzhyan
- Department of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carine Tamamian
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - James H. Tabibian
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Division of Gastroenterology, Adventist Health Glendale Medical Center, Glendale, CA, USA
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18
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Pecker LH, Ruvalcaba E, Lanzkron S, Eakin MN. "The Patient Should Have a Choice": Adults with Sickle Cell Disease Advise Integration of Telemedicine into the Comprehensive Sickle Cell Disease Care Model. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01780-6. [PMID: 37682425 PMCID: PMC10983044 DOI: 10.1007/s40615-023-01780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Adults with sickle cell disease (SCD) constitute a unique and vulnerable patient population with complex healthcare needs including routine follow-up visits and acute care evaluations. The COVID-19 pandemic accelerated healthcare systems' transition to providing telemedicine care. The purpose of this qualitative study was to elicit the perspectives of adults with SCD about their experience with telemedicine during the COVID-19 pandemic and to understand their preferences with respect to future telemedicine care. METHODS Adults with SCD who had a telemedicine visit between March August 2020 and were cared for at our SCD center were eligible to participate in a one-time interview. Interviews were audio taped, transcribed, and analyzed using NVIVO software. RESULTS Among 30 interviewed subjects, 28 transcripts were available for analysis. Analysis identified that participants compared telemedicine to in-person care across several domains including (a) how time is used, (b) personal safety, (c) pain management, and (d) maintaining caring relationships. Participants agreed that telemedicine care was most appropriate for follow-up care and less useful for painful crises or urgent needs. They expressed concerns about the need to expand telemedicine to other specialities and to ensure that privacy and technical support are provided. CONCLUSIONS Telemedicine appeals to adults with SCD for maintenance SCD care. Decisions about in-person or telemedicine care need to be made in discussion with the patient with particular attention to pain management preferences. Ultimately, telemedicine is an option that adults with SCD would like to see continue and that has the potential to expand access to care to more geographically distant regions.
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Affiliation(s)
- Lydia H Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Sabir M, Al-Tarshan Y, Snapp C, Brown M, Walker R, Han A, Kostrominova T. Analysis of COVID-19 Case Demographics and Disease Outcomes in Gary, Indiana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6729. [PMID: 37754588 PMCID: PMC10531445 DOI: 10.3390/ijerph20186729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic further exposed the prevalence of existing health disparities in Black communities in the U.S. The current study evaluates COVID-19 data collected in Gary, Indiana, from June 2020 to June 2021. We hypothesized that the number of COVID-19 cases, hospitalizations, and deaths were influenced by race and income. METHODS In collaboration with the Gary Health Department (GHD), we analyzed demographic data on COVID-19-positive cases. RESULTS Compared to Gary's non-Black population, age- and population-adjusted rates of hospitalizations and deaths in the Black population were 3-fold (p < 0.0001) and 2-fold (p < 0.05) higher, respectively. This is despite a higher infection rate (p < 0.0001) in the non-Black population. The median household income of a zip code was negatively correlated with COVID-19 hospitalizations (R2 = 0.6345, p = 0.03), but did not correlate with infections and deaths. CONCLUSIONS The current study demonstrates clear health disparities of income and race in the context of COVID-19-related infections and outcomes in the city of Gary. Indiana University School of Medicine Northwest and GHD officials can collaborate to utilize these data for the reallocation of resources and health education efforts in Gary's highly populated, low-income, and predominantly Black neighborhoods. It should also prompt further investigation into national health resource allocation.
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Affiliation(s)
- Maryam Sabir
- Northwest Campus, Indiana University School of Medicine, Gary, IN 46408, USA; (M.S.); (Y.A.-T.); (C.S.)
| | - Yazan Al-Tarshan
- Northwest Campus, Indiana University School of Medicine, Gary, IN 46408, USA; (M.S.); (Y.A.-T.); (C.S.)
| | - Cameron Snapp
- Northwest Campus, Indiana University School of Medicine, Gary, IN 46408, USA; (M.S.); (Y.A.-T.); (C.S.)
| | - Martin Brown
- Gary Health Department, Gary, IN 46402, USA; (M.B.); (R.W.)
| | - Roland Walker
- Gary Health Department, Gary, IN 46402, USA; (M.B.); (R.W.)
| | - Amy Han
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Tatiana Kostrominova
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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20
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Yoo JW, Kang HT, Choe I, Kim L, Han DH, Shen JJ, Kim Y, Reed PS, Ioanitoaia-Chaudhry I, Chong MT, Kang M, Reeves J, Tabrizi M. Racial and Ethnic Disparity in 4Ms among Older Adults Among Telehealth Users as Primary Care. Gerontol Geriatr Med 2023; 9:23337214231189053. [PMID: 37529374 PMCID: PMC10387800 DOI: 10.1177/23337214231189053] [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: 02/24/2023] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Telehealth has been widely accepted as an alternative to in-person primary care. This study examines whether the quality of primary care delivered via telehealth is equitable for older adults across racial and ethnic boundaries in provider-shortage urban settings. The study analyzed documentation of the 4Ms components (What Matters, Mobility, Medication, and Mentation) in relation to self-reported racial and ethnic backgrounds of 254 Medicare Advantage enrollees who used telehealth as their primary care modality in Southern Nevada from July 2021 through June 2022. Results revealed that Asian/Hawaiian/Pacific Islanders had significantly less documentation in What Matters (OR = 0.39, 95%, p = .04) and Blacks had significantly less documentation in Mobility (OR = 0.35, p < .001) compared to their White counterparts. The Hispanic ethnic group had less documentation in What Matters (OR = 0.18, p < .001) compared to non-Hispanic ethnic groups. Our study reveals equipping the geriatrics workforce merely with the 4Ms framework may not be sufficient in mitigating unconscious biases healthcare providers exhibit in the telehealth primary care setting in a provider shortage area, and, by extrapolation, in other care settings across the spectra, whether they be in-person or virtual.
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Affiliation(s)
- Ji Won Yoo
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | | | | | - Laurie Kim
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | | | | | | | | | - Iulia Ioanitoaia-Chaudhry
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Veterans Affairs Southern Nevada Health System, North Las Vegas
| | - Maria Teresa Chong
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Veterans Affairs Southern Nevada Health System, North Las Vegas
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