Using Telemedicine During the COVID-19 Pandemic: Attitudes of Adult Health Care Consumers in Israel

An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

Breaking barriers: exploring physiotherapists' willingness and challenges in embracing telerehabilitation in a developing country

INTRODUCTION

Telerehabilitation (TR) is an innovative approach that can address the limited availability and restricted access to rehabilitation services, particularly during challenging times such as pandemics and natural disasters. This study focuses on understanding the desires, perceptions, and barriers that physiotherapists face when implementing TR in a developing country.

METHOD

The study was conducted with 219 physiotherapists residing in a developing country using a web-based survey on Google Docs.

RESULT

The findings revealed that a significant majority of physiotherapists (88.1%) recognized TR as a potential solution for individuals with physical problems during the pandemic. Additionally, 89.5% expressed satisfaction with the opportunity to receive consultations from different hospitals, indicating a positive perception of TR. However, the study also highlighted certain barriers that hindered the implementation of TR. Around 40.2% of physiotherapists reported having training deficiencies, suggesting a need for educational support in utilizing TR effectively. Furthermore, the analysis of demographic factors revealed interesting insights. It was noteworthy that the age and years of experience of physiotherapists had an impact on their willingness and adoption of TR.

CONCLUSION

The study reveals that physiotherapists in the developing country exhibit a positive attitude towards TR and recognize its potential benefits. However, various barriers, such as training deficiencies, need to be addressed to facilitate a broader adoption of TR in their practices. Overcoming these barriers is anticipated to heighten physiotherapists' readiness to embrace TR, ultimately enhancing the accessibility and delivery of rehabilitation services.

Post-abortion needs-based education via the WeChat platform to lessen fear and encourage effective contraception: a post-abortion care service intervention-controlled trial

OBJECTIVE

Our study aims to investigate post-abortion needs-based education via the WeChat platform for women who had intended abortion in the first trimester, whether they are using effective contraception or becoming pregnant again.

DESIGN

This single hospital intervention-controlled trial used a nearly 1:1 allocation ratio. Women who had intended abortions were randomly assigned to a Wechat group (needs-based education) and a control group (Traditional education). The women's ability to use effective contraception was the main result. Whether they unknowingly became pregnant again was the second result. Another result was patient anxiousness. Before and after education, women filled out questionnaires to assess their contraception methods and anxiety.

METHODS

Based on the theoretical framework of contraceptions of IBL (inquiry-based learning), post-abortion women were included in WeChat groups. We use WeChat Group Announcement, regularly sending health education information, one-on-one answers to questions, and consultation methods to explore the possibilities and advantages of WeChat health education for women after abortion. A knowledge paradigm for post-abortion health education was established: From November 2021 until December 2021, 180 women who had an unintended pregnancy and undergone an induced or medical abortion were recruited, their progress was tracked for four months, and the PAC service team monitored the women's speech, discussed and classified the speech entries and summarized the common post-abortion needs in 8 aspects. At least 2 research group members routinely extracted records and categorized the outcomes.

RESULTS

Before education, there were no appreciable variations between the two groups regarding sociodemographic characteristics, obstetrical conditions, abortion rates, or methods of contraception (P > 0.05). Following education, the WeChat group had a greater rate of effective contraception (63.0%) than the control group (28.6%), and their SAS score dropped statistically more than that of the control group (P < 0.05). Following the education, there were no unwanted pregnancies in the WeChat group, whereas there were 2 in the traditional PAC group. Only 5 participants in the WeChat group and 32 in the conventional PAC group reported mild anxiety after the education.

Disparities in telemedicine utilization among kidney transplant patients during the COVID-19 pandemic: Barriers and opportunities

INTRODUCTION

The COVID-19 pandemic allowed for the rapid implementation of telemedicine for kidney transplant patients; however, widespread adoption may worsen existing health care inequities among vulnerable populations. This study aimed to characterize telemedicine utilization by kidney transplant patients during the early pandemic with particular attention to healthcare equity.

METHODS

A retrospective analysis of kidney transplant patients interacting with telemedicine was performed. Patient demographic data and distance to the transplant center were obtained. The National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties and Brokamp Neighborhood Deprivation Index (NDI) score were used to characterize patients' counties of residence. Multivariable logistic regression evaluated associations between patient and community characteristics and the likelihood of an encounter being telemedicine.

RESULTS

This study included 1033 patients who participated in 3727 encounters from March 11 through October 2020. Characteristics associated with decreased likelihood of telemedicine use were increased age (OR = .993; 95% CI = .986-.999, P = .022), non-White vs. White race (OR = .826, 95% CI = .697-.979; P = .028), male vs. female sex (OR = .746, 95% CI = .632-.880; P < .001), and a higher Brokamp Neighborhood Deprivation Index score (OR = .159; 95% CI = .029-.873; P = .034). The effect of distance to the transplant center on the likelihood of a telemedicine encounter differed by NCHS Urban-Rural designation (interaction P = .018), with its likelihood increasing by 2%-3% with each 10-mile increment among persons residing in medium-, small-, and non-metropolitan counties compared to those residing in the most rural counties.

CONCLUSIONS

Telemedicine visits were less often completed by patients of older age, non-white race, male sex, and those residing in counties having higher NDI scores. While telemedicine has the potential to improve healthcare access and decrease costs, proactive efforts need to be taken to mitigate disparities in vulnerable populations.

Patient centeredness, independent health-related Internet use, and online communication with healthcare providers in later life: A cross-sectional study

OBJECTIVE

To test the links between patient centeredness, independent health-related Internet use, and online communication with healthcare provider in later life.

METHODS

These links were tested on a multivariable level through the prism of the socioemotional selectivity theory and the channel complementarity theory. The data were obtained from the Health Information National Trends Survey (Wave 5, Cycle 4) and analyzed using logistic regression models. The sample included older Internet users (N = 1165).

RESULTS

Low patient centeredness corresponded to a decreased likelihood of communicating with healthcare providers online. No particular patient centeredness component was associated with the studied phenomenon. Online health information seeking corresponded to an increased likelihood of communicating with healthcare providers online.

CONCLUSION

Patient centeredness plays a relatively modest role in explanation of the online communication with healthcare providers in later life. In addition, older adults' online health information seeking behavior and online patient-provider communication seem to complement each other.

PRACTICE IMPLICATIONS

The findings can serve public health officials for developing programs aimed at increasing the rates of the online communication with healthcare providers in older population. The findings can also serve healthcare providers in their efforts to improve the quality of (online) communication with their older patients.

The effect of the COVID-19 pandemic on the provision of outpatient clinic services in East Jerusalem hospitals: patients' perspectives

Background

Due to the decreased availability, accessibility, and quality of services, the COVID-19 pandemic has an impact on the healthcare system. In the wake of the COVID-19 pandemic, patients' perceptions of healthcare have changed, and out-patient visits to clinics have decreased. As part of the COVID-19 outbreak in East Jerusalem, this study aims to assess how patients perceive the way that outpatient clinic services were delivered before and during COVID-19 outbreak.

Methodology

Convenience sampling and self-reported questionnaires were used in a cross-sectional study. Three hundred people from three significant outpatient clinic hospitals in East Jerusalem-Al-Makassed Hospital, Augusta Victoria Hospital, and Sant-Joseph Hospital- made up the sample. Multivariate tests, frequencies, and percentages were used in the statistical analysis.

Results

The results showed that the most of the participants (98.6%) had negative opinion when the current situation is compared with before the COVID-19 period in terms of accessibility, availability of resources, quality of care, attitudes and patient's preference. Finally, multivariate analysis indicated a significant relationship between participant opinion and education level and participants with educational levels of 12 study years or less had more positive opinions of the delivery of the healthcare system during the COVID-19 outbreak period than the group with more than 12 study years. Also, the multivariate analysis revealed a significant `relationship between participant opinion and the duration of the illness as those with years of illness and less had more negative opinion toward the delivery of the healthcare system than those with more than 3 years of illness.

Conclusion

This study found that when the current situation during the COVID-19 outbreak is compared to before the COVID-19 period in terms of accessibility, availability of resources, quality of care, attitudes, and patient preferences, the majority of the participants with chronic diseases or cancer had a negative opinion. Policymakers and health managers should enhance patient preferences and attitudes during the COVID-19 pandemic and other pandemics by increasing accessibility, availability of health resources, and the quality of healthcare.

General Public Perceptions and Perceived Barriers Toward the Use of Telehealth: A Cross-Sectional Study from Jordan

Background: Telemedicine implies the provision of health care services, such as diagnosis, treatment, and consultation related to different disease states remotely through harnessing a variety of technologies. Aim: Despite the widespread global applications related to telehealth, there are limited research articles exploring the perceptions and barriers related to telehealth implementation in developing countries such as Jordan. Thus, this study was conducted to explore general public perceptions regarding the provision of health care services through different technological devices and to examine perceived barriers and facilitators. Methods: A cross-sectional study was conducted for 6 months. Participants were recruited through different social media portals. A convenient sample from the Jordanian population was approached. A total of 1,136 responses were collected and included in the final analysis, which was done by the Statistical Package for Social Sciences (SPSS version 25). Results: A total of 1,136 responses were valid for further analysis. The results of this study expressed that the public has positive perceptions toward the use of telemedicine with the majority being capable of using telehealth based on having an active internet connection, technological devices, and the ability to use social media accounts or instant messaging services. Logistic regression analysis revealed that those with comorbid diseases and higher summated capability scores (p = -0.017 and p < 0.001, respectively) had a statistically significant relationship with willingness to use telehealth as reflected by stating a clear intention to use telehealth services once available. Conclusion: In conclusion, the Jordanians had positive perceptions toward the use of telehealth services. However, their willingness to use telehealth services was affected by limited knowledge about the service. Telehealth offers the opportunity to provide quality care and improve patient outcomes, especially for the inhabitants of rural areas or in cases where access to health care facilities is compromised such as pandemics.

Hepatitis C Elimination: Opportunities and Challenges in 2023

Hepatitis C Virus (HCV) infection is a leading etiology of liver cirrhosis and its associated complications, namely, decompensated cirrhosis. As such, hepatitis C potentially necessitates liver transplantation and may result in death. Recently, HCV treatment has evolved. Current HCV treatment is effective in curing HCV; some of the agents are pan-genotypic. Numerous countries have adopted an initiative to eliminate HCV. Achieving elimination poses many challenges; it requires improved availability and accessibility of pan-genotypic therapy. Barriers exist at the level of the collective healthcare system and at the level of the individual healthcare providers and patients. Therefore, organized national and local efforts are needed. Surmounting these barriers calls for interventions concerning screening, linkage to care, and treatment delivery. Pertinent barriers include inadequate availability of screening, ill-equipped laboratory testing before treatment, and insufficient access to treatment. Interventions should seek to decentralize laboratory testing and treatment provision, increase funding for resources and personnel, and spread awareness. Special consideration should be allocated to at-risk populations, such as intravenous drug users, refugees, and prisoners. Computerized medical filing and telemedicine have the potential to refine HCV management by enhancing detection, availability, accessibility, and cost-effectiveness.

The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review

BACKGROUND

Telemedicine has become more convenient and advantageous due to the rapid development of the internet and telecommunications. A growing number of patients are turning to telemedicine for health consultations and health-related information. Telemedicine can increase access to medical care by removing geographical and other barriers. In most nations, the COVID-19 pandemic imposed social isolation. This has accelerated the transition to telemedicine, which has become the most commonly utilized method of outpatient care in many places. Telehealth can assist resolve gaps in access to healthcare services and health outcomes, in addition to its primary function of boosting accessibility to remote health services. However, as the benefits of telemedicine become more apparent, so do the limitations of serving vulnerable groups. Some populations may lack digital literacy or internet access. Homeless persons, the elderly, and people with inadequate language skills are also affected. In such circumstances, telemedicine has the potential to exacerbate health inequities.

AIM AND METHODS

In this narrative review (using the PubMed and Google scholar database), the different benefits and drawbacks of telemedicine are discussed, both globally and in Israel, with particular focus paid to special populations and to the telehealth usage during the Covid-19 period.

FINDINGS

The contradiction and paradox of using telemedicine to address health inequities yet sometimes making them worse is highlighted. The effectiveness of telemedicine in bridging access to healthcare inequities is explored along with a number of potential solutions.

CONCLUSIONS

Policy makers should identify barriers among special populations to using telemedicine. They should initiate interventions to overcome these barriers, while adapting them to the needs of these groups.

Telehealth Use in Pediatric Care during the COVID-19 Pandemic: A Qualitative Study on the Perspectives of Caregivers

This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee County, MI, participated. The caregivers were biological parents, stepparents, foster parents, adoptive parents, and guardians. A total of 105 caregivers completed a survey with open-ended questions via Qualtrics. Two independent coders developed themes based on the responses using grounded theory. Participants were primarily biological parents and non-Hispanic White and African Americans. According to the participants, the benefits of telehealth included prevention of exposure to the COVID-19 virus, quality communication with physicians, savings in travel time, and cost-effective methods to receive care. The challenges included a lack of in-person interaction, fear of compromised confidentiality, and the potential for misdiagnosis. Suggestions for improvement by caregivers included increasing access to telehealth for poorer families, offering a media educational campaign to promote telehealth use, and creating a universal platform to share patient information. Future studies may test the effectiveness of interventions such as those suggested by caregivers in this study to improve telehealth.

Philadelphia-negative chronic myeloproliferative neoplasm follow-up: when the phone rings. Changes during the COVID-19 pandemic and patient satisfaction. Experience in 30 health centers in Spain

The SARS-CoV-2 pandemic has favored the expansion of telemedicine. Philadelphia-negative chronic myeloproliferative neoplasms (Ph-MPN) might be good candidates for virtual follow-up. In this study, we aimed to analyze the follow-up of patients with Ph-MPN in Spain during COVID-19, its effectiveness, and acceptance among patients. We present a multicenter retrospective study from 30 centers. Five hundred forty-one patients were included with a median age of 67 years (yr). With a median follow-up of 19 months, 4410 appointments were recorded. The median of visits per patient was 7 and median periodicity was 2.7 months; significantly more visits and a higher frequency of them were registered in myelofibrosis (MF) patients. 60.1% of visits were in-person, 39.5% were by telephone, and 0.3% were videocall visits, with a predominance of telephone visits for essential thrombocythemia (ET) and polycythemia vera (PV) patients over MF, as well as for younger patients (< 50 yr). The proportion of phone visits significantly decreased after the first semester of the pandemic. Pharmacological modifications were performed only in 25.7% of the visits, and, considering overall management, ET patients needed fewer global treatment changes. Telephone contact effectiveness reached 90% and only 5.4% required a complementary in-person appointment. Although 56.2% of the cohort preferred in-person visits, 90.5% of our patients claimed to be satisfied with follow-up during the pandemic, with an 83% of positive comments. In view of our results, telemedicine has proven effective and efficient, and might continue to play a complementary role in Ph-MPN patients' follow-up.

Assessment of Primary Care Physicians' Perception of Telemedicine Use During the COVID-19 Pandemic in Primary Health Care Corporation, Qatar

While telemedicine has been extensively researched throughout the globe, the Middle East has seen relatively little research on the topic. The purpose of this study was to investigate the primary care physicians' perceptions of the use of telemedicine, as well as its hurdles and benefits, during the COVID-19 pandemic in the state of Qatar. In this multicenter cross-sectional study, an internally validated questionnaire was distributed among primary care physicians utilizing telemedicine during the pandemic at Primary Health Care Corporation (PHCC), the main primary care provider in Qatar. A convenience sample was taken due to the pandemic restrictions. Out of 254 analyzed questionnaires, about half of the physicians (48%) had used telemedicine in the past primarily in the form of telephone consultations. Nearly three-quarters (74%) of physicians agreed that telemedicine is an easy way to communicate during the pandemic, but only half (52%) felt it improved job performance and effectiveness. Most physicians (90%) agreed that telemedicine is safe during the pandemic, but opinion was split on whether an optimum assessment of COVID-19 disease could be conducted. The majority also considered telemedicine an effective tool for chronic disease reviews (63%) and other consultations such as blood test results and medicine prescriptions (71%). The most significant barrier to telemedicine use was a language barrier followed by a lack of proper training. About 79% of responders felt that telemedicine improves access to healthcare and assists in contacting difficult-to-reach individuals, and 74% also thought it minimizes no-shows in the clinics. Our study has shown that most physicians felt comfortable and safer using telemedicine as an alternative means to conduct consultations during the pandemic. Keeping in view its advantages, the majority suggested that it could be incorporated into daily practice even beyond the pandemic. However, concerns were raised about its use to assess COVID-19 disease, lack of training, and potential barriers such as language differences. Further studies are needed to assess the efficiency and cost-effectiveness of telemedicine as well as the evaluation of alternative media such as video consultation, which could increase the utility of telemedicine and potentially mitigate some of its disadvantages.

Patients' experience and satisfaction using telemedicine for outpatient services in a Tertiary Cancer Center in Qatar during COVID-19: A cross-sectional study

Background and Aim

The coronavirus-19 is an ongoing global pandemic resulting in millions of deaths worldwide. For a patient population at higher risk of infection, telemedicine is a promising means of providing safe and alternative care routes while minimizing their risk of exposure. This study gives insight into patients' experiences and satisfaction with telemedicine during this pandemic.

Methods

We conducted a cross-sectional study on 297 patients (RR: 85%) at the National Center for Cancer Care and Research (NCCCR), Qatar. Data was collected through electronic medical records of the eligibe patient population, and phone calls were made whereby the physician read a standard introductory script followed by a survey questionnaire. We focused on patients' experience with telemedicine services amid the pandemic. This was done using a six-point Likert scoring system of seven questions that were scaled from 1 to 6.

Results

More than 80% of patients somewhat to strongly agreed that telemedicine met their healthcare needs, improved their confidence in their healthcare system, and were generally satisfied with the quality of care provided. Nearly all patients (90%) understood their physicians' recommendations over the phone. In addition, more than half of the patients (89%) felt they could freely communicate their concerns. Patients also showed an inclination towards face-to-face consultations at 68%; however, 90% were willing to participate in future teleconsultations.

Conclusion

Our study indicates an overall positive experience among patients towards the use of telemedicine. Telemedicine is a safe, futuristic approach toward patient care management and, thus, provides healthcare professionals a platform to implement further patient and physician education. Even though our data also showed that patients liked in-person visits to some degree, this needs to be looked into more in future studies.

The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic

BACKGROUND

During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020-21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions.

METHODS

Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap^®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls.

RESULTS

Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience.

CONCLUSIONS

Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients.

Longitudinal Effects on Metabolic Biomarkers in Veterans 12 Months Following Discharge from Pharmacist-Provided Diabetes Care: A Retrospective Cohort Study

Clinical pharmacist interventions have resulted in optimized diabetes control in complex patients; however, there are no studies examining the durability of achieved outcomes after patients discontinued being seen by the pharmacist. A pharmacist-led comprehensive medication management (CMM) Diabetes Intensive Medication Management (DIMM) “tune up” clinic provided the opportunity to evaluate long-term glycemic control outcomes following clinical discharge. This study used a retrospective cohort study design with a matched primary care provider (PCP) comparison group. Outcomes were compared between the groups at several post-discharge intervals (6, 9, and 12 months) using independent t tests and chi-square tests, where appropriate. DIMM-managed patients achieved an average HbA1c reduction of 3% upon discharge, and maintained an average HbA1c concentration that was significantly lower than PCP-managed patients at 6 months (p < 0.001) and 9 months (p = 0.009) post-discharge. Although DIMM-managed patients had lower HbA1c than PCP-managed patients at 12 months post-discharge, the difference was not significant (p = 0.105). Similar findings were noted for average FPG and LDL across the study time points. No differences in average HDL levels were reported across the time points. A significantly larger proportion of DIMM-managed patients maintained HbA1c < 8% compared to PCP-managed patients at 6 months (67.5% versus 47.2%, p = 0.001) and 9 months (62.6% versus 40.6%, p = 0.040) post-discharge; DIMM-managed patients had a larger, but non-significant, proportion of goal retention compared to PCP-managed patients at 12 months (56.9% versus 47.2%, p = 0.126) post-discharge. Similarly, a significantly larger proportion of DIMM-managed patients sustained HbA1c < 9% compared to PCP-managed patients at 6 months (87.8% versus 66.7%, p < 0.001) and 9 months (82.1% versus 68.3%, p = 0.012) post-discharge; however, there was no significant difference at 12 months. The attenuation of the DIMM-managed metabolic biomarkers suggests that an additional follow-up visit or touchpoint may be helpful. The personalized care of the DIMM “tune up” approach was successful in achieving sustained glycemic control for up to 9 months. Outcomes can help inform future long-term result durability evaluations.

Experience of Primary Care Physicians in the Aube Department, France, Regarding the COVID-19 Crisis

BACKGROUND

General practitioners (GPs) played a decisive role during the COVID-19 epidemic, particularly in the identification and care of patients at home. This study aimed to describe the primary care physicians' perceptions of the COVID-19 crisis and to guide future decisions regarding measures to prolong, abrogate, or improve upon methods for crisis management.

METHODS

This is a cross-sectional study based on a 30-item questionnaire aiming to investigate how primary care physicians (GPs) working in the rural Aube Department experienced the COVID-19 crisis.

RESULTS

Among the 152 respondents, 60.5% were not satisfied with the level of information from authorities during the crisis. By multivariate analysis, a feeling of having been adequately informed (OR 21.87, 95%CI 4.14-115.53) and a feeling that non-COVID-19-related diseases were adequately managed (OR 6.42, 95%CI 1.07-38.51) were both significantly associated with an overall satisfaction with the management of the crisis.

CONCLUSION

This study about rural primary care physicians in Eastern France highlights some of the weaknesses of the French healthcare system in terms of the provision of primary care during the epidemic. A leading cause of dissatisfaction was that the information relayed by the health authorities about the disease and its management largely overlooked the primary care providers, many of whom had to rely on traditional media to obtain information.

Utilization Gaps During the COVID-19 Pandemic: Racial and Ethnic Disparities in Telemedicine Uptake in Federally Qualified Health Center Clinics

BACKGROUND

The Coronavirus Aid, Relief, and Economic Security (CARES) Act led to the rapid implementation of telemedicine across healthcare office settings. This innovation has the potential to improve healthcare use and ensure continuity of care. However, this delivery model could have an unintended consequence of worsening racial/ethnic disparities in healthcare utilization if adoption varies across sub-populations.

OBJECTIVE

To examine associations between telemedicine use and race/ethnicity between 3/1/2020 and 11/30/2020, and the influence of other individual- and geographical-level factors on this relationship.

DESIGN

Cohort study PARTICIPANTS: EMR data from 55 clinics in a FQHC network MAIN MEASURES: The dependent variable was visit type (in-person vs. telemedicine). Predictors of interest were patient race and ethnicity. To account for repeated visits within each patient nested within clinic, a three-level, mixed-effects, multivariable, logistic regression model was used. Subgroup analyses examined correlates of telemedicine use in African American and Hispanic cohorts, separately.

KEY RESULTS

The analytic sample included 233,302 visits for 67,733 unique patients. African Americans (OR = 0.65, 95% CI: 0.61, 0.69), Asians (OR = 0.58, 95% CI: 0.52, 0.65), and American Indians / Alaska Natives and other Pacific Islanders (OR = 0.82, 95% CI: 0.70, 0.98) were significantly less likely to use telemedicine compared to Whites. Hispanics were also less likely to have a telemedicine visit (OR = 0.49, 95% CI: 0.47, 0.51) compared to non-Hispanics. Nonacute visits were more likely to be conducted via telemedicine. Distance to clinic exhibited a dose-response relationship such that patients who lived farthest from the clinics were most likely to have telemedicine visits. In the subgroup analyses to examine predictors of telemedicine use, the dose-response relationship between distance from clinic and telemedicine use persisted, with increasing distance associated with increasing likelihood of telemedicine use, in both African American and Hispanic cohorts. Nonacute visits were associated with telemedicine use in the Hispanic cohort, but not in the Black / African American cohort.

CONCLUSION

Racial/ethnic disparities in telemedicine use persisted among this cohort. However, telemedicine improved utilization for African Americans and Hispanics living farther away from the clinic.

Contrasting the Expectations and Experiences of Mobile Health Use on Chronic Pain: A Questionnaire Study (Preprint)

Background

Chronic pain is a prolonged condition that deteriorates one's quality of life. Treating chronic pain requires a multicomponent approach, and in many cases, there are no “silver bullet” solutions. Mobile health (mHealth) is a rapidly expanding category of solutions in digital health with proven potential in chronic pain management.

Objective

This study aims to contrast the viewpoints of 2 groups of people with chronic pain concerning mHealth: people who have adopted the use of mHealth and those who have not. We highlight the benefits of mHealth solutions for people with chronic pain and the perceived obstacles to their increased adoption. We also provide recommendations to encourage people to try mHealth solutions as part of their self-care.

Methods

The Prolific crowdsourcing platform was used to collect crowdsourced data. A prescreening questionnaire was released to determine what type of pain potential participants have and whether they are currently using mHealth solutions for chronic pain. The participants were invited based on their experience using mHealth to manage their pain. Similar questions were presented to mHealth users and nonusers. Qualitative and quantitative analyses were performed to determine the outcomes of this study.

Results

In total, 31 responses were collected from people (aged 19-63 years, mean 31.4, SD 12.1) with chronic pain who use mHealth solutions. Two-thirds (n=20, 65%) of the users identified as female and 11 (35%) as male. We matched these mHealth users with an equal number of nonusers: 31 responses from the pool of 361 participants in the prescreening questionnaire. The nonusers’ ages ranged from 18 to 58 years (mean 30.8, SD 11.09), with 15 (50%) identifying as female and 15 (50%) as male. Likert-scale questions were analyzed using the Mann-Whitney-Wilcoxon (MWW) test. Results showed that the 2 groups differed significantly on 10 (43%) of 23 questions and shared similar views in the remaining 13 (57%). The most significant differences were related to privacy and interactions with health professionals. Of the 31 mHealth users, 12 (39%) declared that using mHealth solutions has made interacting with health or social care professionals easier (vs n=22, 71%, of nonusers). The majority of the nonusers (n=26, 84%) compared with about half of the users (n=15, 48%) expressed concern about sharing their data with, for example, third parties.

Conclusions

This study investigated how mHealth is currently used in the context of chronic pain and what expectations mHealth nonusers have for mHealth as a future chronic pain management tool. Analysis revealed contrasts between mHealth use expectations and actual usage experiences, highlighting privacy concerns toward mHealth solutions. Generally, the results showed that nonusers are more concerned about data privacy and expect mHealth to facilitate interacting with health professionals. The users, in contrast, feel that such connections do not exist.

Modifying UTAUT2 for a cross-country comparison of telemedicine adoption

The ongoing COVID19 pandemic has put digital health technologies in the spotlight. To gain a deeper understanding of patients’ usage intentions of virtual doctor appointments, the present research adapts the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) by integrating perceived security and perceived product advantage, two known barriers to successful telemedicine adoption. Applying age-stratified sampling, an online survey was distributed to 800 citizens in Germany and the United States of America. 710 completed and valid questionnaires were subsequently analyzed using SPSS and AMOS (versions 24).

Significant, direct, and positive effects of performance expectancy, hedonic motivation, perceived security, and perceived product advantage on the behavioral intention to use virtual doctor appointments were found. The analysis of the moderating variables, age and gender, showed significant differences in user's performance expectancy and effort expectancy, and perceived product advantage, respectively. With virtual health care models on the rise, these results are important for stakeholders such as policymakers, governments, employers, but also physicians, and insurance companies as they offer clear recommendations to design telemedicine adoption strategies to ensure successful patient engagement.

Listen to Me! - A Mixed-Methods Study of Thoughts and Attitudes Towards Participation in Pulmonary Telerehabilitation Among People with Severe and Very Severe COPD Who Declined Participation in Pulmonary Rehabilitation

INTRODUCTION

Pulmonary rehabilitation (PR) is a key standard treatment for people with chronic obstructive pulmonary disease (COPD) with documented effect on symptom relief, improved physical function, and quality of life. However, referral, uptake and adherence rates remain low. Pulmonary telerehabilitation (PTR) is a safe and effective alternative to conventional PR. This study explores associations, thoughts and attitudes towards PTR in patients with COPD who decline referral to outpatient hospital-based routine PR.

METHODS

A mixed-methods study with integration of survey data (n=84) and semi-structured interviews (n=9).

RESULTS

We found a significant association between belief of effect of PTR and willingness to participate. Increasing age was significantly associated with reduced odds of daily use of central processing unit (CPU) or tablet. One-third of the participants were undecided about potential participation in PTR. Qualitative findings highlight that participants perceived participating in PTR as more convenient and had preferences for individualized, supervised, and monitored rehabilitation.

CONCLUSION

Those willing to participate in a PTR program believed in the benefits, were comfortable with technological devices, had preferences for exercising at home, and saw opportunities in the social setting. Future PTR programs should include monitoring, preferably managed by a familiar health care professional (HCP).

Adapting to change: Clalit's response to the COVID-19 pandemic

The COVID-19 pandemic is the most significant global health event of the past century. The profound and unexpected changes that it brought about have forced healthcare organizations to make far-reaching adjustments to accommodate the new reality. With the outbreak of the pandemic in Israel and the understanding of its consequences, Clalit Health Services (Clalit), the largest healthcare organization in Israel, rapidly mobilized in order to provide the best response possible from the perspective of both its patients and its employees. In the short term, four designated workgroups were established just days into the pandemic. Their task was to prepare operational work plans to achieve the following goals: providing the best possible treatment for COVID patients; maintaining the level of care for non-COVID patients; protecting healthcare personnel without compromising their competence and level of functioning; and beginning the process of post-crisis planning. In the context of the long term, and with the understanding that the changes in healthcare brought about by the COVID-19 pandemic would be long-lasting and irreversible, and would act as a catalyst in Clalit’s preparations for the future, Clalit has carried out the called-for modifications in its organizational strategy. This was based on the need to shift service and treatment foci from the hospitals to the community and the patient’s home and his cellular device, by means of strengthening Clalit’s strategic abilities to become more proactive, more digital and more home-based. In this article, we present a survey of Clalit’s preparations for the new reality in the short and medium terms, as well as the leveraging of insights gained during the first wave of the pandemic, with goal of revising Clalit’s long-term strategic plan. We conclude and point out the organizational abilities required for optimal response to future large-scale emergencies: The ability to quickly identify the need for change, respond quickly while harnessing the various parts of the organization in order to provide an agile and adaptive response, and facilitate long-term planning activity in parallel to providing an operational response in the short and medium terms.

Reasons for Utilizing Telemedicine during and after the COVID-19 Pandemic: An Internet-Based International Study

The COVID-19 pandemic challenges healthcare services. Concomitantly, this pandemic had a stimulating effect on technological expansions related to telehealth and telemedicine. We sought to elucidate the principal patients' reasons for using telemedicine during the COVID-19 pandemic and the propensity to use it thereafter. Our primary objective was to identify the reasons of the survey participants' disparate attitudes toward the use of telemedicine. We performed an online, multilingual 30-question survey for 14 days during March-April 2021, focusing on the perception and usage of telemedicine and their intent to use it after the pandemic. We analyzed the data to identify the attributes influencing the intent to use telemedicine and built decision trees to highlight the most important related variables. We examined 473 answers: 272 from Israel, 87 from Uruguay, and 114 worldwide. Most participants were women (64.6%), married (63.8%) with 1-2 children (52.9%), and living in urban areas (84.6%). Only a third of the participants intended to continue using telemedicine after the COVID-19 pandemic. Our main findings are that an expected substitution effect, technical proficiency, reduced queueing times, and peer experience are the four major factors in the overall adoption of telemedicine. Specifically, (1) for most participants, the major factor influencing their telemedicine usage is the implicit expectation that such a visit will be a full substitute for an in-person appointment; (2) another factor affecting telemedicine usage by patients is their overall technical proficiency and comfort level in the use of common web-based tools, such as social media, while seeking relevant medical information; (3) time saving as telemedicine can allow for asynchronous communications, thereby reducing physical travel and queuing times at the clinic; and finally (4) some participants have also indicated that telemedicine seems more attractive to them after watching family and friends (peer experience) use it successfully.

Telepsychiatry to Provide Mental Health Support to Healthcare Professionals during the COVID-19 Crisis: A Cross-Sectional Survey among 321 Healthcare Professionals in France

Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations.

Willingness to use telemedicine during COVID-19 among health professionals in a low income country

INTRODUCTION

The coronavirus disease 2019 pandemic has prompted rapid restructuring of the health-care system in an effort to stop the spread of the pandemic. Thus, telemedicine is more preferable in order to prevent the COVID-19 pandemic when face to face meeting is forbidden, allowing provision of health service over a distance. This study aimed to assess willingness to use telemedicine and factors that will determine their extent of willingness during COIVID-19 among healthcare providers working in south west of Ethiopia.

METHODS

Institutional based cross-sectional study design was applied to assess willingness to use telemedicine among healthcare providers working at public health hospitals in south west of Ethiopia. Self-administered questionnaires were used. We have used Epi-info for data entry and Analysis of Moment Structure (AMOS) for analysis. A structural equation modeling was performed to identify factors associated with willingness to use telemedicine at 95% confidence interval (CI).

RESULT

In this study, less than half of respondents had high willingness to use telemedicine. Ease of use (β = 0.79, 95% CI: [0.72, 0.86], p < 0.01), attitude (β = 0.91, 95% CI: [0.87, 0.95], p < 0.01) and patient-physician relationships (β = 0.67, 95% CI: [0.54, 0.70], p < 0.01) were variables associated with willingness to use telemedicine. Anxiety towards technology (β = 0.74, 95% CI: [0.69, 0.79], p < 0.01) and patient-physician relationships (β = 0.87, 95% CI: [0.81, 0.92], p < 0.01) were determinant factors of attitude to use telemedicine.

CONCLUSIONS

The overall willingness to use telemedicine during COVID-19 in this setting is 46.5%. Addressing the problem related with ease of use, attitude and patient-physician relationships will help to increase the overall willingness to use telemedicine during COVID-19. An attempt to improving patient-physician relationship, provision of technical training for ease of use and working on healthcare providers' attitude will help to improve the willingness to use telemedicine.