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Kim J, Cai ZR, Chen ML, Onyeka S, Ko JM, Linos E. Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022. JMIR Public Health Surveill 2024; 10:e51279. [PMID: 38669075 DOI: 10.2196/51279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/28/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease's emergence. OBJECTIVE We aim to comprehensively assess telehealth use and its associated factors in the United States. METHODS This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. RESULTS Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers' recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. CONCLUSIONS To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research.
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Affiliation(s)
- Jiyeong Kim
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Zhuo Ran Cai
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Michael L Chen
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Sonia Onyeka
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Justin M Ko
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Eleni Linos
- Stanford Center for Digital Health, School of Medicine, Stanford University, Stanford, CA, United States
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Iroh Tam PY, Twabi HH, Gondwe M, O'Byrne T, Lufesi N, Desmond N. Child acute illness presentation and referrals at primary health clinics in Malawi: a secondary analysis of ASPIRE. BMJ Open 2024; 14:e079589. [PMID: 38670607 DOI: 10.1136/bmjopen-2023-079589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES We aimed to assess the prevalence, presentation and referral patterns of children with acute illness attending primary health centres (PHCs) in a low-resource setting. DESIGN, SETTING AND PARTICIPANTS We conducted a secondary analysis of ASPIRE. Children presenting at eight PHCs in urban Blantyre district in southern Malawi with both recorded clinician and mHealth (non-clinician) triage data were included, and patient records from different data collection points along the patient healthcare seeking pathway were consolidated and analysed. RESULTS Between April 2017 and September 2018, a total of 204 924 children were triaged, of whom 155 931 had both recorded clinician and mHealth triage data. The most common presenting symptoms at PHCs were fever (0.3%), cough (0.2%) and difficulty breathing (0.2%). The most common signs associated with referral for under-5 children were trauma (26.7%) and temperature (7.4%). The proportion of emergency and priority clinician triage were highest among young infants <2 months (0.2% and 81.4%, respectively). Of the 3004 referrals (1.9%), 1644 successfully reached the referral facility (54.7%). Additionally, 372 children were sent home from PHC who subsequently self-referred to the referral facility (18.7%). CONCLUSIONS Fever and respiratory symptoms were the most common presenting symptoms, and trauma was the most common reason for referral. Rates of referral were low, and of successful referral were moderate. Self-referrals constituted a substantial proportion of attendance at the referral facility. Reducing gaps in care and addressing dropouts as well as self-referrals along the referral pathway could improve child health outcomes.
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Affiliation(s)
- Pui-Ying Iroh Tam
- Malawi-Liverpool-Wellcome Trust Research Programme, Blantyre, Malawi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hussein H Twabi
- Malawi-Liverpool-Wellcome Trust Research Programme, Blantyre, Malawi
| | - Mtisunge Gondwe
- Malawi-Liverpool-Wellcome Trust Research Programme, Blantyre, Malawi
| | - Thomasena O'Byrne
- Malawi-Liverpool-Wellcome Trust Research Programme, Blantyre, Malawi
| | - Norman Lufesi
- Acute Respiratory Illness Unit, Government of Malawi Ministry of Health, Lilongwe, Malawi
| | - Nicola Desmond
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Haimi M, Sergienko R. Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis. JMIR Aging 2024; 7:e52317. [PMID: 38656768 DOI: 10.2196/52317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/15/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. OBJECTIVE This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. METHODS We explored the use characteristics of older adults (aged ≥65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. RESULTS Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. CONCLUSIONS Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability.
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Affiliation(s)
- Motti Haimi
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Health Administration Department, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Clalit Research Institute, Tel Aviv, Israel
| | - Ruslan Sergienko
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Neumann A, König HH, Hajek A. Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study. JMIR Aging 2024; 7:e50938. [PMID: 38654578 DOI: 10.2196/50938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 04/26/2024] Open
Abstract
Background The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19-related determinants were examined using multiple Firth logistic regressions. Results Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances.
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Affiliation(s)
- Ariana Neumann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bernal-Jiménez MÁ, Calle G, Gutiérrez Barrios A, Gheorghe LL, Cruz-Cobo C, Trujillo-Garrido N, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e48756. [PMID: 38648103 DOI: 10.2196/48756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. OBJECTIVE This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. METHODS This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. RESULTS The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75% vs 11/61, 42%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). CONCLUSIONS The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. TRIAL REGISTRATION Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504.
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Affiliation(s)
- María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - German Calle
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Alejandro Gutiérrez Barrios
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Livia Luciana Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Celia Cruz-Cobo
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Nuria Trujillo-Garrido
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Biomedicine, Biotechnology and Public Health Department, University of Cádiz, Cádiz, Spain
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain
- Network Biomedical Research Center "Pathophysiology of Obesity and Nutrition", Carlos III Health Institute, Madrid, Spain
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
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Ukert B, Lawley M, Kum HC. Geographic disparities in telemedicine mental health use by applying three way ANOVA on Medicaid claims population data. BMC Health Serv Res 2024; 24:494. [PMID: 38649985 PMCID: PMC11034036 DOI: 10.1186/s12913-024-10898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Utilization of telemedicine care for vulnerable and low income populations, especially individuals with mental health conditions, is not well understood. The goal is to describe the utilization and regional disparities of telehealth care by mental health status in Texas. Texas Medicaid claims data were analyzed from September 1, 2012, to August 31, 2018 for Medicaid patients enrolled due to a disability. METHODS We analyzed the growth in telemedicine care based on urban, suburban, and rural, and mental health status. We used t-tests to test for differences in sociodemographic characteristics across patients and performed a three-way Analyses of Variance (ANOVA) to evaluate whether the growth rates from 2013 to 2018 were different based on geography and patient type. We then estimated patient level multivariable ordinary least square regression models to estimate the relationship between the use of telemedicine and patient characteristics in 2013 and separately in 2018. Outcome was a binary variable of telemedicine use or not. Independent variables of interest include geography, age, gender, race, ethnicity, plan type, Medicare eligibility, diagnosed mental health condition, and ECI score. RESULTS Overall, Medicaid patients with a telemedicine visit grew at 81%, with rural patients growing the fastest (181%). Patients with a telemedicine visit for a mental health condition grew by 77%. Telemedicine patients with mental health diagnoses tended to have 2 to 3 more visits per year compared to non-telemedicine patients with mental health diagnoses. In 2013, multivariable regressions display that urban and suburban patients, those that had a mental health diagnosis were more likely to use telemedicine, while patients that were younger, women, Hispanics, and those dual eligible were less likely to use telemedicine. By 2018, urban and suburban patients were less likely to use telemedicine. CONCLUSIONS Growth in telemedicine care was strong in urban and rural areas between 2013 and 2018 even before the COVID-19 pandemic. Those with a mental health condition who received telemedicine care had a higher number of total mental health visits compared to those without telemedicine care. These findings hold across all geographic groups and suggest that mental health telemedicine visits did not substitute for face-to-face mental health visits.
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Affiliation(s)
- Benjamin Ukert
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Hye-Chung Kum
- Population Informatics Lab, Department of Health Policy and Management, Texas A&M University, College Station, TX, USA.
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Gashaw DG, Alemu ZA, Constanzo F, Belay FT, Tadesse YW, Muñoz C, Rojas JP, Alvarado-Livacic C. COVID-19 patient satisfaction and associated factors in telemedicine and hybrid system. Front Public Health 2024; 12:1384078. [PMID: 38645451 PMCID: PMC11028400 DOI: 10.3389/fpubh.2024.1384078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background The quality assessment of the home-based isolation and care program (HBIC) relies heavily on patient satisfaction and length of stay. COVID-19 patients who were isolated and received HBIC were monitored through telephone consultations (TC), in-person TC visits, and a self-reporting application. By evaluating patient satisfaction and length of stay in HBIC, healthcare providers could gauge the effectiveness and efficiency of the HBIC program. Methods A cross-sectional study design enrolled 444 HBIC patients who answered a structured questionnaire. A binary logistic regression model assessed the association between independent variables and patient satisfaction. The length of stay in HBIC was analyzed using Cox regression analysis. The data collection started on April (1-30), 2022, in Addis Ababa, Ethiopia. Results The median age was 34, and 247 (55.6%) were females. A greater proportion (313, 70.5%) of the participants had high satisfaction. Higher frequency of calls (>3 calls) (AOR = 2.827, 95% CI = 1.798, 4.443, p = 0.000) and those who were symptomatic (AOR = 2.001, 95% CI = 1.289, 3.106, p = 0.002) were found to be significant factors for high user satisfaction. Higher frequency of calls (>3 calls) (AHR = 0.537, 95% CI = 0.415, 0.696, p = 0.000) and more in-person visits (>1 visit) (AHR = 0.495, 95% CI = 0.322, 0.762, p = 0.001) had greater chances to reduce the length of stay in the COVID-19 HBIC. Conclusion 70.5% of the participants had high satisfaction with the system, and frequent phone call follow-ups on patients' clinical status can significantly improve their satisfaction and length of recovery. An in-person visit is also an invaluable factor in a patient's recovery.
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Affiliation(s)
- Dagmawit G. Gashaw
- National Public Health Emergency Operation Center, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Freddy Constanzo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Feben T. Belay
- National Training Center, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Carla Muñoz
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Juan Pablo Rojas
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Cristobal Alvarado-Livacic
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
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Acharya M, Ali MM, Bogulski CA, Pandit AA, Mahashabde RV, Eswaran H, Hayes CJ. Association of Remote Patient Monitoring with Mortality and Healthcare Utilization in Hypertensive Patients: a Medicare Claims-Based Study. J Gen Intern Med 2024; 39:762-773. [PMID: 37973707 PMCID: PMC11043264 DOI: 10.1007/s11606-023-08511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Hypertension management is complex in older adults. Recent advances in remote patient monitoring (RPM) have warranted evaluation of RPM use and patient outcomes. OBJECTIVE To study associations of RPM use with mortality and healthcare utilization measures of hospitalizations, emergency department (ED) utilization, and outpatient visits. DESIGN A retrospective cohort study. PATIENTS Medicare beneficiaries aged ≥65 years with an outpatient hypertension diagnosis between July 2018 and September 2020. The first date of RPM use with a corresponding hypertension diagnosis was recorded (index date). RPM non-users were documented from those with an outpatient hypertension diagnosis; a random visit was selected as the index date. Six months prior continuous enrollment was required. MAIN MEASURES Outcomes studied within 180 days of index date included (i) all-cause mortality, (ii) any hospitalization, (iii) cardiovascular-related hospitalization, (iv) non-cardiovascular-related hospitalization, (v) any ED, (vi) cardiovascular-related ED, (vii) non-cardiovascular-related ED, (viii) any outpatient, (ix) cardiovascular-related outpatient, and (x) non-cardiovascular-related outpatient. Patient demographics and clinical variables were collected from baseline and index date. Propensity score matching (1:4) and Cox regression were performed. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. KEY RESULTS The matched sample had 16,339 and 63,333 users and non-users, respectively. Cumulative incidences of mortality outcome were 2.9% (RPM) and 4.3% (non-RPM), with a HR (95% CI) of 0.66 (0.60-0.74). RPM users had lower hazards of any [0.78 (0.75-0.82)], cardiovascular-related [0.79 (0.73-0.87)], and non-cardiovascular-related [0.79 (0.75-0.83)] hospitalizations. No significant association was observed between RPM use and the three ED measures. RPM users had higher hazards of any [1.10 (1.08-1.11)] and cardiovascular-related outpatient visits [2.17 (2.13-2.19)], while a slightly lower hazard of non-cardiovascular-related outpatient visits [0.94 (0.93-0.96)]. CONCLUSIONS RPM use was associated with substantial reductions in hazards of mortality and hospitalization outcomes with an increase in cardiovascular-related outpatient visits.
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Affiliation(s)
- Mahip Acharya
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mir M Ali
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ambrish A Pandit
- Divison of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruchira V Mahashabde
- Divison of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare Systems, North Little Rock, AR, USA.
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Apathy NC, Zabala G, Gomes K, Spaar P, Krevat SA, Ratwani RM. Telemedicine and In-Person Visit Modality Mix and Electronic Health Record Use in Primary Care. JAMA Netw Open 2024; 7:e248060. [PMID: 38656580 PMCID: PMC11043894 DOI: 10.1001/jamanetworkopen.2024.8060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/22/2024] [Indexed: 04/26/2024] Open
Abstract
This cross-sectional study investigates the association between day-to-day changes in telemedicine share and clinician time spent on electronic health record (EHR) use.
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Affiliation(s)
- Nate C. Apathy
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC
| | - Garrett Zabala
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC
| | - Kylie Gomes
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC
| | - Patti Spaar
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC
| | - Seth A. Krevat
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC
- Department of General Internal Medicine, Georgetown University School of Medicine, Washington, DC
| | - Raj M. Ratwani
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC
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10
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Harris E. A Third of Older Adults Are Interested in Online-Only Health Services. JAMA 2024; 331:554. [PMID: 38294844 DOI: 10.1001/jama.2023.28338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
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11
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Agboryah BENM, Ndip VA, Ngomba AV, Tazinya AA, Adiogo D. Factors associated with the use of digital health among healthcare workers in the Buea and Tiko health districts of Cameroon: a cross-sectional study. Pan Afr Med J 2024; 47:51. [PMID: 38646140 PMCID: PMC11032081 DOI: 10.11604/pamj.2024.47.51.35531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/15/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction digital health has been demonstrated to improve the efficiency and scale of health service delivery in resource-limited settings. Understanding factors influencing its use could accelerate the process of its implementation in routine practice. Methods we conducted a cross-sectional analytic study in Buea and Tiko health districts from January to May 2021. We included healthcare workers selected using multistage stratified sampling. Use of digital health was defined as using at least two digital tools and one digital health intervention (DHI) or at least two DHIs by a healthcare worker. Epi Info was used for statistical analysis. Binary logistic regression was used to evaluate factors associated with the use of digital health. Results in total, 221 participants were included in the study. The mean age was 33±9.1 years and 76.5% were female. Only 39.4% (n=87) of participants used digital health. The most frequently used digital tools for health-related purposes included: Microsoft (MS) Excel (29.9%), MS PowerPoint (26.8%) and MS Word (39.1%). The main DHIs used were research (30.2%) and diagnosing (24.1%) software. The main use of digital health was for research (75.6%). Owning a laptop (adjusted odds ratio (aOR)=1.98, 95% CI, 1.01 - 3.86), availability of internet connection in the health facility (1.99, 1.05 - 3.7) and receiving professional training in ICT/Computer Sciences (2.04, 1.06 - 3.93), were associated with higher odds of using digital health. Conclusion this study shows a low level of use of digital health by healthcare workers. Providing newer devices, internet connection in health facilities and training in ICT for healthcare workers could improve its uptake.
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Affiliation(s)
- Bill-Erich Nkongho Mbianyor Agboryah
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Jalpha Health Tech, Douala, Cameroon
- Department of Population Health Research, Health Education and Research Organization, Buea, Cameroon
| | - Valirie Agbor Ndip
- Department of Population Health Research, Health Education and Research Organization, Buea, Cameroon
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Armelle Viviane Ngomba
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Division of Disease, Epidemics and Pandemics Control, Ministry of Public Health, Yaounde, Cameroon
| | | | - Dieudonné Adiogo
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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12
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Zayar NN, Kittiratchakool N, Saeraneesopon T, Butchon R, Dabak SV, Namahoot P, Kaewchompoo T, Kingkaew P, Teerawattananon Y, Isaranuwatchai W. Telemedicine Utilization Patterns and Implications Amidst COVID-19 Outbreaks in Thailand Under Public Universal Coverage Scheme. Inquiry 2024; 61:469580241246466. [PMID: 38676535 PMCID: PMC11056088 DOI: 10.1177/00469580241246466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024]
Abstract
During COVID-19 pandemic, telemedicine was a strategy to facilitate healthcare service delivery minimizing the risk of direct exposure among people. In Thailand, the National Health Security Office has included telemedicine services under the Universal Coverage Scheme to support social distancing policies to reduce the spread of COVID-19. This study aimed to determine the patterns of telemedicine service use during major COVID-19 outbreaks including Alpha, Delta, and Omicron in Thailand. We retrospectively analyzed a dataset of telemedicine e-claims from the National Health Security Office, which covers services reimbursed under the Universal Coverage Scheme between December 2020 and August 2022. An interrupted time-series analysis, Pearson correlation analysis and binary logistic regression were performed. Almost 70% of the patients using telemedicine services were over 40 years old. Most patients used services for mental health problems (25.6%) and major noncommunicable diseases, including essential hypertension (12.6%) and diabetes mellitus (9.2%). The daily number of using telemedicine service was strongly correlated with the number of COVID-19 new cases detected. An immediate change in the trend of using telemedicine was detected at the onset of outbreaks along with the surge of infection. The follow-up use of telemedicine services was not substantial among female, older adults patients and those with non-communicable diseases except mental health problems, and infectious diseases. Strategies need to be developed to reinforced healthcare resources for telemedicine during the surge of outbreaks and sustain the use of telemedicine services for chronic and infectious diseases, regardless of the pandemic, and promote the efficiency of healthcare systems.
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Affiliation(s)
- Nyi-Nyi Zayar
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Prince of Songkla University, Hat Yai, Thailand
| | - Nitichen Kittiratchakool
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | | | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- National University of Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- University of Toronto, Toronto, Canada
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13
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Fatabhoy MG, Zhu G, Lajaunie A, Schneiderhan JR, Pierce J. Intimate Partner Violence and Telemedicine Usage and Satisfaction Early in the COVID-19 Pandemic. J Am Board Fam Med 2023; 36:755-765. [PMID: 37648405 DOI: 10.3122/jabfm.2023.230021r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND COVID-19 has transformed the landscape of telemedicine utilization, shifting from predominantly in-person services to increased virtual encounters. Although telemedicine offers increased accessibility for medical care, many advocates voice concern about utilization and satisfaction with these services among individuals who experience intimate partner violence (IPV) given the unique practical, mental, and physical health challenges many face. OBJECTIVE The purpose of the present study was to evaluate differences in telemedicine utilization and satisfaction, as well as global health and perceived loneliness, among data-driven patterns of IPV during the early phases of the pandemic. METHODS In this longitudinal survey study, participants first completed an online survey between May 2019 and February 2020 that assessed social, psychological, and physical functioning, as well as emotional and physical IPV. A follow-up survey sent in May 2020 assessed recent telemedicine use and satisfaction, as well as response to the COVID-19 pandemic. RESULTS Latent class analysis favored 4 classes of IPV that differed based on severity and features of IPV experienced. Although all 4 classes reported high satisfaction with telemedicine, individuals reporting low IPV had the highest satisfaction with telemedicine and the lowest rates of telemedicine utilization. Individuals who experienced IPV, particularly multiple forms of emotional and physical IPV, reported high physical and social concerns and perceived stress. CONCLUSIONS Clinicians using telemedicine should be aware of the multiple challenges faced by individuals experiencing IPV and take additional steps to ensure their needs are met in a safe way. These results have potentially important clinical and policy implications.
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Affiliation(s)
- Megha G Fatabhoy
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA (MGF, GZ, AL, JP); Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA (JRS)
| | - Guohao Zhu
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA (MGF, GZ, AL, JP); Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA (JRS)
| | - Aurianna Lajaunie
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA (MGF, GZ, AL, JP); Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA (JRS)
| | - Jill R Schneiderhan
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA (MGF, GZ, AL, JP); Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA (JRS)
| | - Jennifer Pierce
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA (MGF, GZ, AL, JP); Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA (JRS)
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14
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Lee J, Manalew WS. Reasons for Not Pursuing Virtual Prenatal Care in 2020 Through 2021 and Policy Implications. Telemed J E Health 2023; 29:1492-1503. [PMID: 36787485 PMCID: PMC10589501 DOI: 10.1089/tmj.2022.0492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Aim: To investigate patterns of virtual prenatal visits and examine reasons for not pursuing virtual visits for prenatal care. Methods: A pooled cross-sectional study used Pregnancy Risk Assessment Monitoring System from October 2020 through June 2021, a nationally representative surveillance system targeted at women who recently gave live birth. Individuals (n = 11,829) who reported their prenatal care experiences were included. A modified poison regression estimated prevalence ratios for virtual prenatal visits and reasons for not using virtual services. Results: One-third of participants used virtual prenatal care. Hispanics were more likely to use virtual prenatal care than whites. Compared with college graduates, those with high school graduation (Prevalence Ratios [PR] 0.87, 95% confidence interval [CI] 0.76-0.99; p = 0.033) or some college education (PR 0.86, 95% CI 0.77-0.96; p = 0.009) were less likely to use virtual visits. A preference for in-person was the most common reason for not pursuing virtual visits (77.1%), followed by no available virtual appointments (29.5%), technology barriers (6.1%), and no private space (1.7%). Individuals with less than or with high school graduation had 4.16 times (95% CI 2.32-7.46; p ≤ 0.001) and 2.72 times (95% CI 1.67-4.43; p ≤ 0.001) greater technology barriers, and 10.03 times (95% CI 3.42-29.46; p ≤ 0.001) and 4.29 times (95% CI 1.56-11.80; p = 0.005) greater likelihood of lacking private space, respectively, while they had a lesser in-person preference. Conclusions: In a disrupted health care landscape, barriers to accessing virtual prenatal care may have further exacerbated access to care and effective management of pregnancy among those underserved. The findings provide practical implications for safe and effective prenatal care.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, USA
| | - W. Samuel Manalew
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
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15
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Xu RH, Chan HH, Shi L, Li T, Wang D. Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study. JMIR Public Health Surveill 2023; 9:e47556. [PMID: 37773621 PMCID: PMC10576235 DOI: 10.2196/47556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/21/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people's ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown. OBJECTIVE This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults. METHODS The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95% highest density intervals (HDIs) were estimated. RESULTS A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4% (n=2653) were female and 58.7% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from -0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean -0.0016, 95% HDI -0.0022 to -0.0011), depression (posterior mean -0.006, 95% HDI -0.0079 to -0.004), stigma (posterior mean -0.0052, 95% HDI -0.0068 to -0.0036), and irritability (posterior mean -0.0037, 95% HDI -0.0052 to -0.0022). The moderating effects of eHL varied across the rural and urban subsamples. CONCLUSIONS Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19-related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
| | - Ho Hin Chan
- Department of Applied Mathematics, Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
| | - Lushaobo Shi
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Ting Li
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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16
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Wu DC, Zhao X, Wu J. Online Physician-Patient Interaction and Patient Satisfaction: Empirical Study of the Internet Hospital Service. J Med Internet Res 2023; 25:e39089. [PMID: 37616031 PMCID: PMC10485723 DOI: 10.2196/39089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/20/2022] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND In China, a form of online health service called the internet hospital became a prominent means of patient care when face-to-face visits were not possible during the COVID-19 pandemic to minimize transmission of the SARS-CoV-2 virus. Patients' internet hospital experiences largely depend on online physician-patient interaction. Yet, little is known about how physicians can improve patient satisfaction by using specific communication strategies online. OBJECTIVE This study aimed to identify specific communication strategies to help physicians deliver better quality internet hospital services. We also outline recommendations for hospitals to operate internet hospital platforms more effectively. METHODS A longitudinal data set was collected from an internet hospital platform operated by a top hospital in China. By extracting communication patterns from approximately 20,000 records of online health care services and by controlling the features of service requests, we tested the impacts of response load, more detailed style, and emotional comfort on patient satisfaction. We further explored the effects of these communication patterns in different service contexts. RESULTS Physicians with a low response load, a more detailed style, and expressions of emotional comfort received more positive patient feedback. Response load did not affect patient satisfaction with free online health service, whereas a more detailed style and emotional comfort enhanced satisfaction with free service. Response load significantly reduced patient satisfaction with paid online health service, while a more detailed style had no effect. Compared with free service, emotional comfort more strongly promoted patient satisfaction with paid service. CONCLUSIONS The communication strategies identified can help physicians provide patients with a better internet hospital experience. These strategies require hospitals to schedule each physician's online service period more appropriately. In addition, tailoring the strategies to service situations can facilitate more targeted and effective internet hospital service for patients.
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Affiliation(s)
| | - Xianduo Zhao
- School of Business, Sun Yat-Sen University, Guangzhou, China
| | - Ji Wu
- School of Business, Sun Yat-Sen University, Guangzhou, China
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17
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Holmgren AJ, Byron ME, Grouse CK, Adler-Milstein J. Association Between Billing Patient Portal Messages as e-Visits and Patient Messaging Volume. JAMA 2023; 329:339-342. [PMID: 36607621 PMCID: PMC10408262 DOI: 10.1001/jama.2022.24710] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
This study evaluates the adoption of clinician billing for patient portal messages as e-visits, prompted by significant increases in patient messaging after the onset of the COVID-19 pandemic.
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Affiliation(s)
- A. Jay Holmgren
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco
| | - Maria E. Byron
- Department of Medicine, University of California, San Francisco
| | - Carrie K. Grouse
- Department of Neurology, University of California, San Francisco
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco
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18
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Kohn LL, Pascual MG, Schmiege SJ, Novins DK, Manson SM. Dermatology Access and Needs of American Indian and Alaska Native People. J Health Care Poor Underserved 2023; 34:1254-1269. [PMID: 38661754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To describe skin disease prevalence, access to dermatologic care, and teledermatology interest among American Indians and Alaska Natives. METHODS Data were collected via self-report surveys administered in person at two community powwows in Denver, Colorado in 2021 and 2022. RESULTS Most American Indian and/or Alaska Native respondents (94.5%, n=225) reported at least one skin disease. The top three active skin diseases among adolescents were acne, scarring, and eczema. The top three among adults were dry skin, hair loss, and acne. Only 20.9% (n=47) of respondents with skin disease had seen a dermatologist. Approximately one-third of respondents (34.0%, n=81) were open to engaging with teledermatology in their home; 43.3% (n=103) were open to engaging with teledermatology in their local clinic; 42.0% (n=100) were not interested in engaging teledermatology from their home or in their local clinic. CONCLUSIONS Skin disease is prevalent and access to dermatologic care is poor among American Indian and Alaska Native people.
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Aiken ARA, Starling JE, Scott JG, Gomperts R. Requests for Self-managed Medication Abortion Provided Using Online Telemedicine in 30 US States Before and After the Dobbs v Jackson Women's Health Organization Decision. JAMA 2022; 328:1768-1770. [PMID: 36318139 PMCID: PMC9627414 DOI: 10.1001/jama.2022.18865] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study assesses changes in online telemedicine requests to self-manage abortions with medications before vs after the Dobbs v Jackson Women’s Health Organization Supreme Court decision overturning Roe v Wade.
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Affiliation(s)
| | | | - James G. Scott
- Department of Statistics and Data Sciences, University of Texas at Austin
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20
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Abstract
IMPORTANCE Logistical challenges such as travel time and distance to a clinical trial site can be a barrier to patient participation. The association of remote technology use and other decentralization tools that can reduce these barriers with likelihood to enroll in cancer trials is not well understood. OBJECTIVE To assess the association of remote technology and other decentralization tools used to reduce participation-related time and travel with the likelihood to enroll in cancer clinical trials. DESIGN, SETTING, AND PARTICIPANTS Between July 6 and September 8, 2021, a 41-question, cross-sectional, internet-based survey was administered to patients with cancer and survivors of cancer in the US who had been diagnosed with or treated for cancer in the past 7 years. MAIN OUTCOMES AND MEASURES Increase in self-reported likelihood to enroll in cancer clinical trials that use remote technology and other decentralization tools to decrease the need for travel to the trial site. RESULTS There were 1183 survey respondents, with a mean (SD) age of 58.2 (12.5) years. Respondents self-reported their gender, race and ethnicity, cancer type, and treatment status. Of the 1183 respondents, 848 (72%) were female, 296 (25%) were male, 8 (1%) were other/nonbinary, and 31 (3%) declined to answer. With regard to race, 28 respondents (3%) were American Indian or Alaska Native, 25 (2%) were Asian, 234 (20%) were Black or African American, 20 (2%) were Native Hawaiian or Other Pacific Islander, 825 (70%) were White, and 51 (4%) declined to answer. With regard to ethnicity, 115 respondents (10%) were Hispanic, Latino/Latina, or of Spanish origin, whereas 1017 (86%) were not and 51 (4%) declined to answer. Regarding cancer type and treatment status, 483 respondents (41%) either had or had survived breast cancer and 325 (28%) were being treated for cancer during the survey period. Individuals older than 55 years were more likely to say that they would only participate in trials no farther from their home than their regular care health care practitioner compared with younger respondents (26% vs 16%, respectively; P = .02). Higher-income earners (ie, those in households earning >$125 000/y) were significantly more likely than lower-income earners (ie, those in households earning <$70 000/y) to say they would participate in trials requiring additional effort (62% vs 41%, respectively; P = .03). If given the opportunity to enroll in a cancer clinical trial that required travel farther than their regular care, a majority of respondents (range, 60%-85%) indicated that they would be more likely to participate if the trial used remote technology and other tools to decrease the need for travel to a trial site. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the survey findings suggest that cancer clinical trials leveraging remote technology and decentralization tools to reduce patient time and travel burden associated with participation may increase the patient consent rate.
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Affiliation(s)
- Devon V. Adams
- American Cancer Society Cancer Action Network, Washington, DC
| | - Sarah Long
- American Cancer Society Cancer Action Network, Washington, DC
| | - Mark E. Fleury
- American Cancer Society Cancer Action Network, Washington, DC
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21
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Forde H, Choudhary P, Lumb A, Wilmot E, Hussain S. Current provision and HCP experiences of remote care delivery and diabetes technology training for people with type 1 diabetes in the UK during the COVID-19 pandemic. Diabet Med 2022; 39:e14755. [PMID: 34862815 DOI: 10.1111/dme.14755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). METHODS The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. RESULTS One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p < 0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. CONCLUSION This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.
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Affiliation(s)
- Hannah Forde
- Leicester Diabetes Research Centre, Leicester General Hospital, Leicester, UK
| | - Pratik Choudhary
- Leicester Diabetes Research Centre, Leicester General Hospital, Leicester, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes Endocrinology and Metabolism, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Emma Wilmot
- Department of Diabetes, University Hospitals of Derby and Burton NHS FT, Derby, UK
- School of Medicine, Nottingham University, Nottingham, UK
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, Guy's Hospital, London, UK
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
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22
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Ferucci ED, Day GM, Choromanski TL, Freeman SL. Outcomes and Quality of Care in Rheumatoid Arthritis With or Without Video Telemedicine Follow-Up Visits. Arthritis Care Res (Hoboken) 2022; 74:484-492. [PMID: 33053261 PMCID: PMC10695327 DOI: 10.1002/acr.24485] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Telemedicine has been proposed to improve access to care in rheumatology, but few studies of telerheumatology have been published. The objective of this study was to evaluate outcomes and quality of care for rheumatoid arthritis (RA) in patients seen by video telemedicine follow-up compared to in-person only. METHODS Individuals in the Alaska Tribal Health System with a diagnosis of RA were recruited when seeing a rheumatologist either in-person or by video telemedicine, both of which were offered as part of usual follow-up care. At baseline, participants completed the Routine Assessment of Patient Index Data 3 (RAPID3) questionnaire and a telemedicine perception survey and agreed to medical record review. Participants repeated surveys by telephone at 6 and 12 months, and medical record abstraction was performed at 12 months for quality measures. RESULTS At the 12-month outcome assessment, 63 of 122 RA patients (52%) had ever used telemedicine for RA. In univariate analysis, functional status improved over 12 months in the telemedicine group. In multivariate analysis, RAPID3 score and functional status were associated with telemedicine group (higher), with no statistically significant change over the 12-month period. The only quality measure that differed between groups at 12 months in univariate analysis was the proportion of visits in which disease activity was documented (higher in the in-person group, 40% versus 25%; P = 0.02), but this was not significant after multivariate analysis. CONCLUSION In short-term follow-up, there was no significant difference in most outcome and quality measures in patients with RA who incorporated telemedicine follow-up in their care compared to in-person only.
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Broekhuis M, van Velsen L. Improving usability benchmarking for the eHealth domain: The development of the eHealth UsaBility Benchmarking instrument (HUBBI). PLoS One 2022; 17:e0262036. [PMID: 35176033 PMCID: PMC8853524 DOI: 10.1371/journal.pone.0262036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Currently, most usability benchmarking tools used within the eHealth domain are based on re-classifications of old usability frameworks or generic usability surveys. This makes them outdated and not well suited for the eHealth domain. Recently, a new ontology of usability factors was developed for the eHealth domain. It consists of eight categories: Basic System Performance (BSP), Task-Technology Fit (TTF), Accessibility (ACC), Interface Design (ID), Navigation & Structure (NS), Information & Terminology (IT), Guidance & Support (GS) and Satisfaction (SAT).
Objective
The goal of this study is to develop a new usability benchmarking tool for eHealth, the eHealth UsaBility Benchmarking Instrument (HUBBI), that is based on a new ontology of usability factors for eHealth.
Methods
First, a large item pool was generated containing 66 items. Then, an online usability test was conducted, using the case study of a Dutch website for general health advice. Participants had to perform three tasks on the website, after which they completed the HUBBI. Using Partial Least Squares Structural Equation Modelling (PLS-SEM), we identified the items that assess each factor best and that, together, make up the HUBBI.
Results
A total of 148 persons participated. Our selection of items resulted in a shortened version of the HUBBI, containing 18 items. The category Accessibility is not included in the final version, due to the wide range of eHealth services and their heterogeneous populations. This creates a constantly different role of Accessibility, which is a problem for a uniform benchmarking tool.,
Conclusions
The HUBBI is a new and comprehensive usability benchmarking tool for the eHealth domain. It assesses usability on seven domains (BSP, TTF, ID, NS, IT, GS, SAT) in which a score per domain is generated. This can help eHealth developers to quickly determine which areas of the eHealth system’s usability need to be optimized.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, eHealth Group, Enschede, The Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, eHealth Group, Enschede, The Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- * E-mail:
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Maruthur M, Lee E, Dusza S, Nehal K, Rossi A. Pilot Survey of Adoption of Telemedicine in Mohs Surgery During the COVID-19 Pandemic. Dermatol Surg 2022; 48:187-190. [PMID: 34923531 DOI: 10.1097/dss.0000000000003352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Covid-19 Pandemic prompted the widespread implementation of telemedicine across healthcare. OBJECTIVE To analyze telemedicine adoption by Mohs Micrographic surgeons (MMS) during the COVID-19 pandemic; to analyze the attitudes and perceived barriers to its long-term continuation by MMS practices. METHODS AND MATERIALS An online multiple-choice survey was distributed to members of the American College of Mohs Surgeons. RESULTS 86.1% of surveyed Mohs surgeons initiated telemedicine during the pandemic surge. The most common uses for telemedicine amongst respondents were post-surgery management (77.4%), "spot checks" (60.9%), and surgical consultations (59.1%). 73.1% report patients were receptive to telemedicine. 68.6% believe that telemedicine has a place in dermatologic surgery; 49.5% plan to incorporate telemedicine into their surgical practices long-term. Physical exam limitations, fitting telemedicine into practice workflow, and patient reception/patient training were viewed as the most significant barriers to long-term implementation. CONCLUSIONS While valuable use cases for telemedicine were identified with most Mohs surgeon respondents feeling that telemedicine has a place in their practices, there is uncertainty in how to implement telemedicine into the dermatologic surgery practice workflow.
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Affiliation(s)
- Mario Maruthur
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Lee
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, Mohs Micrographic and Dermatologic Surgery, New York, New York
| | - Stephen Dusza
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer Nehal
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, Mohs Micrographic and Dermatologic Surgery, New York, New York
| | - Anthony Rossi
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
This cross-sectional study assesses US population access to emergency departments with acute stroke capabilities and telestroke capacity in 2019.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca E. Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University, St Louis, Missouri
| | - Krislyn M. Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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Eruchalu CN, Bergmark RW, Smink DS, Tavakkoli A, Nguyen LL, Bates DW, Cooper Z, Ortega G. Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods. J Am Coll Surg 2022; 234:191-202. [PMID: 35213441 DOI: 10.1097/xcs.0000000000000030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality. RESULTS During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use. CONCLUSION Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.
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Affiliation(s)
- Chukwuma N Eruchalu
- From the Harvard Medical School, Boston, MA (Eruchalu)
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Regan W Bergmark
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ali Tavakkoli
- Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Laboratory for Surgical and Metabolic Research (Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Louis L Nguyen
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Vascular and Endovascular Surgery, Department of Surgery (Nguyen), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David W Bates
- Division of General Internal Medicine, Department of Medicine (Bates), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (Bates)
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (Cooper), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Macías Saint-Gerons D, Rodovalho S, Barros Dias ÁL, Lacerda Ulysses de Carvalho A, Beratarrechea A, Monteiro WM, Barata Machado M, Fernandes da Costa C, Yoshito Wada M, de Almeida MHMF, Silva de Matos Fonseca R, Mota Cordeiro JS, Antolini APR, Nepomuceno JA, Fleck K, Simioni Gasparotto F, Lacerda M, Rojas-Cortés R, Pal SN, Porrás AI, Ade MDLP, Castro JL. Strengthening therapeutic adherence and pharmacovigilance to antimalarial treatment in Manaus, Brazil: a multicomponent strategy using mHealth. Malar J 2022; 21:28. [PMID: 35093070 PMCID: PMC8800548 DOI: 10.1186/s12936-022-04047-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public health initiatives for improving adherence to primaquine based regimens and enhancing effective pharmacovigilance are needed to support the efforts for malaria elimination in real world conditions. METHODS A multicomponent patient-oriented strategy using a Smart Safety Surveillance (3S) approach including: (1) educational materials for treatment counselling and identification of warning symptoms of haemolytic anaemia; (2) an mHealth component using Short Message Service (SMS) treatment reminders and (3) development and implementation of follow-up phone surveys three days after treatment completion, using a web-based platform linked to the local information system of malaria. Adherence was measured using the Morisky Medication Adherence Scale. Self-reported events were registered using a structured questionnaire and communicated to the Brazilian Health Regulatory Agency. RESULTS Educational materials were disseminated to 5594 patients, of whom 1512 voluntarily entered the mHealth component through the local information system; 7323 SMS were sent, and 1062 participants completed a follow-up survey after treatment. The mean age of patients was 37.36 years (SD 13.65), 61.24% were male, 98.54% were infected with. Plasmodium vivax and 95.90% received a short regimen of chloroquine plus primaquine (CQ + PQ 7 days), as per malaria case management guidelines in Brazil. From the 1062 surveyed participants 93.31% were considered adherent to the treatment. Most of the patients (95.20%) reported at least one adverse event. Headache, lack of appetite and nausea/vomiting were the most frequently reported adverse events by 77.31%, 70.90% and 56.78% of the patients respectively. A quarter of the patients reported anxiety or depression symptoms; 57 (5.37%) patients reported 5 to 6 warning symptoms of haemolytic anaemia including jaundice and dark urine in 44 (4.14%). Overall, three patients presenting symptoms of haemolytic anaemia attended a hospital and were diagnosed with G6PD deficiency, and one had haemolysis. All of them recovered. CONCLUSIONS Under real world conditions, a multicomponent patient-oriented strategy using information and communication technologies allowed health care providers to reinforce treatment adherence and enhance safety surveillance of adverse events associated with regimens using primaquine. Active monitoring through phone surveys also reduced under-reporting of ADRs. This approach is low-cost, scalable and able to support prioritized activities of the national malaria programme.
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Affiliation(s)
- Diego Macías Saint-Gerons
- Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain.
- Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA.
| | - Sheila Rodovalho
- Programa de Pós-Gradação Em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brazil
- Communicable Diseases and Environmental Determinants of Health (CDE), Pan American Health Organization (PAHO/WHO), Brasília, Brazil
| | - Ádila Liliane Barros Dias
- Programa de Pós-Gradação Em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brazil
| | - André Lacerda Ulysses de Carvalho
- Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO, Brasília, Brazil
| | - Andrea Beratarrechea
- Institute of Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Myrna Barata Machado
- State of Amazonas Health Surveillance Foundation, Amazonas State Health Secretariat, Manaus, Amazonas, Brazil
| | | | - Marcelo Yoshito Wada
- General-Coordination for Surveillance of Zoonoses and Vector-Borne Diseases, Secretariat of Health Surveillance, Ministry of Health, Manaus, Brazil
| | | | | | | | | | | | - Karen Fleck
- Pharmacovigilance Office (GFARM), Brazilian Health Regulatory Agency (Anvisa), Brasília, Brazil
| | | | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Robin Rojas-Cortés
- Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA
| | | | - Analía I Porrás
- Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA
| | - María de la Paz Ade
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization (PAHO/WHO), Washington, USA
| | - José Luis Castro
- Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA
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Zeng F, Luo J, Ye J, Huang H, Xi W. Postoperative Curative Effect of Cardiac Surgery Diagnosed by Compressed Sensing Algorithm-Based E-Health CT Image Information and Effect of Baduanjin Exercise on Cardiac Autonomic Nerve Function of Patients. Comput Math Methods Med 2022; 2022:4670003. [PMID: 35126625 PMCID: PMC8813234 DOI: 10.1155/2022/4670003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 12/15/2022]
Abstract
This research was aimed at exploring the effect of CT images reconstructed by optimized compressed sensing algorithm on postoperative diagnosis of patients with hypertensive heart disease and the influence of Baduanjin on cardiac autonomic nerve function. Based on the compressed sensing algorithm, the maximum likelihood expectation maximization algorithm was introduced to optimize it, and the optimization algorithm was established. The optimized algorithm and filtered back projection algorithm (FBP) were compared regarding the root mean squared error (RMSE), peak signal-to-noise ratio (PSNR), and structural similar image metric (SSIM). A total of 126 patients with hypertensive heart disease who underwent CT examination in the hospital were selected as study subjects. According to whether Baduanjin intervention was adopted, patients were divided into observation group (conventional treatment +Baduanjin) and control group (conventional treatment), with 63 patients in each group. The effect of CT examination on postoperative diagnosis was analyzed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), differential pressure (DP), respiratory rate and heart rate (HR), very low-frequency (VLF) power, low-frequency (LF) power, high-frequency (HF) power, total power (TP) of HR variability, and changes in LF/HF of patients before and after treatment were compared. The RMSE of the compressed sensing optimization algorithm (3.28 ± 0.36) was significantly lower than that of the FBP algorithm (9.25 ± 1.03) (P < 0.05). The SSIM and PNSR of the compressed sensing optimization algorithm were (0.87 ± 0.10) and (21.22 ± 1.60) dB, respectively. The SSIM was significantly higher than the FBP algorithm (P < 0.01), and the PNSR was also higher than the FBP algorithm (P < 0.05). The detection rate of CT for pleural effusion was 16 cases (25.40%) higher than 5 cases (7.94%) with TTE (P < 0.01). After treatment, SBP, DBP, HR, LF, VLF, LF/HF, and DP values in the observation group were lower than those in the control group (P < 0.05), and TP and HF were higher than those in the control group (P < 0.05). It suggested that a novel algorithm was established based on compressed sensing algorithm to improve image quality. CT image had important guiding significance for postoperative diagnosis of heart. Baduanjin intervention could improve the integrated function of patient's autonomic nervous system and the regulation ability of the vagus nerve.
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Affiliation(s)
- Fei Zeng
- Cardio-Thoracic Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000 Xinjiang, China
| | - Jing Luo
- Department of Gastroenterology, Xinjiang Urumqi Hospital of Traditional Chinese Medicine, Urumqi, 830000 Xinjiang, China
| | - Jin Ye
- Cardio-Thoracic Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000 Xinjiang, China
| | - Hao Huang
- Cardio-Thoracic Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000 Xinjiang, China
| | - Wei Xi
- Medical Imaging Department, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000 Xinjiang, China
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Mafi JN, Craff M, Vangala S, Pu T, Skinner D, Tabatabai-Yazdi C, Nelson A, Reid R, Agniel D, Tseng CH, Sarkisian C, Damberg CL, Kahn KL. Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA 2022; 327:237-247. [PMID: 35040886 PMCID: PMC8767442 DOI: 10.1001/jama.2021.24294] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/19/2021] [Indexed: 01/24/2023]
Abstract
Importance Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.
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Affiliation(s)
- John N. Mafi
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- RAND Health, RAND Corporation, Santa Monica, California
| | | | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Thomas Pu
- Milliman MedInsight, Seattle, Washington
| | | | | | | | - Rachel Reid
- RAND Health, RAND Corporation, Santa Monica, California
- Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Denis Agniel
- RAND Health, RAND Corporation, Santa Monica, California
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Catherine Sarkisian
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Katherine L. Kahn
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- RAND Health, RAND Corporation, Santa Monica, California
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Fang Z, Zhang M. E-Health Ultrasonic Diagnostic Monitoring for Analysis of Cardiac Insufficiency and Neuronal Regulation in Patients with Sepsis in Emergency Department under Image Reconstruction Algorithm. Comput Math Methods Med 2022; 2022:9415694. [PMID: 35035528 PMCID: PMC8758304 DOI: 10.1155/2022/9415694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 12/28/2022]
Abstract
An anisotropic diffusion filtering- (ADF-) ultrasound (ADF-U) for ultrasound reconstruction was constructed based on the ADF to explore the diagnostic application of ultrasound imaging based on electronic health (E-health) for cardiac insufficiency and neuronal regulation in patients with sepsis. The 144 patients with sepsis were divided into an experimental group (78 patients with cardiac insufficiency) and a control group (66 patients with normal cardiac function), and another 58 healthy people were included in a blank control. The ultrasound examination was performed on all patients. In addition, new ultrasound image reconstruction and diagnosis were performed based on ADF and E-health, and its reconstruction effects were compared with those of the Bilateral Filter-ultrasonic (BFU) algorithm and the Wavelet Threshold-ultrasonic (WTU) algorithm. The left and right ventricular parameters and neuropeptide levels were detected and recorded. The results show that the running time, average gradient (AG), and peak signal-to-noise ratio (SNR) (PSNR) of the ADF-U algorithm were greater than those of the Bilateral Filter-ultrasonic (BFU) and Wavelet Threshold-ultrasonic (WTU), but the mean square error (MSE) was opposite (P < 0.05); the left ventricular end-systolic volume (LVESV) and the vertical distance between the mitral valve E-point to septal separation (EPSS) in the experimental group were higher than those in the control and blank group, while the left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and left ventricular fractional shortening (LVFS) were opposite (P < 0.05); the systolic peak velocity of right ventricular free wall tricuspid annulus (Sm) and pulmonary valve blood velocity (PVBV) in the experimental group were lower than those of the control group and blank group (P < 0.05); the messenger ribonucleic acid (mRNA) of Proopiomelanocortin (POMC) and Cocain and amphetamine-regulated transcript (CART) was higher than the mRNA IN control group and blank group (P < 0.05). In short, the ADF-U algorithm proposed in this study improved the resolution, SNR, and reconstruction efficiency of E-health ultrasound images and provided an effective reference value for the diagnosis of cardiac insufficiency and neuronal adjustment analysis in patients with sepsis in the emergency department.
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Affiliation(s)
- Zhonghua Fang
- Department of Emergency Medicine, Jiande First People's Hospital, Jiande, Hangzhou 311600, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital of Medical College of Zhejiang University, Hangzhou 310006, China
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Chen EM, Andoh JE, Nwanyanwu K. Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic. Ophthalmology 2022; 129:15-25. [PMID: 34245753 PMCID: PMC8415734 DOI: 10.1016/j.ophtha.2021.07.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To identify disparities in the use of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN A cross-sectional study of completed clinical encounters in an academic ophthalmology center from March 2020 through August 2020. PARTICIPANTS A total of 5023 patients comprising 8116 ophthalmic clinical encounters. METHODS Medical charts were abstracted for demographic information. We identified zip code-level socioeconomic characteristics, which were drawn from the 2019 American Community Survey 5-year estimates. MAIN OUTCOME MEASURES The completion of a synchronous video encounter, the completion of a telephone (audio-only) encounter in the absence of any video encounters, or the completion of in-person encounters only. RESULTS During the study period, 8116 total clinical encounters were completed for 5023 unique patients. Of these patients, 446 (8.9%) participated in a video encounter, 642 (12.8%) completed a telephone encounter, and 3935 (78.3%) attended clinical appointments in person only. In adjusted analysis, patients who were Black (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.52-0.80; P < 0.001) or Hispanic/Latino (OR, 0.65; 95% CI, 0.49-0.85; P = 0.002) were significantly less likely to complete a video or telephone appointment. Older patients (OR, 0.99; 95% CI, 0.98-0.99; P < 0.001), patients whose primary language was not English (OR, 0.49; 95% CI, 0.28-0.82; P = 0.01), Black patients (OR, 0.45; 95% CI, 0.32-0.62; P < 0.001), and Hispanic/Latino patients (OR, 0.56; 95% CI, 0.37-0.83; P = 0.005) were significantly less likely to complete a video encounter. Finally, among patients completing any type of telemedicine encounter, older age, (OR, 1.02; 95% CI, 1.01-1.03; P < 0.001), Medicare insurance (OR, 1.55; 95% CI, 1.11-2.17; P = 0.01), and Black race (OR, 1.97; 95% CI, 1.33-2.94; P < 0.001) were associated with using only phone visits. CONCLUSIONS Ethnic/racial minorities, older patients, and non-English-speaking individuals were significantly less likely to complete a video telehealth encounter. With the expansion of telemedicine and the need to reduce the disparate impact of COVID-19 on minorities, it will be increasingly important to identify barriers to telehealth use and opportunities to improve access.
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Affiliation(s)
- Evan M Chen
- Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, California; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Joana E Andoh
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
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Elam AR, Sidhom D, Ugoh P, Andrews CA, De Lott LB, Woodward MA, Lee PP, Newman-Casey PA. Disparities in Eye Care Utilization During the COVID-19 Pandemic. Am J Ophthalmol 2022; 233:163-170. [PMID: 34324852 PMCID: PMC8312151 DOI: 10.1016/j.ajo.2021.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the relationship between telemedicine utilization and sociodemographic factors among patients seeking eye care. DESIGN Comparative utilization analysis. METHODS We reviewed the eye care utilization patterns of a stratified random sample of 1720 patients who were seen at the University of Michigan Kellogg Eye Center during the height of the COVID-19 pandemic (April 30 to May 25, 2020) and their odds of having a video, phone, or in-person visit compared with having a deferred visit. Associations between independent variables and visit type were determined using a multinomial logistic regression model. RESULTS Older patients had lower odds of having a video visit (P = .007) and higher odds of having an in-person visit (P = .023) compared with being deferred, and in the nonretina clinic sample, older patients still had lower odds of a video visit (P = .02). Non-White patients had lower odds of having an in-person visit (P < .02) in the overall sample compared with being deferred, with a similar trend seen in the retina clinic. The mean neighborhood median household income was $76,200 (±$33,500) and varied significantly (P < .0001) by race with Blacks having the lowest estimated mean income. CONCLUSION Disparities exist in how patients accessed eye care during the COVID-19 pandemic with older patients-those for whom COVID-19 posed a higher risk of mortality-being more likely to be seen for in-person care. In our affluent participant sample, there was a trend toward non-White patients being less likely to access care. Reimbursing telemedicine solely through broadband internet connection may further exacerbate disparities in eye care.
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Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - David Sidhom
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School
| | | | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC.
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Abstract
The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). The MEPS is widely used to study how policy changes and major shocks, such as the COVID-19 pandemic, affect insurance coverage, access, and preventive and other health care utilization and how these relate to population health. We describe how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules. The impact of the pandemic on response rates varied considerably across the MEPS. Investigations to date show little effect on the quality of data collected. However, lower response rates may reduce the statistical precision of some estimates. We also describe several enhancements made to the MEPS that will allow researchers to better understand the impact of the pandemic on US residents, employers, and the US health care system. (Am J Public Health. 2021;111(12):2157-2166. https://doi.org/10.2105/AJPH.2021.306534).
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Affiliation(s)
- Samuel H Zuvekas
- Samuel H. Zuvekas and David Kashihara are with the Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD
| | - David Kashihara
- Samuel H. Zuvekas and David Kashihara are with the Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD
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Lee DJ, Shelton JB, Brendel P, Doraiswami R, Makarov D, Meeks W, Fang R, Roe MT, Cooperberg MR. Impact of the COVID-19 Pandemic on Urological Care Delivery in the United States. J Urol 2021; 206:1469-1479. [PMID: 34470508 PMCID: PMC8584199 DOI: 10.1097/ju.0000000000002145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 12/05/2022]
Abstract
PURPOSE We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. MATERIALS AND METHODS We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. RESULTS We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively). CONCLUSIONS This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.
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Affiliation(s)
- Daniel J. Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy B. Shelton
- Department of Urology, University of California Los Angeles, Los Angeles, California
| | | | | | - Danil Makarov
- VA New York Harbor Healthcare System and Departments of Urology and Population Health, New York University Langone Medical Center, New York, New York
| | - William Meeks
- American Urological Association Education & Research, Department of Data Management & Statistical Analysis, Linthicum, Maryland
| | - Raymond Fang
- American Urological Association Education & Research, Department of Data Management & Statistical Analysis, Linthicum, Maryland
| | | | - Matthew R. Cooperberg
- Departments of Urology, and Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Rozga M, Handu D, Kelley K, Jimenez EY, Martin H, Schofield M, Steiber A. Telehealth During the COVID-19 Pandemic: A Cross-Sectional Survey of Registered Dietitian Nutritionists. J Acad Nutr Diet 2021; 121:2524-2535. [PMID: 33612436 PMCID: PMC7834621 DOI: 10.1016/j.jand.2021.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 01/12/2023]
Abstract
During the current coronavirus disease 2019 (COVID-19) pandemic, health care practices have shifted to minimize virus transmission, with unprecedented expansion of telehealth. This study describes self-reported changes in registered dietitian nutritionist (RDN) practice related to delivery of nutrition care via telehealth shortly after the onset of the COVID-19 pandemic in the United States. This cross-sectional, anonymous online survey was administered from mid-April to mid-May 2020 to RDNs in the United States providing face-to-face nutrition care prior to the COVID-19 pandemic. This survey included 54 questions about practitioner demographics and experience and current practices providing nutrition care via telehealth, including billing procedures, and was completed by 2016 RDNs with a median (interquartile range) of 15 (6-27) years of experience in dietetics practice. Although 37% of respondents reported that they provided nutrition care via telehealth prior to the COVID-19 pandemic, this proportion was 78% at the time of the survey. Respondents reported spending a median (interquartile range) of 30 (20-45) minutes in direct contact with the individual/group per telehealth session. The most frequently reported barriers to delivering nutrition care via telehealth were lack of client interest (29%) and Internet access (26%) and inability to conduct or evaluate typical nutrition assessment or monitoring/evaluation activities (28%). Frequently reported benefits included promoting compliance with social distancing (66%) and scheduling flexibility (50%). About half of RDNs or their employers sometimes or always bill for telehealth services, and of those, 61% are sometimes or always reimbursed. Based on RDN needs, the Academy of Nutrition and Dietetics continues to advocate and provide resources for providing effective telehealth and receiving reimbursement via appropriate coding and billing. Moving forward, it will be important for RDNs to participate fully in health care delivered by telehealth and telehealth research both during and after the COVID-19 public health emergency.
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Affiliation(s)
- Mary Rozga
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
| | - Deepa Handu
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics Nutrition Research Network, Chicago, IL
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Chicago, IL
| | - Hannah Martin
- Legislative and Government Affairs, Academy of Nutrition and Dietetics, Washington, DC
| | - Marsha Schofield
- Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL
| | - Alison Steiber
- Academy of Nutrition and Dietetics Nutrition Research Network, Chicago, IL
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Johnson C, Dupuis JB, Goguen P, Grenier G. Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic. PLoS One 2021; 16:e0258839. [PMID: 34813618 PMCID: PMC8610241 DOI: 10.1371/journal.pone.0258839] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telehealth technologies were used in the primary health care setting in New Brunswick as a means to continue providing care to patients while following public health guidelines. This study aimed to measure these changes and examine if they improved timely access to primary care. A secondary goal was to identify which telehealth technologies were deemed sustainable by primary care providers. METHODS This was a comparative study on the use of telehealth technology before and during the COVID-19 pandemic. Between April 2020 and November 2020, 114 active primary care providers (family physicians or nurse practitioners) responded to the online survey. RESULTS The findings illustrated an increase in the use of telehealth technologies. The use of phone consultations increased by 122%, from 43.9% pre-pandemic to 97.6% during the pandemic (p < 0.001). The use of virtual consultation (19.3% pre-pandemic vs. 41.2% during the pandemic, p < 0.001), emails and texts also increased during the pandemic. Whereas the more structural organizational tools (electronic medical charts and reservation systems) remained stable. However, those changes did not coincide with a significant improvement to timely access to care during the pandemic. Many participants (40.1%) wanted to keep phone consultations, and 21.9% of participants wanted to keep virtual consultations as part of their long-term practice. INTERPRETATION The observed increase in the use of telehealth technologies may be sustainable, but it has not significantly improved timely access to primary care in New Brunswick.
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Affiliation(s)
- Claire Johnson
- School of Public Policy Studies, Université de Moncton, Moncton, New Brunswick, Canada
- * E-mail:
| | - Jérémie B. Dupuis
- Faculty of Education, Université de Moncton, Moncton, New Brunswick, Canada
| | - Pierre Goguen
- Champlain Library, Université de Moncton, Moncton, New Brunswick, Canada
| | - Gabrielle Grenier
- School of Public Policy Studies, Université de Moncton, Moncton, New Brunswick, Canada
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Crotty BH, Hyun N, Polovneff A, Dong Y, Decker MC, Mortensen N, Holt JM, Winn AN, Laud PW, Somai MM. Analysis of Clinician and Patient Factors and Completion of Telemedicine Appointments Using Video. JAMA Netw Open 2021; 4:e2132917. [PMID: 34735013 PMCID: PMC8569484 DOI: 10.1001/jamanetworkopen.2021.32917] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Telemedicine provides patients access to episodic and longitudinal care. Policy discussions surrounding future support for telemedicine require an understanding of factors associated with successful video visits. OBJECTIVE To assess patient and clinician factors associated with successful and with failed video visits. DESIGN, SETTING, AND PARTICIPANTS This was a quality improvement study of 137 846 scheduled video visits at a single academic health system in southeastern Wisconsin between March 1 and December 31, 2020, supplemented with patient experience survey data. Patient information was gathered using demographic information abstracted from the electronic health record and linked with block-level socioeconomic data from the US Census Bureau. Data on perceived clinician experience with technology was obtained using the survey. MAIN OUTCOMES AND MEASURES The primary outcome of interest was the successful completion of a scheduled video visit or the conversion of the video visit to a telephone-based service. Visit types and administrative data were used to categorize visits. Mixed-effects modeling with pseudo R2 values was performed to compare the relative associations of patient and clinician factors with video visit failures. RESULTS In total, 75 947 patients and 1155 clinicians participated in 137 846 scheduled video encounters, 17 190 patients (23%) were 65 years or older, and 61 223 (81%) patients were of White race and ethnicity. Of the scheduled video encounters, 123 473 (90%) were successful, and 14 373 (10%) were converted to telephone services. A total of 16 776 patients (22%) completed a patient experience survey. Lower clinician comfort with technology (odds ratio [OR], 0.15; 95% CI, 0.08-0.28), advanced patient age (66-80 years: OR, 0.28; 95% CI, 0.26-0.30), lower patient socioeconomic status (including low high-speed internet availability) (OR, 0.85; 95% CI, 0.77-0.92), and patient racial and ethnic minority group status (Black or African American: OR, 0.75; 95% CI, 0.69-0.81) were associated with conversion to telephone visits. Patient characteristics accounted for systematic components for success; marginal pseudo R2 values decreased from 23% (95% CI, 21.1%-26.1%) to 7.8% (95% CI, 6.3%-9.4%) with exclusion of patient factors. CONCLUSIONS AND RELEVANCE As policy makers consider expanding telehealth coverage and hospital systems focus on investments, consideration of patient support, equity, and friction should guide decisions. In particular, this quality improvement study suggests that underserved patients may become disproportionately vulnerable by cuts in coverage for telephone-based services.
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Affiliation(s)
- Bradley H. Crotty
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Noorie Hyun
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Alexandra Polovneff
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Yilu Dong
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Michael C. Decker
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Natalie Mortensen
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Jeana M. Holt
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
- School of Nursing, University of Wisconsin, Milwaukee
| | - Aaron N. Winn
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Purushottam W. Laud
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Melek M. Somai
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
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Reed M, Huang J, Graetz I, Muelly E, Millman A, Lee C. Treatment and Follow-up Care Associated With Patient-Scheduled Primary Care Telemedicine and In-Person Visits in a Large Integrated Health System. JAMA Netw Open 2021; 4:e2132793. [PMID: 34783828 PMCID: PMC8596201 DOI: 10.1001/jamanetworkopen.2021.32793] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Telemedicine visits can offer patients convenient access to a clinician, but it is unclear whether treatment differs from that with in-person visits or how often patients require in-person follow-up. OBJECTIVE To examine whether physician prescribing and orders differ between telemedicine and office visits, whether physicians conducting telemedicine visits are more likely to require in-person follow-up, and whether telemedicine visits are associated with more health events. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all patients who scheduled primary care appointments through the patient portal of a large integrated health care delivery system newly implementing patient-scheduled video telemedicine visits from January 2016 to May 2018. MAIN OUTCOMES AND MEASURES Adjusted rates of any medication prescribed or laboratory tests or imaging ordered and rates of follow-up health care utilization (in-person visits, emergency department visits, and hospitalizations) within 7 days after the index visit, stratified by index primary care visit type, were generated using multivariable adjustment for patient, access, and clinical characteristics. RESULTS This study included 1 131 722 patients (611 821 [54%] female; mean [SD] age, 43 [22] years) with 2 178 440 total appointments (307 888 [14%] telemedicine), of which 13.5% were for patients younger than 18 years, 22.2% were for patients 65 years or older, and 54.9% were for female patients. After adjustment, 38.6% (95% CI, 38.0%-39.3%) of video visits, 34.7% (95% CI, 34.5%-34.9%) of telephone visits, and 51.9% (95% CI, 51.8%-52.0%) of office visits had any medication prescribed; laboratory tests or imaging were ordered for 29.2% (95% CI, 28.5%-29.8%) of video visits, 27.3% (95% CI, 27.1%-27.5%) of telephone visits, and 59.3% (95% CI, 59.3%-59.4%) of clinic visits. After adjustment, follow-up visits within 7 days occurred after 25.4% (95% CI, 24.7%-26.0%) of video visits, 26.0% (95% CI, 25.9%-26.2%) of telephone visits, and 24.5% (95% CI, 24.5%-24.6%) of office visits. Adjusted emergency department visits and rates of hospitalizations were not statistically significantly different by primary care index visit type. CONCLUSIONS AND RELEVANCE In this cohort study of patient self-scheduled primary care telemedicine visits within ongoing patient-physician relationships, prescribing and orders were significantly lower for telemedicine visits than for clinic visits, with slightly higher follow-up office visits for telemedicine but no difference in health events (emergency department visits or hospitalizations). Video or telephone visits may be a convenient and efficient way to access primary care and address patient needs.
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Affiliation(s)
- Mary Reed
- Kaiser Permanente Division of Research, Oakland, California
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, California
| | - Ilana Graetz
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emilie Muelly
- Department of Internal Medicine, Kaiser Permanente Santa Clara, Santa Clara, California
| | - Andrea Millman
- Kaiser Permanente Division of Research, Oakland, California
| | - Catherine Lee
- Kaiser Permanente Division of Research, Oakland, California
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Bizot A, Karimi M, Rassy E, Heudel PE, Levy C, Vanlemmens L, Uzan C, Deluche E, Genet D, Saghatchian M, Giacchetti S, Grenier J, Patsouris A, Dieras V, Pierga JY, Petit T, Ladoire S, Jacot W, Benderra MA, De Jesus A, Delaloge S, Lambertini M, Pistilli B. Multicenter evaluation of breast cancer patients' satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic. Br J Cancer 2021; 125:1486-1493. [PMID: 34588616 PMCID: PMC8480754 DOI: 10.1038/s41416-021-01555-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period. METHODS Eighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation. RESULTS Among the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score. CONCLUSION Patients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.
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Affiliation(s)
- Alexandra Bizot
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | - Maryam Karimi
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | | | - Christelle Levy
- Institut Normand du Sein, Centre Francois Baclesse, Caen, France
| | | | - Catherine Uzan
- Breast and Gynecologic Surgery, Assistance Publique - Hopitaux De Paris, Paris, France
| | - Elise Deluche
- Medical Oncology Department, CHU Limoges - Hopital Dupuytren, Limoges, France
| | - Dominique Genet
- Medical Oncology Department, Clinique Chenieux, Limoges, France
| | | | | | - Juline Grenier
- Medical Oncology Department, Institut Ste Catherine, Avignon, France
| | - Anne Patsouris
- Medical Oncology Department, ICO - Institut de Cancérologie de l'Ouest Nantes-Angers, Angers, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugene - Marquis, Rennes, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie & St Cloud, Université de Paris, Paris, France
| | - Thierry Petit
- Medical Oncology Department, Centre Paul Strauss Centre de Lutte contre le Cancer, Strasbourg, France
| | - Sylvain Ladoire
- Medical Oncology Department, Centre Georges-François Leclerc (Dijon), Dijon, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM, U1194, Montpellier, France
| | | | - Anne De Jesus
- Patient Relationship Coordination, Gustave Roussy, Villejuif, France
| | | | - Matteo Lambertini
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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Noisette ML, Phillips S, Schlenz AM, Mueller M, Kanter J. Changes in Care Delivery for Children With Sickle Cell Anemia During the COVID-19 Pandemic. J Pediatr Hematol Oncol 2021; 43:e1231-e1234. [PMID: 33235147 PMCID: PMC8376185 DOI: 10.1097/mph.0000000000002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Specialty care for children with sickle cell disease (SCD) may be disrupted during the coronavirus (COVID-19) pandemic. Our DISPLACE consortium includes 28 pediatric SCD centers. METHODS In May 2020, we surveyed the consortium on the impact of COVID-19 on their practice focusing on transcranial Doppler ultrasound, chronic red cell transfusions, telehealth, and COVID-19 testing. OBSERVATION Twenty-four DISPLACE providers completed the survey. Transcranial Doppler ultrasound screening decreased to 67% but chronic red cell transfusions remained at 96%. Most investigators (92%) used telehealth and 40% of providers had patients test positive for COVID-19. CONCLUSION The COVID-19 pandemic has affected routine care and necessitated changes in practice in SCD.
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Affiliation(s)
- M. Laurence Noisette
- Division of Pediatric Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Alyssa M. Schlenz
- Section of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama Birmingham, Birmingham, Alabama
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Neeman E, Kumar D, Lyon L, Kolevska T, Reed M, Sundaresan T, Arora A, Li Y, Seaward S, Kuehner G, Likely S, Trosman J, Weldon C, Liu R. Attitudes and Perceptions of Multidisciplinary Cancer Care Clinicians Toward Telehealth and Secure Messages. JAMA Netw Open 2021; 4:e2133877. [PMID: 34817586 PMCID: PMC8613601 DOI: 10.1001/jamanetworkopen.2021.33877] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/05/2021] [Indexed: 01/16/2023] Open
Abstract
Importance Telehealth use including secure messages has rapidly expanded since the COVID-19 pandemic, including for multidisciplinary aspects of cancer care. Recent reports described rapid uptake and various benefits for patients and clinicians, suggesting that telehealth may be in standard use after the pandemic. Objective To examine attitudes and perceptions of multidisciplinary cancer care clinicians toward telehealth and secure messages. Design, Setting, and Participants Cross-sectional specialty-specific survey (ie, some questions appear only for relevant specialties) among multidisciplinary cancer care clinicians, collected from April 29, 2020, to June 5, 2020. Participants were all 285 clinicians in the fields of medical oncology, radiation oncology, surgical oncology, survivorship, and oncology navigation from all 21 community cancer centers of Kaiser Permanente Northern California. Main Outcomes and Measures Clinician satisfaction, perceived benefits and challenges of telehealth, perceived quality of telehealth and secure messaging, preferred visit and communication types for different clinical activities, and preferences regarding postpandemic telehealth use. Results A total of 202 clinicians (71%) responded (104 of 128 medical oncologists, 34 of 37 radiation oncologists, 16 of 62 breast surgeons, 18 of 28 navigators, and 30 of 30 survivorship experts; 57% (116 of 202) were women; 73% [147 of 202] between ages 36-55 years). Seventy-six percent (n = 154) were satisfied with telehealth without statistically significant variations based on clinician characteristics. In-person visits were thought to promote a strong patient-clinician connection by 99% (n = 137) of respondents compared with 77% (n = 106) for video visits, 43% (n = 59) for telephone, and 14% (n = 19) for secure messages. The most commonly cited benefits of telehealth to clinicians included reduced commute (79%; n = 160), working from home (74%; n = 149), and staying on time (65%; n = 132); the most commonly cited negative factors included internet connection (84%; n = 170) or equipment problems (72%; n = 146), or physical examination needed (64%; n = 131). Most respondents (59%; n = 120) thought that video is adequate to manage the greater part of patient care in general; and most deemed various telehealth modalities suitable for any of the queried types of patient-clinician activities. For some specific activities, less than half of respondents thought that only an in-person visit is acceptable (eg, 49%; n = 66 for end-of-life discussion, 35%; n = 58 for new diagnosis). Most clinicians (82%; n = 166) preferred to maintain or increase use of telehealth after the pandemic. Conclusions and Relevance In this survey of multidisciplinary cancer care clinicians in the COVID-19 era, telehealth was well received and often preferred by most cancer care clinicians, who deemed it appropriate to manage most aspects of cancer care. As telehealth use becomes routine in some cancer care settings, video and telephone visits and use of asynchronous secure messaging with patients in cancer care has clear potential to extend beyond the pandemic period.
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Affiliation(s)
- Elad Neeman
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco
| | - Deepika Kumar
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco
| | - Liisa Lyon
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Tatjana Kolevska
- Napa/Solano Medical Center, Kaiser Permanente Northern California, Napa
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Tilak Sundaresan
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco
| | - Amit Arora
- San Leandro Medical Center, Kaiser Permanente Northern California, San Leandro
| | - Yan Li
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland
- Richmond Medical Center, Kaiser Permanente Northern California, Richmond
| | - Samantha Seaward
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland
| | - Gillian Kuehner
- Vallejo Medical Center, Kaiser Permanente Northern California, Vallejo
| | - Sharon Likely
- Modesto Medical Center, Kaiser Permanente Northern California, Modesto
| | - Julia Trosman
- The Center for Business Models in Healthcare, Chicago, Illinois
| | | | - Raymond Liu
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco
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Askari Javaran T, Hassanpour H. Using a Blur Metric to Estimate Linear Motion Blur Parameters. Comput Math Methods Med 2021; 2021:6048137. [PMID: 34745327 PMCID: PMC8568521 DOI: 10.1155/2021/6048137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/23/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
Motion blur is a common artifact in image processing, specifically in e-health services, which is caused by the motion of a camera or scene. In linear motion cases, the blur kernel, i.e., the function that simulates the linear motion blur process, depends on the length and direction of blur, called linear motion blur parameters. The estimation of blur parameters is a vital and sensitive stage in the process of reconstructing a sharp version of a motion blurred image, i.e., image deblurring. The estimation of blur parameters can also be used in e-health services. Since medical images may be blurry, this method can be used to estimate the blur parameters and then take an action to enhance the image. In this paper, some methods are proposed for estimating the linear motion blur parameters based on the extraction of features from the given single blurred image. The motion blur direction is estimated using the Radon transform of the spectrum of the blurred image. To estimate the motion blur length, the relation between a blur metric, called NIDCT (Noise-Immune Discrete Cosine Transform-based), and the motion blur length is applied. Experiments performed in this study showed that the NIDCT blur metric and the blur length have a monotonic relation. Indeed, an increase in blur length leads to increase in the blurriness value estimated via the NIDCT blur metric. This relation is applied to estimate the motion blur. The efficiency of the proposed method is demonstrated by performing some quantitative and qualitative experiments.
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Affiliation(s)
- Taiebeh Askari Javaran
- Computer Science Department, Faculty of Mathematics and Computer, Higher Education Complex of Bam, Bam, Iran
| | - Hamid Hassanpour
- Image Processing and Data Mining (IPDM) Research Lab, Faculty of Computer Engineering and Information Technology, Shahrood University of Technology, Shahrood, Iran
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Premji K, Sucha E, Glazier RH, Green ME, Wodchis WP, Hogg WE, Kiran T, Frymire E, Freeman TR, Ryan BL. Primary care bonus payments and patient-reported access in urban Ontario: a cross-sectional study. CMAJ Open 2021; 9:E1080-E1096. [PMID: 34848549 PMCID: PMC8648352 DOI: 10.9778/cmajo.20200235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings. METHODS We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome. RESULTS We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98-1.42; Q3 OR 1.34, 95% CI 1.10-1.63; Q4 OR 1.46, 95% CI 1.19-1.79; Q5 OR 1.87, 95% CI 1.50-2.33), after hours access (Q2 OR 1.26, 95% CI 1.09-1.47; Q3 OR 1.46, 95% CI 1.23-1.74; Q4 OR 1.77, 95% CI 1.46-2.15; Q5 OR 1.88, 95% CI 1.52-2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85-1.20; Q3 OR 1.17, 95% CI 0.97-1.41; Q4 OR 1.27, 95% CI 1.05-1.55; Q5 OR 1.63, 95% CI 1.32-2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98-1.69; Q3 OR 1.29, 95% CI 0.94-1.77; Q4 OR 1.58, 95% CI 1.16-2.13; Q5 OR 1.98, 95% CI 1.38-2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes. INTERPRETATION Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience.
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Affiliation(s)
- Kamila Premji
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.
| | - Ewa Sucha
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Richard H Glazier
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Michael E Green
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Walter P Wodchis
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - William E Hogg
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Tara Kiran
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Eliot Frymire
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
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Mallenahalli S, Fifolt M, Gundeti M, Lakshmanan Y, Gargollo P, Ost MC, Dangle PP. Survey of COVID-19 impact on pediatric urology services. Can J Urol 2021; 28:10834-10840. [PMID: 34657656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To better understand how the COVID-19 pandemic has forced rapid operational changes in the global healthcare industry, changes implemented on an individual, institutional basis must be considered. There currently is not adequate literature about the overall impact COVID-19 has had on pediatric urology services worldwide. We believe that they have dramatically decreased during the COVID-19 crisis, but have adapted to accommodate changes. We hypothesize that patient care was widely variant due to inadequate standardized recommendations or crisis planning. MATERIALS AND METHODS A web-based survey was deployed to 377 pediatric urologists globally via email to analyze COVID-19's impact on various types of pediatric urology practices. Key categories included impacts on elective services, telemedicine use, finances, and recovery operations. A total of 114 responses were collected between April 29th - May 22nd, 2020. RESULTS The widespread cancellation of elective surgical procedures caused significant disturbances in the field. There was a uniform, significant increase (75%) in telemedicine use across practices. The pandemic has created many changes in care provision for physicians, institutions, and patients themselves. Furthermore, the sudden economic burden on healthcare facilities could lead to cost-cutting measures, creating further strain within institutions. Though telemedicine has its limitations, it is a very viable option when traditional services are unavailable. CONCLUSIONS Immediate steps should be taken to ensure that the recovery phases of pediatric urology practices are as efficient as possible. Institutions should develop task forces to develop critical workflow processes in the event of health crises, while still maintaining patient-centered care. This will be essential in maximizing appropriate care allocation.
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Affiliation(s)
| | - Matthew Fifolt
- University of Alabama at Birmingham School of Public Health, Alabama, USA
| | - Mohan Gundeti
- The University of Chicago Medicine Comer Children's Hospital and Pritzker School of Medicine Chicago, Illinois, USA
| | | | | | - Michael C Ost
- West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Pankaj P Dangle
- Department of Urology, University of Alabama at Birmingham, Alabama, USA
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Newman-Casey PA, De Lott L, Cho J, Ballouz D, Azzouz L, Saleh S, Woodward MA. Telehealth-based Eye Care During the COVID-19 Pandemic: Utilization, Safety, and the Patient Experience. Am J Ophthalmol 2021; 230:234-242. [PMID: 33940006 PMCID: PMC8087573 DOI: 10.1016/j.ajo.2021.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE To assess the initial utilization, safety, and patient experience with tele-ophthalmology during the COVID-19 pandemic. DESIGN Cross-sectional study. METHODS We conducted a telephone survey and interview of a random sample of patients who received different modalities of care (in-person, telephone, videocall, or visits deferred) during Michigan's shelter-in-place order beginning March 23, 2020. The survey assessed patient safety, patient satisfaction with care, perceptions of telehealth-based eye care, and worry about eyesight. Data were analyzed via frequency measures (eg, means and standard deviations), χ2 tests, ANOVA, and paired t tests. Interviews were analyzed using grounded theory. RESULTS A total of 3,274 patients were called and 1,720 (53%) agreed to participate. In-person participants were significantly older than telephone (P = .002) and videocall visit (P = .001) participants. Significantly more white participants had in-person visits than minority participants (P = .002). In-person visit participants worried about their eyesight more (2.7, standard deviation [SD] = 1.2) than those who had telephone (2.5, SD = 1.3), videocall (2.4, SD = 1.1), or deferred visits (2.4, SD = 1.2) (P = .004). Of all telephone or videocall visits, 1.5% (n = 26) resulted in an in-person visit within 1 day, 2.9% (n = 48) within 2-7 days, and 2.4% (n = 40) within 8-14 days after the virtual visit demonstrating appropriate triage to telemedicine-based care. Patients frequently cited a desire for augmenting the telephone or videocall visits with objective test data. CONCLUSIONS When appropriately triaged, tele-ophthalmology appears to be a safe way to reduce the volume of in-person visits to promote social distancing in the clinic. A hybrid model of eye care combining ancillary testing with a video or phone visit represents a promising model of care.
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Affiliation(s)
- Paula Anne Newman-Casey
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.); and Institute for Healthcare Policy and Innovation (P.A.N.-C., L.D.L., M.A.W.), University of Michigan, Ann Arbor, Michigan, USA.
| | - Lindsey De Lott
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.); and Institute for Healthcare Policy and Innovation (P.A.N.-C., L.D.L., M.A.W.), University of Michigan, Ann Arbor, Michigan, USA
| | - Juno Cho
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.)
| | - Dena Ballouz
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.)
| | - Lyna Azzouz
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.)
| | - Sahal Saleh
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.)
| | - Maria A Woodward
- From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center (P.A.N.-C., L.D.L., J.C., D.B., L.A., S.S., M.A.W.); and Institute for Healthcare Policy and Innovation (P.A.N.-C., L.D.L., M.A.W.), University of Michigan, Ann Arbor, Michigan, USA
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Browne T, McKinney SH, Duck L, Blake EW, Baliko B, English S, Christopher R. Preparing Health Professions Students to Serve Southern Rural Communities in the Time of COVID-19 and Beyond: A Model for Interprofessional Online Telehealth Education. South Med J 2021; 114:665-667. [PMID: 34599348 PMCID: PMC8505031 DOI: 10.14423/smj.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
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Abstract
This cross-sectional study evaluates how the growth of virtual care has impacted health care utilization in an integrated delivery network.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Zhiyu Yan
- Department of Neurology, Boston, Massachusetts
| | - Lee H. Schwamm
- Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Boston, Massachusetts
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Abstract
This cross-sectional study assesses changes in health care delivery methods, including all forms of care either purchased or provided by the Veterans Health Administration (VHA), for VHA enrollees in response to the COVID-19 pandemic.
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Affiliation(s)
- Liam Rose
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Stanford Surgery Policy Improvement and Education Center, Stanford Medicine, Stanford University, Stanford, California
| | - Linda Diem Tran
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Stanford Surgery Policy Improvement and Education Center, Stanford Medicine, Stanford University, Stanford, California
| | - Steven M. Asch
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Stanford Medicine, Stanford University, Stanford, California
| | - Anita Vashi
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Emergency Medicine, University of California, San Francisco
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Affiliation(s)
- Cassandra B Yeboah
- Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, USA
| | - Nailah Harvey
- Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, USA
| | - Rohan Krishnan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 4170 City Avenue, Philadelphia, PA 19131, USA
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 4170 City Avenue, Philadelphia, PA 19131, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Vera San Juan N, Shah P, Schlief M, Appleton R, Nyikavaranda P, Birken M, Foye U, Lloyd-Evans B, Morant N, Needle JJ, Simpson A, Lyons N, Rains LS, Dedat Z, Johnson S. Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis. PLoS One 2021; 16:e0257270. [PMID: 34529705 PMCID: PMC8445423 DOI: 10.1371/journal.pone.0257270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.
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Affiliation(s)
- Norha Vera San Juan
- Department of Health Service and Population Research, NIHR Mental Health Policy Research Unit, King’s College London, London, United Kingdom
| | - Prisha Shah
- NIHR Mental Health Policy Research Unit COVID-19 Co-Production Group, London, United Kingdom
| | - Merle Schlief
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Rebecca Appleton
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit COVID-19 Co-Production Group, London, United Kingdom
| | - Mary Birken
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Una Foye
- Department of Health Service and Population Research, NIHR Mental Health Policy Research Unit, King’s College London, London, United Kingdom
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Justin J. Needle
- Division of Health Services Research and Management, City University of London, London, United Kingdom
| | - Alan Simpson
- Department of Health Service and Population Research, NIHR Mental Health Policy Research Unit, King’s College London, London, United Kingdom
| | - Natasha Lyons
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Zainab Dedat
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
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