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Lee JS, Bhatt A, Pollack LM, Jackson SL, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries. Telemed J E Health 2024; 30:1262-1271. [PMID: 38241486 PMCID: PMC11065593 DOI: 10.1089/tmj.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ali M, Sullivan G. Racial Differences in Expanded Telemedicine Use During COVID-19: A Literature Review. Telemed J E Health 2024; 30:1394-1400. [PMID: 38064549 DOI: 10.1089/tmj.2023.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background: The COVID-19 pandemic prompted the widespread adoption of telemedicine to deliver health care services while minimizing in-person contact. However, concerns persist regarding equitable access to telemedicine, especially for vulnerable populations. This study examines the utilization patterns of telemedicine by race in the United States, considering different modalities, medical specialties, and geographic regions. Methods: A comprehensive review of 26 articles published between January 2020 and August 2022 was conducted to analyze racial disparities in telemedicine use during the pandemic. Data from electronic health records and self-reported race were compiled for analysis. Variations based on geography, clinical care types, telemedicine modalities (audio or video), and study design were explored. Results: The findings indicate the presence of racial disparities in telemedicine utilization, with minority groups exhibiting lower usage rates compared with Whites. The location of outpatient clinics and clinical care types did not significantly influence telemedicine use by race. Among studies comparing telemedicine modalities, African Americans were more likely to choose audio/phone visits over video visits. Studies employing a pre-post design were less likely to identify disparities in telemedicine use by race. Conclusions: This study consistently demonstrates increasing racial disparities in telemedicine use. Future research should focus on identifying contributing factors and developing strategies to address these disparities. Policymakers should consider implementing initiatives promoting equitable access to telemedicine, including financial assistance, improved broadband infrastructure, and digital literacy programs. By addressing these barriers, telemedicine can play a crucial role in reducing health care disparities and improving access to care for all Americans.
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Affiliation(s)
- Mohab Ali
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Greer Sullivan
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Katzow MW, Steinway C, Capossela E, Chen J, Chen V, Fenster T, Galagedera N, Hamill M, Lin E, Mamauag E, Moriarty S, Pathania S, Pliskin L, Ripp A, Ronay A, Santiago MT, Yang M, Jan S. Utilization and Patient-Reported Outcomes of Direct-to-Consumer Telemedicine During the First 6 Weeks of the COVID-19 Pandemic in the Largest Pediatric Ambulatory Network in New York State. Telemed J E Health 2024. [PMID: 38597957 DOI: 10.1089/tmj.2023.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective: We aimed to (1) describe telemedicine utilization and usability during the first 6 weeks of the pandemic and (2) determine if usability varied by individual- or visit-level characteristics. Methods: We conducted a retrospective cohort study of ambulatory pediatric telemedicine visits occurring between March 10, 2020, and April 18, 2020, across a large academic health system. We performed manual chart review to assess individual- and visit-level characteristics and invited caregivers to respond to an adapted Telehealth Usability Questionnaire (TUQ). We used multiple logistic regression to determine predictors of high usability. Results: There were 3,197 ambulatory pediatric telemedicine visits, representing 2,967 unique patients. Patients were racially/ethnically diverse (42.5% non-Hispanic White) and primarily English-speaking (89.2%). Surveys were completed by 441 (17%) of those invited. Every item of the TUQ had agreement or strong agreement from the majority of respondents. Compared with non-Hispanic White, non-Hispanic Asian identity was associated with lower usability in three domains and overall, and non-Hispanic Black identity was associated with higher satisfaction and future use. As compared with caregivers of infants younger than 1 year, caregivers of older patients reported lower usability in the three domains. Conclusions: Telemedicine was successfully implemented across 18 ambulatory pediatric specialties in the largest health system in New York State at the onset of COVID-19, and caregivers found it usable and acceptable. Usability scores did not vary by visit-level characteristics but did vary by race/ethnicity and age. Further research is necessary to identify modifiable drivers of the patient experience, particularly in non-Hispanic Asian communities and older adolescents.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Errica Capossela
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital, La Jolla, California, USA
| | - Jack Chen
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Talia Fenster
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Nirupa Galagedera
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Megan Hamill
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Elaine Lin
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA
| | - Erica Mamauag
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shannon Moriarty
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Shivany Pathania
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Gastroenterology, Brown University/Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Lyndsey Pliskin
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Asher Ripp
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Avy Ronay
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Maria T Santiago
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Margaret Yang
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
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Rabbani M, Bogulski CA, Allison MK, Eswaran H, Hayes C. Telehealth and Willingness to Pay for Internet Services. Telemed J E Health 2024. [PMID: 38588557 DOI: 10.1089/tmj.2023.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Introduction: Telehealth is becoming integral to health care delivery, which may create a higher need for better internet. This is the first study to examine whether users are willing to spend more on their internet if they are (1) more experienced in using telehealth, (2) more optimistic about telehealth benefits, and (3) less concerned about the difficulty of using telehealth. Methods: We surveyed 5,200 Americans about their willingness to pay (WTP) for internet speed and quality on the one hand, and their (1) prior use of telehealth, (2) opinion about the benefits of telehealth, and (3) opinion about the difficulties of using telehealth. We stratified the sample using the three aspects above and conducted a conjoint analysis to estimate the WTP for internet speed and quality within each stratum. Results: Compared with respondents who had never used telehealth, respondents who had used five to six different types of telehealth services were willing to spend 50.4% more on their internet plans. Users who most firmly believed in the benefits of telehealth were willing to spend 59.2% more than the most pessimistic users. Users who had the lowest concerns about the difficulty of using telehealth were willing to spend 114% more than users with the most perceived difficulty. Discussion: We found strong ties between the WTP for internet and prior telehealth use and perceptions of telehealth benefits and barriers. Thus, internet expenditures may be influenced by users' anticipation of using telehealth. Future studies may investigate the causality of the relationship.
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Affiliation(s)
- Maysam Rabbani
- Department of Economics, Feliciano School of Business, Montclair State University, Montclair, New Jersey, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - M Kathryn Allison
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corey Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Healthcare System, Eugene J. Towbin Healthcare Center, North Little Rock, Arkansas, USA
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5
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Cobbs LV, Mahmoudzadeh R, Salabati M, Hamati J, Yonekawa Y, Russ Soares R. Trends in Geographic Distribution of Visual Disability - United States, 2010-2019. Semin Ophthalmol 2024; 39:209-216. [PMID: 37876215 DOI: 10.1080/08820538.2023.2273855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE We aimed to describe changes in the geographic distribution of self-reported visual impairment (VI) over the last decade (2010-2019) in the U.S. METHODS Our study was an analysis of publicly available data collected between 2010 and 2019 from the Census Bureau American Community Survey. RESULTS The mean overall prevalence of self-reported VI from 2010 to 2019 was 2.31% in the United States, and there was a significant increase in VI over the past decade from 2.25% in 2010-2014 to 2.37% in 2015-2019 (p < .001). VI was significantly higher in rural counties (3.58%), compared to urban (3.10%) or metropolitan counties (2.18%) (p < .001). In terms of geographic region, the South of the United States had the highest rate of VI (2.63%) (p < .001). For age groups > 17-years-old in the 2010-2019 data, women had higher rates of VI compared to men. CONCLUSIONS Prevalence of self-reported visual impairment has risen and disproportionately affects certain communities. This includes individuals living in the South, in rural counties, and women.
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Affiliation(s)
- Lucy V Cobbs
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Raziyeh Mahmoudzadeh
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Mirataollah Salabati
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Jacquelyn Hamati
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Yoshihiro Yonekawa
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Rebecca Russ Soares
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
- Retina Service, Ophthalmic Consultants of Boston, Boston, USA
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6
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Hua CL, Halladay CW, Rudolph JL, Celardo C, Heyworth L, Harmon AR, Mills WL, Cornell PY. Trends and geographic differences in social work telehealth utilization. SOCIAL WORK IN HEALTH CARE 2024; 63:399-413. [PMID: 38529768 DOI: 10.1080/00981389.2024.2333747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Abstract
We plotted trends in social work telehealth use among Veterans in a U.S. national social work staffing program and examined the relationship between geographic factors (rurality and neighborhood disadvantage) and telehealth use (audio and video) using linear probability models. Social work telehealth use increased among Veterans during the COVID-19 pandemic. There were no geographic differences in telephone telehealth use. Video telehealth use was less common among Veterans in isolated rural areas and among Veterans in highly disadvantaged areas. Outreach efforts can address barriers that Veterans who live in rural and disadvantaged areas may experience in using video telehealth.
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Affiliation(s)
- Cassandra L Hua
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Christopher W Halladay
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
| | - James L Rudolph
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Caitlin Celardo
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- VHA Food Security Office, Washington, DC, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, USA
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Alita R Harmon
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Gulf Coast Veterans Health Care System, Biloxi, Mississippi, USA
| | - Whitney L Mills
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Portia Y Cornell
- Department of Veterans Affairs (VA) Medical Center, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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7
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Duffy CM, Wall CS, Hagiwara N. Factors Associated with College Students' Attitudes Toward Telehealth for Primary Care. Telemed J E Health 2024. [PMID: 38436593 DOI: 10.1089/tmj.2023.0687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Establishing routine primary care visits helps to prevent serious health issues. College students are less likely than the general population to have a regular primary care provider and engage in routine health visits. Recent research provides evidence that telehealth is a convenient alternative to in-person primary care and that college students are comfortable using this technology, suggesting that telehealth has the potential to mitigate this disparity. As attitudes toward telehealth are one critical precursor to behavioral intention and actual utilization of telehealth, the goal of this study was to investigate which factors predict positive or negative attitudes toward telehealth. Methods: Data for this study were collected from a sample of 621 college students at a large southeastern university between September 19, 2022 and December 19, 2022. Results: The study found that college students who reported more trust in physicians, less medical mistrust, and less discrimination in health care settings reported more positive attitudes toward telehealth. Conclusions: These findings suggest that health care providers' skills in delivering patient-centered culturally informed care and building trust and rapport with patients might promote more positive attitudes toward telehealth and, potentially, greater overall utilization of health care services (including both telehealth and in-person services) among college students. This study lays the foundation for future research to examine psychological mechanisms underlying individuals' utilization of telehealth.
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Affiliation(s)
- Conor Mc Duffy
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Catherine Sj Wall
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nao Hagiwara
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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Zeineddin S, Macy ML, Bouchard ME, Carroll MS, Linton S, De Boer C, Abdullah F, Ghomrawi H. Disparities in Telemedicine Use Among Children Seen in Surgical Clinics During the COVID-19 Pandemic: Experience of One Tertiary Care Freestanding Children's Hospital. Telemed J E Health 2024; 30:642-650. [PMID: 37910777 DOI: 10.1089/tmj.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background: Telemedicine use dramatically increased during the COVID-19 pandemic. However, the effects of telemedicine on pre-existing disparities in pediatric surgical access have not been well described. We describe our center's early experience with telemedicine and disparities in patients' access to outpatient surgical care. Methods: A retrospective study of outpatient visits within all surgical divisions from May to December 2020 was conducted. We assessed the rates of scheduled telemedicine visits during that period, as well as the rate of completing a visit after it has been scheduled. Descriptive and logistic regression analyses were used to test for associations between these rates and patient characteristics. Results: Over the study period, 109,601 visits were scheduled. Telemedicine accounted for 6.1% of all visits with lower cancellation rates than in-person visits (26.9% vs. 34.7%). More scheduled telemedicine encounters were observed for older patients, White, English speakers, those with private insurance, and those living in rural areas. Lower odds of telemedicine visit completion were observed among patients with public insurance (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.64-0.77), Spanish language preference (OR 0.84, 95% CI 0.72-0.97), and those living in rural areas (OR 0.73, 95% CI 0.64-0.84). In contrast, higher odds of telemedicine visit completion were associated with a higher Social Deprivation Index score (OR 1.41, 95% CI 1.27-1.58). Telemedicine visit completion was also associated with increasing community-level income and distance from the hospital. Conclusions: Telemedicine use for outpatient surgical care was generally low during the peak of the pandemic, and certain populations were less likely to utilize it. These findings call for further action to bridge gaps in telemedicine use.
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Affiliation(s)
- Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michelle L Macy
- Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Bouchard
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael S Carroll
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Hassan Ghomrawi
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Medicine (Rheumatology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Rezac L, Wallis L, Black WH, Pearlman RL. Evaluation of a Teledermatology Postoperative Follow-up Model After Mohs Micrographic Surgery. Dermatol Surg 2024:00042728-990000000-00695. [PMID: 38416800 DOI: 10.1097/dss.0000000000004126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Laura Rezac
- Department of Dermatology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Luke Wallis
- Department of Dermatology, University of Mississippi Medical Center, Jackson, Mississippi
| | - William H Black
- Department of Dermatology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ross L Pearlman
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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10
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Bange EM, Li Y, Kumar P, Doucette A, Gabriel P, Parikh R, Li EH, Mamtani R, Getz KD. The association between telemedicine, advance care planning, and unplanned hospitalizations among high-risk patients with cancer. Cancer 2024; 130:636-644. [PMID: 37987207 PMCID: PMC10922036 DOI: 10.1002/cncr.35116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/31/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high-risk cancer. For these patients, high-quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in-person clinic visits was examined among patients with cancer at high risk for 6-month mortality. METHODS This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6-month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in-person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in-person clinic visits. RESULTS The occurrence of advance care planning was similar between telemedicine and in-person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92-1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03-2.11). The 3-month risk for unplanned hospitalization was comparable for telemedicine compared to in-person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81-1.38). CONCLUSIONS In this study, care delivered by telemedicine, compared to in-person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine.
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Affiliation(s)
- Erin M Bange
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pallavi Kumar
- Palliative and Hospice Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abigail Doucette
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Gabriel
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravi Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Hematology/Oncology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Eric H Li
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronac Mamtani
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly D Getz
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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11
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Bogulski CA, Pro G, Acharya M, Ali MM, Brown CC, Hayes CJ, Eswaran H. The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims. J Telemed Telecare 2024:1357633X241226741. [PMID: 38314738 DOI: 10.1177/1357633x241226741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Telehealth services have the potential to increase healthcare access among underserved populations, such as rural residents and racial/ethnic minority groups. The COVID-19 public health emergency led to unprecedented growth in telehealth utilization, but evidence suggests the growth has not been equitable across all patient populations. This study aimed to explore whether telehealth utilization and expansion changed equitably from 2019 to 2020 among sub-groups of Medicare beneficiaries. METHODS We conducted an analysis of telehealth utilization among a 20% random sample of 2019-2020 Medicare beneficiaries on a national level. We fit multivariable logistic regression models and calculated average marginal effects (AME) to assess the association between demographic and clinical characteristics on telehealth utilization. RESULTS We found telehealth utilization was less likely among non-Hispanic Black/African-American (2019: adjusted odds ratio [aOR] = 0.77, AME = -0.15; 2020: aOR = 0.85, AME = -3.50) and Hispanic (2019: aOR = 0.79, AME = -0.13; 2020: aOR = 0.87, AME = -2.89) beneficiaries, relative to non-Hispanic White beneficiaries in both 2019 and 2020, with larger disparities in 2020. Rural beneficiaries were more likely to utilize telehealth than urban beneficiaries in 2019 (aOR = 2.62, AME = 0.84), but less likely in 2020 (aOR = 0.57, AME = -14.47). In both years, dually eligible Medicare/Medicaid beneficiaries were more likely than non-dually eligible beneficiaries to utilize telehealth (2019: aOR = 4.75, AME = 0.84; 2020: aOR = 1.34, AME = 2.25). However, the effects of dual eligibility and rurality changed in both models as the number of chronic conditions increased. DISCUSSION We found evidence of increasing disparities in telehealth utilization among several Medicare beneficiary sub-groups in 2020 relative to 2019, including individuals of minority race/ethnicity, rural residents, and dually eligible beneficiaries, with disparities increasing among individuals with more chronic conditions. Although telehealth has the potential to address health inequities, our findings suggest that many of the patients in greatest need of healthcare are least likely to utilize telehealth services.
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Affiliation(s)
- Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - George Pro
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahip Acharya
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clare C Brown
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Hari Eswaran
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Hung CT, Hung YC. Telemedicine Use Among Adults with Asthma in the United States, 2021-2022. Telemed J E Health 2024. [PMID: 38301206 DOI: 10.1089/tmj.2023.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Introduction: While previous studies have mainly focused on the impact of telemedicine on asthma management, little is known about the disparities in the use of telemedicine among individuals with asthma. This study aimed to investigate the factors associated with telemedicine use among adults with asthma in the United States using a nationally representative survey. Methods: Data from the 2021 and 2022 National Health Interview Survey were used. The multivariable logistic regression model was conducted to identify the factors associated with telemedicine use among adults with asthma. Results: In 2021-2022, the prevalence of telemedicine use among adults with asthma was 47.7%. Females, individuals who were obese, current smokers, those with educational levels of college and higher, health insurance coverage, a usual place for care, a history of asthma attacks, and coronavirus disease 2019 were more likely to use telemedicine. Non-Hispanic blacks, residents in the Midwest, South, and nonmetropolitan areas were less likely to use telemedicine. Conclusions: Disparities in telemedicine use were found among several characteristics in adults with asthma. It is crucial to identify the vulnerable populations in accessing telemedicine and ensure equality in telemedicine use among patients with asthma.
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Affiliation(s)
- Chun-Tse Hung
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chien Hung
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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13
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Tilhou AS, Jain A, DeLeire T. Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19. JAMA Netw Open 2024; 7:e2347686. [PMID: 38180762 PMCID: PMC10770767 DOI: 10.1001/jamanetworkopen.2023.47686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/01/2023] [Indexed: 01/06/2024] Open
Abstract
Importance Primary care (PC) receipt is associated with better health outcomes. How telehealth expansion and internet speed are associated with PC use is unclear. Objective To examine the association of telehealth and internet speed with PC use across sociodemographic determinants of health. Design, Setting, and Participants This cohort study performed difference-in-differences regression of the change in in-person and telehealth PC visits between pre-COVID-19 public health emergency (PHE) (June 1, 2019, to February 29, 2020) and an initial (March 1, 2020, to May 31, 2020) and prolonged (March 1, 2020, to December 31, 2021) PHE period among continuously enrolled nonpregnant, nondisabled Wisconsin Medicaid beneficiaries aged 18 to 64 years. Data were analyzed from March 2022 to March 2023. Exposure PHE-induced telehealth expansion. Main Outcomes and Measures Change in PC telehealth (using Current Procedural Terminology codes) visits: (1) count; (2) visit share completed by telehealth; (3) percentage of PHE-induced visit decline offset by telehealth. High-speed internet (HSI) defined as living in a census block group with a median block maximum download speed of 940 megabits per second or greater (June 2020 Federal Communications Commission broadband data); other census block groups classified as low-speed internet (LSI). Results In the total cohort of 172 387 participants, 102 989 (59.7%) were female, 103 848 (60.2%) were non-Hispanic White, 34 258 (19.9%) were non-Hispanic Black, 15 020 (8.7%) were Hispanic, 104 239 (60.5%) were aged 26 to 45 years, and 112 355 (66.0%) lived in urban counties. A total of 142 433 (82.6%) had access to HSI; 72 524 (42.1%) had a chronic condition. There was a mean (SD) of 0.138 (0.261) pre-PHE PC visits per month. In the pre-PHE period, visit rates were significantly higher for female than male participants, non-Hispanic White than non-Hispanic Black individuals, urban than rural residents, those with HSI than LSI, and patients with chronic disease than patients without. In the initial PHE period, female participants had a greater increase in telehealth visits than male participants (43.1%; 95% CI, 37.02%-49.18%; P < .001), share (2.20 percentage point difference [PPD]; 95% CI, 1.06-3.33 PPD; P < .001) and offset (6.81 PPD; 95% CI, 3.74-9.87 PPD; P < .001). Non-Hispanic Black participants had a greater increase in share than non-Hispanic White participants (5.44 PPD; 95% CI, 4.07-6.81 PPD; P < .001) and offset (15.22 PPD; 95% CI, 10.69-19.75 PPD; P < .001). Hispanic participants had a greater increase in telehealth visits than Non-Hispanic White participants (35.60%; 95% CI, 25.55%-45.64%; P < .001), share (8.50 PPD; 95% CI, 6.75-10.26 PPD; P < .001) and offset (12.93 PPD; 95% CI, 6.25-19.60 PPD; P < .001). Urban participants had a greater increase in telehealth visits than rural participants (63.87%; 95% CI, 52.62%-75.11%; P < .001), share (9.13 PPD; 95% CI, 7.84-10.42 PPD; P < .001), and offset (13.31 PPD; 95% CI; 9.62-16.99 PPD; P < .001). Participants with HSI had a greater increase in telehealth visits than those with LSI (55.23%; 95% CI, 42.26%-68.20%; P < .001), share (6.61 PPD; 95% CI, 5.00-8.23 PPD; P < .001), and offset (6.82 PPD; 95% CI, 2.15-11.49 PPD; P = .004). Participants with chronic disease had a greater increase in telehealth visits than those with none (188.07%; 95% CI, 175.27%-200.86%; P < .001), share (4.50 PPD; 95% CI, 3.58-5.42 PPD; P < .001), and offset (9.03 PPD; 95% CI, 6.01-12.04 PPD; P < .001). Prolonged PHE differences were similar. Differences persisted among those with HSI. Conclusions and Relevance In this cohort study of Wisconsin Medicaid beneficiaries, greater telehealth uptake occurred in groups with higher pre-PHE utilization, except for high uptake among Hispanic and non-Hispanic Black individuals despite low pre-PHE utilization. HSI did not moderate disparities. These findings suggest telehealth and HSI may boost PC receipt, but will generally not close utilization gaps.
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Choi SL, Hites L, Bolland AC, Lee J, Payne-Foster P, Bissell K. Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity. Aging Ment Health 2024; 28:160-168. [PMID: 36450359 DOI: 10.1080/13607863.2022.2149696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)-threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)-are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans. METHODS Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors. RESULTS Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity (b = 0.13, 95% confidence interval (CI) [0.11, 0.15], p < 0.001), and response efficacy, particularly participation in communication via social media (b = 0.24, 95% CI [0.21, 0.27], p < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts (b = 0.20, 95% CI [0.12, 0.28], p < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults (b = -0.11, 95% CI [-0.19, -0.04], p < 0.01) and non-Hispanic Asian/other races adults (b = -0.13, 95% CI [-0.26, -0.01], p < 0.05) than it was for their non-Hispanic White counterparts. CONCLUSION Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.
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Affiliation(s)
- Shinae L Choi
- Department of Consumer Sciences, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
- Center for Innovation in Social Science, College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Lisle Hites
- Department of Community Medicine and Population Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Anneliese C Bolland
- Department of Communication Studies, College of Communication and Information Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Jiyoung Lee
- Department of Journalism and Creative Media, College of Communication and Information Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Pamela Payne-Foster
- Department of Community Medicine and Population Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Kimberly Bissell
- Department of Journalism and Creative Media, College of Communication and Information Sciences, The University of Alabama, Tuscaloosa, AL, USA
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15
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Charlesworth CJ, Nagy D, Drake C, Manibusan B, Zhu JM. Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid. J Rural Health 2024; 40:16-25. [PMID: 37088967 PMCID: PMC10590824 DOI: 10.1111/jrh.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Medicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid-participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population. METHODS Using 2018 Medicaid claims data, we identified enrollees aged 18-64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30- and 60-minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2-step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas. RESULTS Overall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30-minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access). CONCLUSIONS Some frontier areas with relatively poor access to Medicaid-participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.
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Affiliation(s)
| | - Dylan Nagy
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Coleman Drake
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Brynna Manibusan
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane M. Zhu
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
- Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Norman K, French A, Lake A, Tchuisseu YP, Repka S, Vasudeva K, Dong C, Whitaker R, Bettger JP. Describing Perspectives of Telehealth and the Impact on Equity in Access to Health Care from Community and Provider Perspectives: A Multimethod Analysis. Telemed J E Health 2024; 30:242-259. [PMID: 37410525 DOI: 10.1089/tmj.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction: The rapid adoption of telehealth as a result of the COVID-19 pandemic provided the opportunity to examine perceptions of health care access and use of telehealth for delivery of effective and equitable care in low-income and historically marginalized communities. Methods: Focusing on communities with high social vulnerability, a multimethod analysis of combined perspectives, collected February through August 2022 from 112 health care providers, obtained from surveys and interviews, and 23 community members via 3 focus groups on access to care and telehealth. Qualitative data were analyzed using the Health Equity and Implementation Framework to identify barriers, facilitators, and recommendations for the implementation of telehealth using a health equity lens. Results: Participants perceived that telehealth helped maintain access to health care during the pandemic by addressing barriers including provider shortages, transportation concerns, and scheduling conflicts. Additional benefits suggested were improved care quality and coordination attributed to convenient avenues for care delivery and communication among providers and patients. However, many barriers to telehealth were reported and considered to limit equitable access to care. These included restrictive or changing policies regarding allowable services provided via telehealth, and availability of technology and broadband services to enable telehealth visits. Recommendations provided insight into care delivery innovation opportunities and potential policy changes to address equitable access to care. Conclusion: Integration of telehealth into models of care delivery could improve access to health care services and promote communication among providers and patients to improve care quality. Our findings have implications that are critical for future policy reforms and telehealth research.
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Affiliation(s)
- Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Ashley Lake
- Department of Rehabilitation Services, Duke Physical Therapy Sports Medicine at Center for Living, Duke University, Durham, North Carolina, USA
| | | | - Samantha Repka
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Karina Vasudeva
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia Dong
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Rebecca Whitaker
- The Duke Margolis Center for Health Policy, Washington, District of Columbia, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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Pullyblank K, Scribani M, Krupa N, Chapman A, Kern M, Brunner W. Exploring Multiple Dimensions of Access to and Preferences for Telehealth Use. TELEMEDICINE REPORTS 2023; 4:348-358. [PMID: 38098780 PMCID: PMC10719637 DOI: 10.1089/tmr.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/17/2023]
Abstract
Introduction During the pandemic, telehealth became critically important in care provision. Yet, research exposed the inequities facing various groups of people in terms of accessing telehealth. The purpose of this analysis was to examine the various dimensions of access that impact a person's ability to use and preference for telehealth. Methods We used a mixed-methods approach framed by Levesque's Access to Health care model. In August, 2021, a stratified random sample of 500 patients of an integrated rural health care network was invited to participate in a survey designed to capture familiarity with, use of, and preference for digital technologies in general as well as with telehealth. In addition, key informant interviews were conducted between January 2022 and June 2022. Results Patients' willingness to use telehealth was influenced by multiple dimensions of access, including approachability of the resource, acceptability, availability, affordability, and appropriateness. Clinician beliefs and attitudes as well as health care system policies affected how a patient perceived, sought, reached, and engaged with telehealth. Conclusions Access is a dynamic, multifaceted concept that is influenced by individual-, organization-, and systemic-level factors. Looking beyond patient determinants and examining different dimensions of access is important to better facilitate implementation and sustainment of telehealth.
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Affiliation(s)
- Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Melissa Scribani
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Nicole Krupa
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Amanda Chapman
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Megan Kern
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Wendy Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
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18
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Xie Z, Hong YR, Jo A, Marlow NM. Telehealth Utilization During the COVID-19 Pandemic Among People With Functional Disabilities in the U.S.: A Preliminary Analysis of National Health Interview Survey 2020 Data. AJPM FOCUS 2023; 2:100149. [PMID: 37920402 PMCID: PMC10618695 DOI: 10.1016/j.focus.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction Telehealth has been widely promoted and adopted at multiple levels in the U.S. healthcare system during the COVID-19 pandemic. However, this rapid expansion of telehealth services may have further exacerbated health inequities among marginalized groups. Methods Using the 2020 National Health Interview Survey, this study compared patterns of telehealth use between people with functional disabilities and people without disabilities during the first year of the pandemic. Results In the multivariable-adjusted logistic regression models, respondents with moderate disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.25, 95% CI=1.03, 1.52) and telehealth use, pandemic related (OR=1.43, 95% CI=1.28, 1.60) than people without disabilities. Similarly, respondents with severe disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.46, 95% CI=1.07, 2.00) and telehealth use, pandemic related (OR=2.06, 95% CI=1.72, 2.46). In addition, telehealth use varied by the number of limitations and disability type. Conclusions People with functional disabilities were more likely to report telehealth use than people without disabilities. Furthermore, these associations strengthened with increasing disability severity and number of limitations while varying by disability type. Additional studies are warranted to explore ways of providing patient-centered telehealth to responsively meet various healthcare needs of people with functional disabilities and improve their health outcomes.
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Affiliation(s)
- Zhigang Xie
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
- UF Health Cancer Center, Gainesville, Florida
| | - Ara Jo
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Nicole M. Marlow
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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Simione M, Aschbrenner K, Farrar-Muir H, Luo M, Granadeno J, Caballero-Gonzalez A, Price SN, Torres C, Boudreau AA, Fiechtner L, Hambidge SJ, Sease K, Taveras EM. Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic. Implement Sci Commun 2023; 4:139. [PMID: 37974245 PMCID: PMC10652425 DOI: 10.1186/s43058-023-00523-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND To address the evolving needs and context changes due to the COVID-19 pandemic, we adapted Connect for Health, an evidence-based, primary care, pediatric weight management intervention. The objective of this study is to describe the planned adaptation process to ensure continued and equitable program uptake during the pandemic. METHODS Guided by adaptation frameworks, we identified the core functions and forms of Connect for Health and then adapted the intervention in response to a changing healthcare context. We engaged stakeholders and surveyed parents of children with a BMI ≥ 85th percentile and pediatric clinicians and examined their experiences using telehealth for pediatric weight management and needs and preferences. Using multivariable logistic regression, we examined the preferences of parents with limited English proficiency regarding key aspects of pediatric weight management. RESULTS We surveyed 200 parents and 43% had a primary language of Spanish. Parents wanted care to be a combination of in-person and virtual visits (80%). We found that parents with limited English proficiency had a higher odds ratio of affirming in-person visits are better than virtual visits for ensuring their child's health concern can be taken care of (OR: 2.91; 95% CI: 1.36, 6.21), feeling comfortable when discussing personal information (OR: 3.91; 95% CI: 1.82, 8.43), talking about healthy behaviors and setting goals (OR: 3.09; 95% CI: 1.39, 6.90), and talking about mental health and overall well-being (OR: 4.02; 95% CI: 1.83, 8.87) than parents without limited English proficiency. We surveyed 75 clinicians and 60% felt telehealth was a useful tool to provide care for pediatric weight management. Clinicians felt virtual visits did not pose barriers to all aspects of care. Informed by the surveys and stakeholder input, we made clinician- and family-level adaptations while retaining the program's function. CONCLUSIONS By engaging stakeholders and adapting the program for telehealth, we optimized the reach and fit of Connect for Health to ensure its continued uptake. We have provided a real-world example of how clinical innovations can evolve and how to systematically plan adaptations in response to changing healthcare contexts. TRIAL REGISTRATION Clinicaltrials.gov (NCT04042493), Registered on August 2, 2019.
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Affiliation(s)
- Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Haley Farrar-Muir
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Jazmin Granadeno
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Ariadne Caballero-Gonzalez
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Sarah N Price
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Carlos Torres
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- MGH Chelsea HealthCare Center, Chelsea, MA, USA
| | - Alexy Arauz Boudreau
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Simon J Hambidge
- Ambulatory Care Services, Denver Health, Denver, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kerry Sease
- Department of Pediatrics, University of South Carolina School of Medicine, Greenville, SC, USA
- Prisma Health, Greenville, SC, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Shusted CS, Juon HS, Ruane B, Till B, Zeigler-Johnson C, McIntire RK, Grenda T, Okusanya O, Evans NR, Kane GC, Barta JA. Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making. BMC Health Serv Res 2023; 23:1179. [PMID: 37899430 PMCID: PMC10614340 DOI: 10.1186/s12913-023-10185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Although lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS. METHODS This retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 - March 18, 2021 in a centralized LCS program. Individuals were categorized into Complete Screening vs. Incomplete Screening subgroups based on the status of subsequent LDCT completion. A multi-level, multivariate model was constructed to identify factors associated with incomplete screening. RESULTS Among individuals undergoing telemedicine SDM during the study period, 20.6% did not complete a LDCT scan. Bivariate analysis demonstrated that Black/African-American race, Medicaid insurance status, and new patient type were associated with greater odds of incomplete screening. On multi-level, multivariate analysis, individuals who were new patients undergoing baseline LDCT or resided in a census tract with a high level of socioeconomic deprivation had significantly higher odds of incomplete screening. Individuals with a greater level of education experienced lower odds of incomplete screening. CONCLUSIONS Among high-risk individuals undergoing telemedicine SDM for LCS, predictors of incomplete screening included low education, high neighborhood-level deprivation, and new patient type. Future research should focus on testing implementation strategies to improve LDCT completion rates while leveraging telemedicine for high-quality LCS.
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Affiliation(s)
- Christine S Shusted
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA
| | - Hee-Soon Juon
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Brooke Ruane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA
| | - Brian Till
- Division of Thoracic Surgery, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Charnita Zeigler-Johnson
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Tyler Grenda
- Division of Thoracic Surgery, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Olugbenga Okusanya
- Division of Thoracic Surgery, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Nathaniel R Evans
- Division of Thoracic Surgery, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Gregory C Kane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA
| | - Julie A Barta
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA.
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21
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Brunner W, Pullyblank K, Scribani M, Krupa N, Fink A, Kern M. Determinants of Telehealth Technologies in a Rural Population. Telemed J E Health 2023; 29:1530-1539. [PMID: 36877537 DOI: 10.1089/tmj.2022.0490] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Background: Telehealth's applicability may be limited for vulnerable populations including rural communities. While broadband access is a known barrier to telehealth use, other factors may influence a person's ability or preference to use telehealth. Objective/Purpose: To compare characteristics of telehealth users versus nontelehealth users in a rural health care network. Methods: We surveyed a stratified random sample of 500 adult patients in August 2021 about telehealth use. We used descriptive statistics to compare characteristics of telehealth users with nontelehealth users. Telehealth was defined in three different ways as follows: (1) phone or video visit, (2) video visit, and (3) patient portal use. Results: Mean age of the 206 respondents was 60 years, 60.7% were female, 60.4% had some college education; 84.9% had home internet, and 73.3% used the internet independently. Video telehealth use was independently associated with younger age (<65), having some college education, being married/partnered, and being enrolled in Medicaid. When telehealth included a phone option, disability was positively associated with telehealth use, and living in a rural town versus metropolitan/micropolitan area was negatively associated with telehealth use. Being younger, married/partnered, and having some college education were significantly associated with patient portal use. Conclusion: Videoconferencing and patient portal use pose barriers to those who are older and have less education. However, these barriers disappear when telehealth is available through telephone.
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Affiliation(s)
- Wendy Brunner
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Kristin Pullyblank
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Melissa Scribani
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Nicole Krupa
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Amanda Fink
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
| | - Megan Kern
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York, USA
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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] [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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Tewari S, Coyne KD, Weinerman RS, Findley J, Kim ST, Flyckt RLR. Racial disparities in telehealth use during the coronavirus disease 2019 pandemic. Fertil Steril 2023; 120:880-889. [PMID: 37244379 PMCID: PMC10210818 DOI: 10.1016/j.fertnstert.2023.05.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the impact of coronavirus disease 2019 on initial infertility consultations. DESIGN Retrospective cohort. SETTING Fertility practice in an academic medical center. PATIENTS Patients presenting for initial infertility consultation between January 2019 and June 2021 were randomly selected for prepandemic (n = 500) and pandemic (n = 500) cohorts. EXPOSURE Coronavirus disease 2019 pandemic. MAIN OUTCOME MEASURES The primary outcome was a change in the proportion of African American patients using telehealth after pandemic onset compared with all other patients. Secondary outcomes included presentation to an appointment vs. no-show or cancellation. Exploratory outcomes included appointment length and in vitro fertilization initiation. RESULTS The prepandemic cohort vs. the pandemic cohort had fewer patients with commercial insurance (64.4% vs. 72.80%) and more African American patients (33.0% vs. 27.0%), although the racial makeup did not differ significantly between the two cohorts. Rates of missed appointments did not differ between the cohorts, but the prepandemic cohort vs. the pandemic cohort was more likely to no-show (49.4% vs. 27.8%) and less likely to cancel (50.6% vs. 72.2%). African American patients, compared with all other patients, during the pandemic were less likely to use telehealth (57.0% vs. 66.8%). African American patients, compared with all other patients, were less likely to have commercial insurance (prepandemic: 41.2% vs. 75.8%; pandemic: 57.0% vs. 78.6%), present to their scheduled appointment (prepandemic: 52.7% vs. 73.7%; pandemic: 48.1% vs. 74.8%), and cancel vs. no-show (prepandemic: 30.8% vs. 68.2%, pandemic: 64.3% vs. 78.3%). On multivariable analysis, African American patients were less likely (odds ratio 0.37, 95% confidence interval 0.28-0.50) and telehealth users were more likely (odds ratio 1.54, 95% confidence interval 1.04-2.27) to present to their appointments vs. no-show or cancel when controlling for insurance type and timing relative to the onset of the pandemic. CONCLUSION Telehealth implementation during the coronavirus disease 2019 pandemic decreased the overall no-show rate, but this shift did not apply to African American patients. This analysis highlights disparities in insurance coverage, telehealth utilization, and presentation for an initial consultation in the African American population during the pandemic.
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Affiliation(s)
- Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kathryn D Coyne
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rachel S Weinerman
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joseph Findley
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sung Tae Kim
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca L R Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Ang IYH, Wang Y, Tyagi S, Koh GCH, Cook AR. Preferences and willingness-to-pay for a blood pressure telemonitoring program using a discrete choice experiment. NPJ Digit Med 2023; 6:176. [PMID: 37749387 PMCID: PMC10520087 DOI: 10.1038/s41746-023-00919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023] Open
Abstract
This study aimed to elicit the preferences and willingness-to-pay for blood pressure (BP) telemonitoring programs. This study also investigated the different factors or participant characteristics that could influence preferences and choice behaviors. Participants with hypertension were identified from an online survey panel demographically representative of Singapore's general population. Participants completed a discrete choice experiment (DCE) with 12 choice sets, selecting their preferred BP monitoring program differing on five attributes: mode of consultation, BP machine type (with Bluetooth or not), BP machine price, monthly fee, and program duration. The base reference population (male, married, higher income, more formal education years, full-time worker, aged 55 to <65 years, and digital skills score of 36) preferred teleconsultation over in-person consultation, Bluetooth feature, lower machine price, lower monthly fee, and shorter program duration. A subgroup of participants can be considered teleconsultation-resistant, and three demographic factors were associated with lower preference for teleconsultation: female, fewer formal education years, and lower income. Considering the reference population and Bluetooth attribute, participants were willing to pay 66 SGD (~49 USD) additional for the machine to obtain the Bluetooth feature. Considering the reference population and teleconsultation attribute, participants were willing to pay 6.80 SGD (~5.10 USD) extra monthly fee for a program using teleconsultation. Here we report that amongst participants with hypertension, there is strong preference for the use of teleconsultation and a BP machine with Bluetooth feature in a BP monitoring program. However, a subgroup of participants are teleconsultation-resistant and would prefer in-person consultation.
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Affiliation(s)
- Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- MOH Office for Healthcare Transformation, Ministry of Health, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- MOH Office for Healthcare Transformation, Ministry of Health, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med 2023; 6:161. [PMID: 37723240 PMCID: PMC10507089 DOI: 10.1038/s41746-023-00899-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/01/2023] [Indexed: 09/20/2023] Open
Abstract
Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3522, USA
| | - Hebatullah Abdulazeem
- Department of Sport and Health Science, Techanische Universität München, Munich, 80333, Germany
| | - Lenny Thinagaran Vasanthan
- Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Edson Zangiacomi Martinez
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University Library of Southern Denmark, Odense, 5230, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark.
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Wilson LA, Harder B, Kelley C, Powell R, Foster M, Roberts E. Geriatric Telehealth: A Standardized Patient Case for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11345. [PMID: 37706040 PMCID: PMC10495538 DOI: 10.15766/mep_2374-8265.11345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/12/2023] [Indexed: 09/15/2023]
Abstract
Introduction The COVID-19 pandemic has necessitated the rapid expansion of telemedicine. However, there has been minimal coverage of telemedicine in traditional undergraduate medicine curricula. Telemedicine presents specific challenges in the geriatric population, including unfamiliarity with technology, cognitive and sensory barriers, inclusion of family and/or caregivers, multimorbidity, and a high degree of medical complexity. Methods We developed a workshop to allow rising third-year medical students to practice a telemedicine patient encounter while developing skills for assessing and communicating with geriatric patients. This 90-minute workshop consisted of an introductory didactic presentation and a standardized patient activity for small groups of two to five students. Students' level of comfort with telemedicine for assessment of geriatric patients was evaluated with a pre- and postsurvey. Results Fifty-eight students participated in the workshop and completed the surveys (presurvey = 58, postsurvey = 40), with roughly half (52%) reporting prior experience with telemedicine. A 5-point Likert-type scale (1 = very uncomfortable, 5 = very comfortable) was used. Students reported statistically significant increases in comfort using telemedicine (presurvey = 3.1, postsurvey = 3.9, p < .001) and using telemedicine for patients ≥65 years (presurvey = 2.8, postsurvey = 3.9, p < .001) after completing the workshop. Discussion Medical students' comfort levels using telemedicine and caring for patients ages 65 and older with a telehealth visit improved after participating in this workshop. To help prepare students for telehealth practice in their future careers, educators should provide them with opportunities to practice and develop this critical skill set.
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Affiliation(s)
- Lindsay A. Wilson
- Associate Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Brianna Harder
- Assistant Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Casey Kelley
- Research Assistant, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Ross Powell
- Resident Physician, Department of Internal Medicine, East Carolina University
| | - Megan Foster
- Resident Physician, Department of Family Medicine, University of Virginia School of Medicine
| | - Ellen Roberts
- Associate Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
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Klee D, Pyne D, Kroll J, James W, Hirko KA. Rural patient and provider perceptions of telehealth implemented during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:981. [PMID: 37700286 PMCID: PMC10496200 DOI: 10.1186/s12913-023-09994-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Understanding perceptions of telehealth implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits. METHODS Using anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September-October 2020. We examined whether telehealth perceptions differed according to patients' age, educational attainment, insurance status, and distance to clinical site and providers' age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test. RESULTS Over 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age (p = 0.67 and p = 0.67, respectively) or time in practice (p = 0.53 and p = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p = 0.39). CONCLUSIONS Telehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.
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Affiliation(s)
- David Klee
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA.
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
- , 1400 Medical Campus Drive, Traverse City, MI, 49684, USA.
| | - Derek Pyne
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - Joshua Kroll
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - William James
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Shoemaker HE, Thorpe A, Stevens V, Butler JM, Drews FA, Burpo N, Scherer LD, Fagerlin A. Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study. JMIR Form Res 2023; 7:e42217. [PMID: 37527547 PMCID: PMC10494868 DOI: 10.2196/42217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/15/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. OBJECTIVE This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. METHODS A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. RESULTS There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). CONCLUSIONS Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all.
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Affiliation(s)
- Holly E Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Vanessa Stevens
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jorie M Butler
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Geriatrics Research, Education, and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Psychology, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
| | - Nicole Burpo
- Research Operations, American Heart Association, Dallas, TX, United States
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, CO, United States
- VA Denver Center for Innovation, Denver, CO, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
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Gerber BS, Biggers A, Tilton JJ, Smith Marsh DE, Lane R, Mihailescu D, Lee J, Sharp LK. Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333629. [PMID: 37773498 PMCID: PMC10543137 DOI: 10.1001/jamanetworkopen.2023.33629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/05/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Clinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes. Objective To determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels. Design, Setting, and Participants This randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year. Interventions The mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients' primary care physicians, including medication reconciliation and adjustment. Main Outcomes and Measures Outcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months. Results Among the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of -0.79 percentage points in the intervention group compared with -0.24 percentage points in the waiting list control group (treatment effect, -0.62; 95% CI, -1.04 to -0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, -0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes. Conclusions and Relevance In this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach-delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities. Trial Registration ClinicalTrials.gov Identifier: NCT02990299.
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Affiliation(s)
- Ben S. Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago
| | - Alana Biggers
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago
| | - Jessica J. Tilton
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago
| | - Daphne E. Smith Marsh
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago
| | - Rachel Lane
- Center for Clinical and Translational Science, University of Illinois Chicago, Chicago
| | - Dan Mihailescu
- Department of Endocrinology, Cook County Health, Chicago, Illinois
| | - JungAe Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Lisa K. Sharp
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago
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Zachrison KS, Yan Z, White BA, Park L, Schwamm LH. Factors Associated with the Digital Patient Experience of Virtual Care Across Specialties. TELEMEDICINE REPORTS 2023; 4:227-235. [PMID: 37637376 PMCID: PMC10457601 DOI: 10.1089/tmr.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/29/2023]
Abstract
Background We aimed to characterize patient experience with virtual care across medical specialties using validated survey data. Primary objective: to determine whether experience varied by visit modality (virtual vs. in-person) and whether relationships persisted after adjusting for patient and provider characteristics. Secondarily, among physicians with sufficient data, we compared virtual versus in-person patient experience scores at the physician level and identified characteristics associated with better experience scores for virtual care. Methods This was a retrospective analysis of administrative databases from a large New England health care system, including all ambulatory visits from October 1, 2020 to September 30, 2021 with patient experience scores recorded. We compared experience between virtual and in-person at the visit level (score: 0-10) and the physician level for likelihood of recommending the physician to friends or family. We used a series of cross-classified hierarchical models with visits grouped by patient and by physician to decompose sources of variation. Among physicians with sufficient data, we compared physicians with higher virtual versus higher in-person net promoter score (NPS). Results Of 378,472 visits performed by 3368 physicians, 86,878 (23%) were conducted virtually. Most scored ≥9 for either modality, with a small preference for virtual versus in-person care (9.6 vs. 9.5, p < 0.001). We found that more variation in scores was explained by patient than by physician (22.9% vs. 3%). Visit modality was of minimal explanatory value. Most physicians' virtual and in-person NPS were similar, and virtual visit volume was not associated. Conclusions We found robust evidence for the parity of patient experience between virtual and in-person modalities across specialties.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zhiyu Yan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin A. White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee Park
- Department of Internal Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
- Mass General Brigham, Boston, Massachusetts, USA
| | - Lee H. Schwamm
- Mass General Brigham, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Ulyte A, Mehrotra A, Wilcock AD, SteelFisher GK, Grabowski DC, Barnett ML. Telemedicine Visits in US Skilled Nursing Facilities. JAMA Netw Open 2023; 6:e2329895. [PMID: 37594760 PMCID: PMC10439478 DOI: 10.1001/jamanetworkopen.2023.29895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
Importance Telemedicine in skilled nursing facilities (SNFs) has the potential to improve access and timeliness of care. During the COVID-19 pandemic in 2020 to 2022, telemedicine coverage expanded, but little is known about patterns of use in SNFs. Objective To describe patterns of telemedicine use in SNFs. Design, Setting, and Participants This cohort study used 2018 to 2022 Medicare fee-for-service claims and Minimum Data Set 3.0 records to identify short- and long-term care SNF residents. Clinician visits were grouped into routine SNF visits (ie, regular primary care within SNF) and other outpatient visits (ie, with non-SNF affiliated primary and specialty care clinicians). Using a difference-in-differences approach, assessments included whether off-hours visits (measured as weekend visits), new specialist visits, psychiatrist visits, or visits for residents with limited mobility changed differentially between 2018 to 2019 and 2020 to 2021 for SNFs with high compared with low telemedicine use in 2020. Exposure Telemedicine adoption at SNF after 2020. Main Outcomes and Measures Number and proportion of telemedicine SNF and outpatient visits. Results Across 15 434 SNFs and 4 463 591 residents from the period January 2019 through June 2022 (mean [SD] age, 79.7 [11.6] years; 61% female in 2020), telemedicine visits increased from 0.15% in January 2019 to February 2020 to 15% SNF visits and 25% outpatient visits in May 2020. By 2022, telemedicine dropped to 2% of SNF visits and 8% of outpatient visits. The proportion of SNFs with any telemedicine visits annually dropped from 91% in 2020 to 61% in 2022. The facilities with high telemedicine use were more likely to be rural (adjusted odds ratio vs urban, 2.06; 95% CI, 1.77 to 2.40). Psychiatry visits differentially increased in high vs low telemedicine-use SNFs (20.2% relative increase; 95% CI, 1.2% to 39.2%). In contrast, there was little change in outpatient visits for residents with limited mobility (7.2%; 95% CI, -0.1% to 14.6%) or new specialist visits (-0.7%; 95% CI, -2.5% to 1.2%). Conclusions and Relevance In this cohort study of SNF residents, telemedicine was rapidly adopted in early 2020 but subsequently stabilized at a low use rate that was nonetheless higher than before 2020. Higher telemedicine use in SNFs was associated with improved access to psychiatry visits in SNFs. A policy to encourage continued telemedicine use may facilitate further access to important services as the technology matures.
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Affiliation(s)
- Agne Ulyte
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew D. Wilcock
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Gillian K. SteelFisher
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Vallejo-Bocanumen CE, Pérez-Martínez D, Quiceno-Salazar DC, Mejía-Gonzalez YP, García-Cano JF, Martínez-Pérez DC. Experience of a TelEmergency program in Colombia South America: descriptive observational study between 2019 and 2021. BMC Emerg Med 2023; 23:75. [PMID: 37403026 PMCID: PMC10321012 DOI: 10.1186/s12873-023-00842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Colombia has 50,912,429 inhabitants, but only 50-70% of the population can effectively access health care services. The emergency room (ER) is a main contributor to the in-hospital care system since up to half of the admissions come through it. Telemedicine has become a tool to facilitate effective access to health care services, improve the timeliness of care, reduce diagnostic variability, and reduce costs associated with health. The aim of this study is to describe the experience of a Distance Emergency Care Program through Telemedicine (TelEmergency) to improve specialist access for patients at the Emergency Room (ER) in low- and medium-level care hospitals in Colombia. METHODS An observational descriptive study of a cohort including 1,544 patients during the program's first two years was conducted. Descriptive statistics were used to analyze the available data. The data are presented with summarized statistics of sociodemographic, clinical, and patient-care variables. RESULTS The study included a total of 1,544 patients, and the majority were adults between 60 and 79 years of age (n = 491, 32%). More than half were men (n = 832, 54%), and 68% (n = 1,057) belonged to the contributory health care regime. The service was requested from 346 municipalities, 70% (n = 1,076) from intermediate and rural settings. The most common diagnoses were related to COVID-19 (n = 356, 22%), respiratory diseases (n = 217, 14%), and cardiovascular diseases (n = 162, 10%). We observed 44% (n = 681) of local admissions either under observation (n = 53, 3%) or hospitalization (n = 380, 24%), limiting the need for hospital transfers. Program operation data revealed that 50% (n = 799) of requests were answered within two hours by the medical staff. The initial diagnosis was modified in 7% (n = 119) of the patients after being evaluated by specialists at the TelEmergency program. CONCLUSIONS This study shows the operational data collected during the first two years after the implementation of the TelEmergency program in Colombia, the first of its kind in the country. Its implementation offered specialized timely management of patients at the ER in low- and medium-level care hospitals, where there is no availability of specialized doctors.
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Affiliation(s)
- Carlos E Vallejo-Bocanumen
- Urgencies and Emergencies Research Group, Faculty of Medicine, University of Antioquia, Carrera 51D #62 - 29, Office MUA 302, 050010, Medellín, Colombia.
| | - Daniel Pérez-Martínez
- Urgencies and Emergencies Research Group, Faculty of Medicine, University of Antioquia, Carrera 51D #62 - 29, Office MUA 302, 050010, Medellín, Colombia
| | | | | | - Juan F García-Cano
- Urgencies and Emergencies Research Group, Faculty of Medicine, University of Antioquia, Carrera 51D #62 - 29, Office MUA 302, 050010, Medellín, Colombia
| | - Diana C Martínez-Pérez
- Urgencies and Emergencies Research Group, Faculty of Medicine, University of Antioquia, Carrera 51D #62 - 29, Office MUA 302, 050010, Medellín, Colombia
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Miller-Rosales C, Morden NE, Brunette MF, Busch SH, Torous JB, Meara ER. Provision of Digital Health Technologies for Opioid Use Disorder Treatment by US Health Care Organizations. JAMA Netw Open 2023; 6:e2323741. [PMID: 37459098 PMCID: PMC10352858 DOI: 10.1001/jamanetworkopen.2023.23741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/31/2023] [Indexed: 07/20/2023] Open
Abstract
Importance Digital health technologies may expand organizational capacity to treat opioid use disorder (OUD). However, it remains unclear whether these technologies serve as substitutes for or complements to traditional substance use disorder (SUD) treatment resources in health care organizations. Objective To characterize the use of patient-facing digital health technologies for OUD by US organizations with accountable care organization (ACO) contracts. Design, Setting, and Participants This cross-sectional study analyzed responses to the 2022 National Survey of Accountable Care Organizations (NSACO), collected between October 1, 2021, and June 30, 2022, from US organizations with Medicare and Medicaid ACO contracts. Data analysis was performed between December 15, 2022, and January 6, 2023. Exposures Treatment resources for SUD (eg, an addiction medicine specialist, sufficient staff to treat SUD, medications for OUD, a specialty SUD treatment facility, a registry to identify patients with OUD, or a registry to track mental health for patients with OUD) and organizational characteristics (eg, organization type, Medicaid ACO contract). Main Outcomes and Measures The main outcomes included survey-reported use of 3 categories of digital health technologies for OUD: remote mental health therapy and tracking, virtual peer recovery support programs, and digital recovery support for adjuvant cognitive behavior therapy (CBT). Statistical analysis was conducted using descriptive statistics and multivariable logistic regression models. Results Overall, 276 of 505 organizations responded to the NSACO (54.7% response rate), with a total of 304 respondents. Of these, 161 (53.1%) were from a hospital or health system, 74 (24.2%) were from a physician- or medical group-led organization, and 23 (7.8%) were from a safety-net organization. One-third of respondents (101 [33.5%]) reported that their organization used at least 1 of the 3 digital health technology categories, including remote mental health therapy and tracking (80 [26.5%]), virtual peer recovery support programs (46 [15.1%]), and digital recovery support for adjuvant CBT (27 [9.0%]). In an adjusted analysis, organizations with an addiction medicine specialist (average marginal effect [SE], 32.3 [4.7] percentage points; P < .001) or a registry to track mental health (average marginal effect [SE], 27.2 [3.8] percentage points; P < .001) were more likely to use at least 1 category of technology compared with otherwise similar organizations lacking these capabilities. Conclusions and Relevance In this cross-sectional study of 276 organizations with ACO contracts, organizations used patient-facing digital health technologies for OUD as complements to available SUD treatment capabilities rather than as substitutes for unavailable resources. Future studies should examine implementation facilitators to realize the potential of emerging technologies to support organizations facing health care practitioner shortages and other barriers to OUD treatment delivery.
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Affiliation(s)
| | - Nancy E. Morden
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
- UnitedHealthcare, Minnetonka, Minnesota
| | - Mary F. Brunette
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Bureau of Mental Health Services, New Hampshire Department of Health and Human Services, Concord
| | - Susan H. Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - John B. Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ellen R. Meara
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Liu L, Alford-Teaster J, Onega T, Wang F. Refining 2SVCA Method for Measuring Telehealth Accessibility of Primary Care Physicians in Baton Rouge, Louisiana. CITIES (LONDON, ENGLAND) 2023; 138:104364. [PMID: 37274944 PMCID: PMC10237453 DOI: 10.1016/j.cities.2023.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Equity in health care delivery is a longstanding concern of public health policy. Telehealth is considered an important way to level the playing field by broadening health services access and improving quality of care and health outcomes. This study refines the recently developed "2-Step Virtual Catchment Area (2SVCA) method" to assess the telehealth accessibility of primary care in the Baton Rouge Metropolitan Statistical Area, Louisiana. The result is compared to that of spatial accessibility via physical visits to care providers based on the popular 2-Step Floating Catchment Area (2SFCA) method. The study shows that both spatial and telehealth accessibilities decline from urban to low-density and then rural areas. Moreover, disproportionally higher percentages of African Americans are in areas with higher spatial accessibility scores; but such an advantage is not realized in telehealth accessibility. In the study area, absence of broadband availability is mainly a rural problem and leads to a lower average telehealth accessibility than physical accessibility in rural areas. On the other side, lack of broadband affordability is a challenge across the rural-urban continuum and is disproportionally associated with high concentrations of disadvantaged population groups such as households under the poverty level and Blacks.
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Affiliation(s)
- Lingbo Liu
- Department of Urban Planning, School of Urban Design, Wuhan University, Wuhan 430072, China
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138, USA
| | - Jennifer Alford-Teaster
- Norris Cotton Cancer Center, Lebanon, NH 03755, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah; Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
| | - Fahui Wang
- Graduate School and Department of Geography and Anthropology, Louisiana State University, LA 70803, USA
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Tomlinson SRL, Gore N, McGill P. Family carer and professional perceptions of the potential use of telehealth for behavioural support. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:531-546. [PMID: 36919000 DOI: 10.1111/jir.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Telehealth (i.e. the use of technology across distance) is widespread in many fields. Although its use for behavioural support for people with intellectual or developmental disabilities (IDD) is emerging, there are no known studies examining stakeholder perceptions of this. METHODS A four-round Delphi consultation was conducted with 11 professionals and six family carers of children with IDD to generate consensus on what would influence participants' use of telehealth for behavioural support. Data were collected prior to the coronavirus pandemic. RESULTS Thirty-six items reached consensus for professionals (26 advantages and 10 disadvantages/barriers) and 22 for family carers (8 advantages and 14 disadvantages/barriers). A range of solutions were also identified for the disadvantages/barriers. CONCLUSIONS Participants were willing to use telehealth for behavioural support. However, disadvantages/barriers need to be addressed, and guidelines relating to the use of telehealth in this field are needed. We report a number of practice recommendations including combining telehealth with in-person supports where possible, incorporating video technologies, and considering client perspectives and confidence with telehealth methodologies.
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Affiliation(s)
| | - N Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | - P McGill
- Tizard Centre, University of Kent, Canterbury, UK
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Chandrasekaran R, Bapat P, Venkata PJ, Moustakas E. Face time with physicians: How do patients assess providers in video-visits? Heliyon 2023; 9:e16883. [PMID: 37292342 PMCID: PMC10238118 DOI: 10.1016/j.heliyon.2023.e16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction The COVID-19 pandemic has triggered a massive acceleration in the use of virtual and video-visits. As more patients and providers engage in video-visits over varied digital platforms, it is important to understand how patients assess their providers and the video-visit experiences. We also need to examine the relative importance of the factors that patients use in their assessment of video-visits in order to improve the overall healthcare experience and delivery. Methods A data set of 5149 reviews of patients completing a video-visit was assembled through web scraping. Sentiment analysis was performed on the reviews and topic modeling was used to extract latent topics embedded in the reviews and their relative importance. Results Most patient reviews (89.53%) reported a positive sentiment towards their providers in video-visits. Seven distinct topics underlying the reviews were identified: bedside manners, professional expertise, virtual experience, appointment scheduling and follow-up process, wait times, costs, and communication. Communication, bedside manners and professional expertise were the top factors patients alluded to in the positive reviews. Appointment-scheduling and follow-ups, wait-times, costs, virtual experience and professional expertise were important factors in the negative reviews. Discussion To improve the overall experience of patients in video-visits, providers need to engage in clear communication, grow excellent bedside and webside manners, promptly attend the video-visit with minimal delays and follow-up with patients after the visit.
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Affiliation(s)
| | - Prathamesh Bapat
- Department of Information & Decision Sciences, University of Illinois at Chicago, USA
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Hindman D, Windish D, Michtalik H, Bertram A, Prichett L, Pahwa A. An Educational Needs Assessment of Telehealth in Primary Care Among US Internal Medicine Residents. South Med J 2023; 116:511-517. [PMID: 37263616 DOI: 10.14423/smj.0000000000001568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES As a result of the coronavirus disease 2019 pandemic, many Internal Medicine (IM) residency programs converted to telehealth for primary care. Our objectives in this study were to better understand resident past and present telehealth education, their perceived barriers to telehealth practice, and their perceived solutions to improving telehealth use and education. METHODS We performed a cross-sectional needs assessment survey between November 2020 and February 2021 among residents at 10 IM residency programs across the United States. Our primary measures were telehealth use in resident continuity clinics before and during the coronavirus disease 2019 pandemic, telehealth training, and confidence and barriers in using telehealth. RESULTS Of 857 residents contacted, 314 (36.6%) responded. Residents reported low rates of education in telehealth prepandemic with significant improvements after the start of the pandemic across all visit domains (range of 10.7%-19.6% prepandemic compared with 25.6%-55.7% postpandemic, all P < 0.001). Resident confidence levels were significantly lower (P < 0.001) for video visits and telephone visits compared with in-person visiting across domains of communication, history taking, using an interpreter, making a diagnosis, counseling patients, providing psychosocial support, performing medical management, and coordinating after-visit care. Reported barriers included patient resources, clinic resources, lack of preceptor feedback, and lack of observation. Reported resources for improvement included tutorials on physical examination techniques, clinical space for telehealth, and patient resources for telehealth. CONCLUSIONS To effectively address the educational needs for telehealth practice by IM residents, educators must consider not only curricular needs but also clinical, preceptor, and patient barriers to the high-quality use of telehealth for primary care.
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Affiliation(s)
| | - Donna Windish
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Laura Prichett
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Teti S, Murray LL, Orange JB, Page AD, Kankam KS. Telehealth Assessments and Interventions for Individuals With Poststroke Aphasia: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1360-1375. [PMID: 37120860 DOI: 10.1044/2023_ajslp-22-00324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE There are increasing demands for aphasia assessment and intervention services to be delivered remotely. The purpose of this scoping review was to address what is known about the delivery of assessments and interventions using telehealth for people with poststroke aphasia. Specifically, the review sought to (a) identify which telehealth assessment protocols have been used, (b) identify which telehealth intervention protocols have been used, and (c) describe evidence on the effectiveness and feasibility of telehealth for people with poststroke aphasia. METHOD A scoping review of the literature published in English since 2013 was conducted by searching MEDLINE, Embase, PsycINFO, CINAHL, and Scopus databases to identify relevant studies. A total of 869 articles were identified. Two reviewers screened records independently, finding 25 articles eligible for inclusion. Data extraction was conducted once and validated by the second reviewer. RESULTS Two of the included studies examined telehealth assessment protocols, whereas the remaining studies focused on the delivery of telehealth interventions. The results of the included studies illustrated both effectiveness and feasibility regarding telehealth for people with poststroke aphasia. However, a lack of procedural variation among the studies was found. CONCLUSIONS Overall, this scoping review yielded continued support for the use of telehealth practices as an alternate mode of delivering both assessment and intervention services to people with poststroke aphasia. However, further research is needed to investigate the range of aphasia assessment and intervention protocols that can be offered via telehealth, such as assessments or interventions that use patient-reported measures or address extralinguistic cognitive abilities.
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Affiliation(s)
- Selina Teti
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Laura L Murray
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Canadian Centre for Activity and Aging, Western University, London, Ontario
| | - J B Orange
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Canadian Centre for Activity and Aging, Western University, London, Ontario
| | - Allyson D Page
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Keren S Kankam
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
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A comparative analysis of outpatient nutrition clinic scheduling outcomes based on in-person and telehealth patient care delivery modalities ☆. HEALTHCARE ANALYTICS (NEW YORK, N.Y.) 2023; 3:100163. [PMID: 36999092 PMCID: PMC10032049 DOI: 10.1016/j.health.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
During the start of the global COVID-19 pandemic in March 2020, patient care modalities changed from in-person to telehealth to comply with physical distancing guidelines. Our study uniquely examines operations data from three distinct periods: before the transition to telehealth, early transition from in-person care to telehealth, and the eventual adoption of telehealth. We present a comparative analysis of outpatient nutrition clinic scheduling outcomes based on care delivery modality. We used descriptive statistics to report means and variance and frequencies. We used inferential statistics to make comparisons: categorical data were compared using chi- square analysis with post-hoc comparisons using a z-test with alpha at 0.05. Means of continuous variables were compared using ANOVA with Tukey HSD post-hoc analysis. We found patient demographics remained widely unchanged across the three distinct periods as the demand for telehealth visits increased, with a notable rise in return patient visits, signaling both adaptability across the patient population and acceptance of the telehealth modality. These analyses along with evidence from the included literature review point to many the benefits of telehealth, thus telehealth as a healthcare delivery modality is here to stay. Our work serves as a foundation for future studies in this field, provides information for decision-makers in telehealth-related strategic planning, and can be utilized in advocacy for the extension of telehealth coverage.
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Jiang Y, Nuerdawulieti B, Chen Z, Guo J, Sun P, Chen M, Li J. Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial. J Telemed Telecare 2023:1357633X231156631. [PMID: 36919365 DOI: 10.1177/1357633x231156631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR. OBJECTIVE This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence. METHODS A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients' quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes. RESULTS A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George's Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028). CONCLUSIONS PDA supported recurring SDM intervention was helpful in maintaining older COPD patients' PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients' rehabilitation adherence and quality of life. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.
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Affiliation(s)
- Yuyu Jiang
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Baiyila Nuerdawulieti
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Zhongyi Chen
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Jianlan Guo
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Pingping Sun
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Mengjie Chen
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Jinping Li
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
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Cengil AB, Eksioglu B, Eksioglu S, Eswaran H, Hayes CJ, Bogulski CA. Using data analytics for telehealth utilization: A case study in Arkansas. J Telemed Telecare 2023:1357633X231160039. [PMID: 36883218 DOI: 10.1177/1357633x231160039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Many patients used telehealth services during the COVID-19 pandemic. In this study, we evaluate how different factors have affected telehealth utilization in recent years. Decision makers at the federal and state levels can use the results of this study to inform their healthcare-related policy decisions. METHODS We implemented data analytics techniques to determine the factors that explain the use of telehealth by developing a case study using data from Arkansas. Specifically, we built a random forest regression model which helps us identify the important factors in telehealth utilization. We evaluated how each factor impacts the number of telehealth patients in Arkansas counties. RESULTS Of the 11 factors evaluated, five are demographic, and six are socioeconomic factors. Socioeconomic factors are relatively easier to influence in the short term. Based on our results, broadband subscription is the most important socioeconomic factor and population density is the most important demographic factor. These two factors were followed by education level, computer use, and disability in terms of their importance as it relates to telehealth use. DISCUSSION Based on studies in the literature, telehealth has the potential to improve healthcare services by improving doctor utilization, reducing direct and indirect waiting times, and reducing costs. Thus, federal and state decision makers can influence the utilization of telehealth in specific locations by focusing on important factors. For example, investments can be made to increase broadband subscriptions, education levels, and computer use in targeted locations.
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Affiliation(s)
- Aysenur Betul Cengil
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Burak Eksioglu
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Sandra Eksioglu
- Department of Industrial Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hari Eswaran
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics/Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Ekwegh T, Cobb S, Adinkrah EK, Vargas R, Kibe LW, Sanchez H, Waller J, Ameli H, Bazargan M. Factors Associated with Telehealth Utilization among Older African Americans in South Los Angeles during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2675. [PMID: 36768041 PMCID: PMC9915549 DOI: 10.3390/ijerph20032675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic transformed healthcare delivery with the expansive use of telemedicine. However, health disparities may result from lower adoption of telehealth among African Americans. This study examined how under-resourced, older African Americans with chronic illnesses use telehealth, including related sociodemographic and COVID-19 factors. METHODS Using a cross-sectional design, 150 middle-aged and older African Americans were recruited from faith-based centers from March 2021 to August 2022. Data collected included sociodemographics, comorbidities, technological device ownership, internet usage, and attitudes toward COVID-19 disease and vaccination. Descriptive statistics and multivariable regression models were conducted to identify factors associated with telehealth use. RESULTS Of the 150 participants, 32% had not used telehealth since the COVID-19 pandemic, with 75% reporting no home internet access and 38% having no cellular/internet network on their mobile device. Age, access to a cellular network on a mobile device, and wireless internet at home were significantly associated with the utilization of telehealth care. Higher anxiety and stress with an increased perceived threat of COVID-19 and positive attitudes toward COVID-19 vaccination were associated with telehealth utilization. DISCUSSION Access and integration of telehealth services were highlighted as challenges for this population of African Americans. To reduce disparities, expansion of subsidized wireless internet access in marginalized communities is necessitated. Education outreach and training by healthcare systems and community health workers to improve uptake of telehealth currently and post-COVID-19 should be considered.
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Affiliation(s)
- Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing (MMDSON), Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing (MMDSON), Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Roberto Vargas
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Lucy W. Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Humberto Sanchez
- Office of Research, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Joe Waller
- Office of Research, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Hoorolnesa Ameli
- Department of Emergency Medicine, Mellie’s Bank Hospital, Tehran 1135933763, Iran
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90059, USA
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Mavragani A, Whitebridge S, Kumar N, Aljenaee K, Atkin SL, Ali KF. The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study. JMIR Form Res 2023; 7:e34074. [PMID: 36652596 PMCID: PMC9897307 DOI: 10.2196/34074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Due to the COVID-19 pandemic, telehealth has become a safer way to access health care. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region. OBJECTIVE The primary aim was to assess the prevalence of telehealth use before and during the pandemic by using social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth among those using it. METHODS An Instagram account that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability toward this modality of health care delivery during the COVID-19 pandemic. RESULTS A total of 1524 respondents participated in the survey (n=1356, 89% female; median age 31 years), of whom 97.6% (n=1487) lived in the Gulf Cooperation Council (GCC) region. Prior to COVID-19, 1350 (88.6%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth use increased by 251% to a total of 611 users (40% of all users). About 89% (571/640) of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8%) reported their willingness to continue using telehealth, 241 (37.5%) were unsure, and 164 (25.5%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth use and the number of medical comorbidities (odds ratio [OR] 0.81, 95% CI 0.64-1.03; P=.09). Compared to the respondents who chose only messaging as the modality they used for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR 0.42, 95% CI 0.22-0.80; P=.009). Overall, there was general satisfaction with telehealth, and respondents reported that telehealth consultations made them feel safer and saved both time and money. CONCLUSIONS Telehealth use increased dramatically after the COVID-19 pandemic, and telehealth was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of health care.
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Affiliation(s)
| | - Simon Whitebridge
- Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Nitya Kumar
- Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | | | - Stephen L Atkin
- Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Khawla Fuad Ali
- Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
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Sodhi N. CORR Insights®: Do Americans Lacking a Local Orthopaedic Surgeon Have Adequate Broadband for Telehealth? Clin Orthop Relat Res 2023; 481:356-358. [PMID: 36668699 PMCID: PMC9831200 DOI: 10.1097/corr.0000000000002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Nipun Sodhi
- Resident Physician, Long Island Jewish Medical Center, Northwell Health, Department of Orthopaedic Surgery, New York, NY, USA
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Hung TK, Latte-Naor S, Li Y, Kuperman GJ, Seluzicki C, Pendleton E, Pfister DG, Mao JJ. Assessment of Oncology Patient Engagement and Interest in Virtual Mind-Body Programming: Moving Toward Personalization of Virtual Care. JCO Oncol Pract 2023; 19:e185-e196. [PMID: 36399698 PMCID: PMC9970275 DOI: 10.1200/op.22.00424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Accelerated by the COVID-19 pandemic, the virtual platform has become a prominent medium to deliver mind-body therapies, but the extent to which patients engage in virtual mind-body programming remains unclear. This study aims to assess oncology patient engagement in a virtual mind-body program. METHODS We surveyed oncology patients enrolled in a live-streamed (synchronous) virtual mind-body program in May 2021. Patients self-reported engagement by weekly attendance. We applied multivariate regression to identify associations of engagement with sociodemographic and clinical factors. As an exploratory analysis, we used machine learning to partition engagement subgroups to determine preferential interest in prerecorded (asynchronous) mind-body therapy videos. RESULTS Among 148 patients surveyed (response rate: 21.4%), majority were female (94.5%), White (83.1%), age 65 years or older (64.9%), retired (64.2%), and in survivorship (61.8%). Patient engagement ranged from 1 to 13 classes/week (mean [standard deviation]: 4.23 [2.56]) and was higher for female (β, .82; 95% CI, 0.01 to 1.62), non-White (β, .63; 95% CI, 0.13 to 1.13), and retired patients (β, .50; 95% CI, 0.12 to 0.88). The partition model identified three engagement subgroups: employed (low engagers), retired White (intermediate engagers), and retired non-White (high engagers). Particularly, low engagers had preferential interest in meditation videos (odds ratio, 2.85; 95% CI, 1.24 to 6.54), and both low and high engagers had preferential interest in Tai Chi videos (odds ratio, 2.26; 95% CI, 1.06 to 4.82). CONCLUSION In this cross-sectional study among oncology patients, engagement in virtual mind-body programming was higher for female, non-White, and retired patients. Our findings suggest the need for both synchronous and asynchronous mind-body programming to meet the diverse needs of oncology patients.
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Affiliation(s)
| | | | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Eva Pendleton
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
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Bogulski CA, Payakachat N, Rhoads SJ, Jones RD, McCoy HC, Dawson LC, Eswaran H. A Comparison of Audio-Only and Audio-Visual Tele-Lactation Consultation Services: A Mixed Methods Approach. J Hum Lact 2023; 39:93-106. [PMID: 36196975 DOI: 10.1177/08903344221125118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life; however, a lack of access to breastfeeding resources influences breastfeeding initiation and continuation. Tele-lactation services may reduce some of these barriers to access. RESEARCH AIMS To identify facilitators and barriers of two modes of tele-health service utilization and to compare the differences between two modes of providing tele-lactation services on breastfeeding knowledge, breastfeeding intention, perceived social support, and 3-month breastfeeding continuation behavior. METHODS We conducted a mixed method, longitudinal pilot study utilizing prospective convenience sampling and random assignment of postpartum women recruited from two medical centers in Little Rock, Arkansas. Participants (N = 43) were randomized into telephone-only (n = 23) or audio-visual (n = 20) intervention groups. Participants completed a self-administered pre- and post-intervention survey, as well as a semi-structured qualitative phone interview at 4-6 weeks post-discharge. RESULTS No significant difference in demographic characteristics across groups was found. At 3 months after discharge, both groups reported continued breastfeeding (telephone-only: n = 17, 81%; audio-visual: n = 18, 90%) with no significant difference between the two groups (p = .663). Additionally, no group differences were found for breastfeeding knowledge or perceived social support. Overall, participants reported positive experiences with tele-lactation, emphasizing the convenience, accessibility, education, and support provided. CONCLUSION We found that both telephone-only and audio-visual delivery of tele-lactation services were equally effective. Both methods of tele-lactation services should be considered by health care providers to encourage and sustain breastfeeding behavior in mothers.
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Affiliation(s)
- Cari A Bogulski
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nalin Payakachat
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah J Rhoads
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca D Jones
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hannah C McCoy
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Leah C Dawson
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Lovis C, Hefner J, Chen C, Huang Y, Wang X, Yang Q, Zhu X, Zhang X, Hao M, Shui L. Developing a Capsule Clinic-A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China. JMIR Med Inform 2023; 11:e41212. [PMID: 36622737 PMCID: PMC9871876 DOI: 10.2196/41212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 01/10/2023] Open
Abstract
Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients' usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process-from diagnosis to prescription services-can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations' PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.
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Affiliation(s)
| | | | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yunyun Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Qingren Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xuebo Zhu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiangyang Zhang
- Engineering Research Center of Intelligent Medicine (2016E10011), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mo Hao
- School of Public Health, Fudan University, Shanghai, China
| | - Liming Shui
- Yinzhou District Health Bureau, Ningbo, China
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Mavragani A, Pash E, Zhou MS, Broffman L, Bialonczyk D, Doron T, Chiquette E. Characteristics and Weight Loss Practices From a Cohort of 20,000 Patients Using Direct-to-Consumer Telehealth: Observational Cross-sectional Study. JMIR Form Res 2023; 7:e40062. [PMID: 36602855 PMCID: PMC9893727 DOI: 10.2196/40062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Despite the increasing prevalence of obesity, the use of pharmacotherapy treatment remains low. Telehealth platforms have the potential to facilitate access to pharmacotherapy interventions, but little is known about telehealth patients. OBJECTIVE This study describes a large patient population taking Plenity, an oral superabsorbent hydrogel (OSH) used in the treatment of excess weight or obesity (BMI 25-40 kg/m2). The analysis compared differences in weight loss practices and in-person access to obesity care among telehealth patients with preobesity and obesity. METHODS This was a cross-sectional assessment of a random sample of 20,000 telehealth patients who completed a structured, web-based visit and received at least one prescription of OSH. Patients were eligible to receive care via telehealth if they were adults, were not pregnant, and had a BMI ≥25 kg/m2. During the visit, patients provided baseline health information including comorbidities, diet, and exercise habits. Their zip code of residence was used to determine their proximity to an obesity medicine provider. Descriptive statistical analysis and tests of differences (chi-square and 2-tailed t tests) were used to compare patients with preobesity (BMI 25-29.9 kg/m2) and obesity (BMI 30-40 kg/m2). RESULTS Most (15,576/20,000, 77.88%) of the cohort were female, with a mean age of 44 (SD 11) years and a mean BMI of 32.4 (SD 4.1) kg/m2. Among the cohort, 32.13% (6426/20,000) had preobesity, and 40.18% (8036/20,000) of all patients had ≥1 weight-related comorbidity. Almost all (19,732/20,000, 98.66%) patients attempted 1 weight loss method before OSH and half (10,067/20,000, 50.34%) tried ≥4 different methods. Exercise and low-calorie diets were the most attempted weight loss methods, and 28.76% (5752/20,000) of patients reported a prior prescription of weight loss medication. Patients with obesity were more likely than patients with preobesity to have previously tried commercial weight loss plans (7294/13,574, 53.74% vs 2791/6426, 43.43%; P<.001), specialized diets (8493/13,574, 62.57% vs 3799/6426, 59.12%; P<.001), over-the-counter supplements (6807/13,574, 50.15% vs 2876/6426, 44.76%; P<.001), and prescription weight loss medications (4407/13,574, 32.47% vs 1345/6426, 20.93%; P<.001). Females were more likely to seek treatment for preobesity (5332/15,576, 34.23% vs 1094/4424, 24.73% male; P<.001) and reported fewer comorbidities (5992/15,576, 38.47% vs 2044/4424, 46.2% male; P<.001), despite >90% of both sexes reporting the belief that excess weight negatively affected their health (14,247/15,576, 91.47% female participants, 4116/4424, 93.04% male participants). Moreover, 29.25% (5850/20,000) of patients lived in the same zip code and 85.15% (17,030/20,000) lived in the same county as an obesity medicine provider. CONCLUSIONS Data from this large patient cohort supports the potential for telehealth to provide prescriptive weight management treatment to a population seeking care. Patients with preobesity are an undertreated population who actively seek new weight management options. Female participants sought weight management treatment earlier in the disease continuum than males, despite reporting fewer comorbidities.
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Price-Haywood EG, Arnold C, Harden-Barrios J, Davis T. Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations. Ochsner J 2023; 23:34-42. [PMID: 36936477 PMCID: PMC10016217 DOI: 10.31486/toj.22.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Background: The coronavirus disease 2019 pandemic ushered in rapid adoption of telehealth services. This study examines patient and provider experience and provides recommendations for facilitating the use of digital health interventions among socially disadvantaged populations. Methods: This qualitative study was conducted from May to July 2021 via semistructured interviews. Forty patients and 30 primary care providers (PCPs) in Louisiana were recruited within an integrated delivery health system and a rural health center. Technology acceptance models were used to develop a thematic coding scheme. Results: Most patients self-identified as Black (67.5%) and female (72.5%), had a mean age of 51 years, lived in an urban area (76.9%), and had Medicaid (57.9%). Most PCPs were White (79.3%) and male (51.7%), had a mean age of 39 years, and reported Medicaid as the predominant insurer (58.6%). Patient use of smartphones for internet access to health and nonhealth activities was common. PCPs noted the need to address misinformation or misinterpretation of information on the internet. Most patients had used a patient portal (72.5%) and noted the convenience of messaging. PCPs reported large increases in messaging workloads. Most patients had had telemedicine visits (65.6%); however, Wi-Fi/broadband problems limited video visits. PCPs expressed concerns regarding the types of chief complaints that are appropriate for telemedicine visits and reported workflow inefficiencies when clinic sessions had mixed visit types. Patients and PCPs valued remote telemonitoring as adjuncts to care; however, limited service availability and insurance coverage were barriers. Conclusion: Infrastructure barriers (broadband, insurance) and workload imbalance temper enthusiasm for using digital health solutions. Health systems should implement complementary patient and provider user-centric strategies for facilitating uptake of technology.
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Affiliation(s)
- Eboni G. Price-Haywood
- Ochsner-Xavier Institute for Health Equity and Research, New Orleans, LA
- Department of Research, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
- Address correspondence to Eboni G. Price-Haywood, MD, MPH, Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, 1401 Jefferson Hwy., New Orleans, LA 70121. Tel: (504) 842-8256.
| | - Connie Arnold
- Department of Medicine, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
| | - Jewel Harden-Barrios
- Ochsner-Xavier Institute for Health Equity and Research, New Orleans, LA
- Department of Research, Ochsner Clinic Foundation, New Orleans, LA
| | - Terry Davis
- Department of Medicine, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
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Crouch J, Winters K, Zhang L, Stewart MW. Telehealth during the pandemic: Patient perceptions and policy implications. J Nurs Scholarsh 2023; 55:141-148. [PMID: 36218219 PMCID: PMC9874805 DOI: 10.1111/jnu.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID-19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID-19 pandemic and explore relevant policy implications. DESIGN Researchers used a cross-sectional, non-experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. METHODS As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID-19 pandemic has made me more open to using telehealth" on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Means of the different groups were analyzed using independent t-test and one-way ANOVA with Bonferroni post-hoc multiple comparisons. RESULTS Of the total participants, 73% (n = 366) either agreed or strongly agreed that the COVID-19 pandemic had made them more open to using telehealth. Significant differences existed by age (p = 0.016), race/ethnicity (p = 0.015), and sex (p < 0.001), however, groups did not differ by age during post-hoc analysis. A significant difference in the mean responses was observed between black participants (M = 4.29) and white participants (M = 3.91; p = 0.011). In addition, female participants (M = 4.11) rated the item higher than male participants (M = 3.65). CONCLUSION As access to telehealth increased due to the COVID-19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. CLINICAL RELEVANCE Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID-19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions.
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Affiliation(s)
- Jacob Crouch
- The University of Mississippi Medical CenterJacksonMississippiUSA,Mississippi CollegeClintonMississippiUSA
| | - Karen Winters
- The University of Mississippi Medical CenterJacksonMississippiUSA
| | - Lei Zhang
- The University of Mississippi Medical CenterJacksonMississippiUSA
| | - Mary W. Stewart
- The University of Mississippi Medical CenterJacksonMississippiUSA
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