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Dahiya P, Riano NS, Dilley JW, Olfson M, Cournos F, Mangurian C, Arnold EA. Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2024; 24:690. [PMID: 38822307 DOI: 10.1186/s12913-024-11146-1] [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: 07/31/2023] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic. METHODS We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis. RESULTS Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices. CONCLUSIONS Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.
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Affiliation(s)
- Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Nicholas S Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Psychological Science, School of Social Ecology, University of California Irvine. 4220 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - James W Dilley
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Mark Olfson
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th Street, Suite 350, San Francisco, CA, 94110, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, Box 0886, San Francisco, CA, 94143, USA.
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Cox AL, Tsang D, Spacek LA, Daskalakis C, Coppock D. The Impact of Telemedicine on Human Immunodeficiency Virus (HIV)-Related Clinical Outcomes During the COVID-19 Pandemic. AIDS Behav 2024:10.1007/s10461-024-04342-x. [PMID: 38662279 DOI: 10.1007/s10461-024-04342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic exacerbated barriers to care for people living with human immunodeficiency virus (HIV) (PLWH). The quick uptake of telemedicine in the outpatient setting provided promise for care continuity. In this study, we compared appointment and laboratory no-show rates in an urban outpatient HIV clinic during three time periods: (1) Pre-COVID-19: 9/15/2019-3/14/2020 (predominately in-person), (2) "Early" COVID-19: 3/15/2020-9/14/2020 (predominately telemedicine), and (3) "Later" COVID-19: 9/15/2020-3/14/2021 (mixed in-person/telemedicine). Multivariable logistic regression models evaluated the two study hypotheses: (i) equivalence of Period 2 with Period 1 and of Period 3 with Period 1 and (ii) improved outcomes with telemedicine over in-person visits. No-show rates were 1% in Period 1, 4% in Period 2, and 18% in Period 3. Compared to the pre-pandemic period, individuals had a higher rate of appointment no-shows during Period 2 [OR (90% CI): 7.67 (2.68, 21.93)] and 3 [OR (90% CI): 30.91 (12.83 to 75.06). During the total study period, those with telemedicine appointments were less likely to no-show than those with in-person appointments [OR (95% CI): 0.36 (0.16-0.80), p = 0.012]. There was no statistical difference between telemedicine and in-person appointments for laboratory completion rates. Our study failed to prove that no-show rates before and during the pandemic were similar; in fact, no-show rates were higher during both the early and later pandemic. Overall, telemedicine was associated with lower no-show rates compared to in-person appointments. In future pandemics, telemedicine may be a valuable component to maintain care in PLWH.
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Affiliation(s)
- Avery Lin Cox
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Daniel Tsang
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Lisa A Spacek
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Constantine Daskalakis
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Dagan Coppock
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
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Haemmerle R, Paludo J, Haddad TC, Pritchett JC. The Growing Role of Digital Health Tools in the Care of Patients with Cancer: Current Use, Future Opportunities, and Barriers to Effective Implementation. Curr Oncol Rep 2024:10.1007/s11912-024-01534-5. [PMID: 38652424 DOI: 10.1007/s11912-024-01534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This article aims to describe the ways in which digital health technologies are currently being used to improve the delivery of cancer care, highlight opportunities to expand their use, and discuss barriers to effective and equitable implementation. RECENT FINDINGS The utilization of digital health tools and development of novel care delivery models that leverage such tools is expanding. Recent studies have shown feasibility and increased implementation in the setting of oncologic care. With technological advances and key policy changes, utilization of digital health tools has greatly increased over the past two decades and transformed how cancer care is delivered. As digital health tools are expanded and refined, there is potential for improved access to and quality and efficiency of cancer care. However, careful consideration should be given to key barriers of digital health tool adoption, such as infrastructural, patient-level, and health systems-level challenges, to ensure equitable access to care and improvement in health outcomes.
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Affiliation(s)
| | - Jonas Paludo
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Center for Digital Health, Mayo Clinic, Rochester, USA
| | - Joshua C Pritchett
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Shaw J, Glover W. The Political Economy of Digital Health Equity: Structural Analysis. J Med Internet Res 2024; 26:e46971. [PMID: 38530341 PMCID: PMC11005444 DOI: 10.2196/46971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/30/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wiljeana Glover
- Technology, Operations, and Information Management Division, Babson College, Wellesley, MA, United States
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Chang E, Penfold RB, Berkman ND. Patient Characteristics and Telemedicine Use in the US, 2022. JAMA Netw Open 2024; 7:e243354. [PMID: 38517438 DOI: 10.1001/jamanetworkopen.2024.3354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Importance Telemedicine use was common during the COVID-19 pandemic, expanding many patients' approaches to accessing health care. Of concern is whether telemedicine access was poorer among higher-needs and disadvantaged populations. Objective To assess patient characteristics associated with telemedicine use and telemedicine mode and describe telemedicine visit experiences by telemedicine mode. Design, Setting, and Participants This cross-sectional study included data from the 2022 Health Information National Trends Survey and included US adults with a health care visit. Data were analyzed from May to September 2023. Exposure Patient characteristics. Main Outcomes and Measures Any telemedicine visits vs in-person visits only; telemedicine mode (video vs audio-only). Multivariable logistic models assessed patient characteristics associated with telemedicine visits and mode. Bivariate analyses compared telemedicine experiences by mode. Results The study included 5437 adult patients (mean [SE] age, 49.4 [0.23] years; 3136 females [53.4%]; 1928 males [46.6%]). In 2022, 2384 patients (43%) had a telemedicine visit; 1565 (70%) had a video visit while 819 (30%) had an audio-only visit. In multivariable models, older age (≥75 years: adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.94), no internet use (aOR, 0.62; 95% CI, 0.48-0.81), and living in the Midwest (aOR, 0.50; 95% CI, 0.35-0.70) were negatively associated with having telemedicine visits. Female sex (aOR, 1.43; 95% CI, 1.12-1.83), having chronic conditions (aOR, 2.13; 95% CI, 1.66-2.73), and multiple health care visits (2-4 visits: aOR, 1.77; 95% CI, 1.23-2.54; ≥5 visits: aOR, 3.29; 95% CI, 2.20-4.92) were positively associated. Among individuals who used telemedicine, older age (65-74 years: aOR, 2.13; 95% CI, 1.09-4.14; ≥75 years: aOR, 3.58; 95% CI, 1.60-8.00), no health insurance (aOR, 2.84; 95% CI, 1.42-5.67), and no internet use (aOR, 2.11; 95% CI, 1.18-3.78) were positively associated with having audio-only visits. We observed no significant differences in telemedicine use or mode by education, race and ethnicity, or income. Patients' experiences using telemedicine were generally similar for video and audio-only except more individuals who used audio-only had privacy concerns (20% vs 12%, P = .02). Conclusions and Relevance In this cross-sectional study of adults with health care visits, many patients, including those with the greatest care needs, chose telemedicine even after in-person visits were available. These findings support continuing this care delivery approach as an option valued by patients. Differences were not observed by most common measures of socioeconomic status. Continued monitoring of telemedicine use is needed to ensure equitable access to health care innovations.
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Affiliation(s)
- Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
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Koay WLA, Aware Y, Andine T, Cruz Figueroa GM, Selekman RE, Bryant Y, Rakhmanina NY. Patient Perspectives on Telehealth for HIV and Mental Health Care at a Pediatric and Adolescent HIV Clinic in Washington, DC. AIDS Behav 2024; 28:993-1001. [PMID: 37843684 DOI: 10.1007/s10461-023-04209-7] [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] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Despite the scale-up of telehealth for children and youth living with HIV during the COVID-19 pandemic, their experience and interest in continued telehealth use in the future is unknown. We conducted a quality improvement project to identify areas for improvement of telehealth delivery to children and youth living with HIV and evaluate youth's experiences when using telehealth for mental health services. Children and youth living with HIV (up to 24 years) seen at a specialty HIV program during 2020-2021 were surveyed regarding technology access, telehealth knowledge, barriers to telehealth use and interest in future telehealth use for HIV care. Youth (12-<24 years) who used telehealth for mental health services were surveyed regarding their experiences. Data were analyzed using descriptive statistics. Of the 170 patients in care, we surveyed 103 children and youth living with HIV (median age 17.6 years, 88.3% Black, 52.4% female, 77.7% perinatally infected), of whom 69.9% had prior telehealth use for their clinical visit. Most patients had access to a device with internet (99%) and were interested in future telehealth use for HIV care (87.4%). Reasons for not wanting to use telehealth included privacy concerns, distrust, discomfort with telehealth, preferring in-person visits, technology access issues and needing translation services. Most youth (81%) surveyed regarding telehealth for mental health services were satisfied and very likely to recommend it to others. Despite some reported barriers to telehealth, there is a high desirability for continued telehealth use among children and youth receiving HIV care.
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Affiliation(s)
- Wei Li Adeline Koay
- Department of Pediatrics, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA.
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
| | - Yashvi Aware
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Tsion Andine
- College of Medicine, Howard University, Washington, DC, USA
| | | | - Rachel E Selekman
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | | | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Elizabeth Glaser Pediatrics AIDS Foundation, Washington, DC, USA
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7
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Petretto DR, Carrogu GP, Gaviano L, Berti R, Pinna M, Petretto AD, Pili R. Telemedicine, e-Health, and Digital Health Equity: A Scoping Review. Clin Pract Epidemiol Ment Health 2024; 20:e17450179279732. [PMID: 38660571 PMCID: PMC11041391 DOI: 10.2174/0117450179279732231211110248] [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: 09/11/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 04/26/2024]
Abstract
Background With the progressive digitization of people's lives and in the specific healthcare context, the issue of equity in the healthcare domain has extended to digital environments or e-environments, assuming the connotation of "Digital Health Equity" (DHE). Telemedicine and e-Health, which represent the two main e-environments in the healthcare context, have shown great potential in the promotion of health outcomes, but there can be unintended consequences related to the risk of inequalities. In this paper, we aimed to review papers that have investigated the topic of Digital Health Equity in Telemedicine and e-Health [definition(s), advantages, barriers and risk factors, interventions]. Methods We conducted a scoping review according to the methodological framework proposed in PRISMA-ScR guidelines on the relationship between Digital Health Equity and Telemedicine and e-Health via Scopus and Pubmed electronic databases. The following inclusion criteria were established: papers on the relationship between Digital Health Equity and Telemedicine and/or e-Health, written in English, and having no time limits. All study designs were eligible, including those that have utilized qualitative and quantitative methods, methodology, or guidelines reports, except for meta-reviews. Results Regarding Digital Health Equity in Telemedicine and e-Health, even if there is no unique definition, there is a general agreement on the idea that it is a complex and multidimensional phenomenon. When promoting Digital Health Equity, some people may incur some risk/s of inequities and/or they may meet some obstacles. Regarding intervention, some authors have proposed a specific field/level of intervention, while other authors have discussed multidimensional interventions based on interdependence among the different levels and the mutually reinforcing effects between all of them. Conclusion In summary, the present paper has discussed Digital Health Equity in Telemedicine and e-Health. Promoting equity of access to healthcare is a significant challenge in contemporary times and in the near future. While on the one hand, the construct "equity" applied to the health context highlights the importance of creating and sustaining the conditions to allow anyone to be able to reach (and develop) their "health potential", it also raises numerous questions on "how this can happen". An overall and integrated picture of all the variables that promote DHE is needed, taking into account the interdependence among the different levels and the mutually reinforcing effects between all of them.
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Affiliation(s)
- Donatella Rita Petretto
- Department of Education, Philosophy and Psychology, University of Cagliari, Cagliari 09124, Italy
| | - Gian Pietro Carrogu
- Department of Education, Philosophy and Psychology, University of Cagliari, Cagliari 09124, Italy
| | - Luca Gaviano
- Department of Education, Philosophy and Psychology, University of Cagliari, Cagliari 09124, Italy
| | - Roberta Berti
- Department of Education, Philosophy and Psychology, University of Cagliari, Cagliari 09124, Italy
| | - Martina Pinna
- Department of Education, Philosophy and Psychology, University of Cagliari, Cagliari 09124, Italy
| | - Andrea Domenico Petretto
- Department of Education, Philosophy and Psychology, University of Cagliari, Cagliari 09124, Italy
| | - Roberto Pili
- IERFOP Onlus, Via Platone 1/3, Cagliari 09100, Italy
- Global Community on Longevity, Italy
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Brenner IR, Simpson KN, Flanagan CF, Dark T, Dooley M, Agwu AL, Koay WLA, Freedberg KA, Ciaranello AL, Neilan AM. Projecting the Clinical and Economic Impacts of Changes to HIV Care Among Adolescents and Young Adults in the United States: Lessons From the COVID-19 Pandemic. J Pediatric Infect Dis Soc 2024; 13:60-68. [PMID: 37963069 PMCID: PMC10824262 DOI: 10.1093/jpids/piad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/13/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, many US youth with HIV (YHIV) used telehealth services; others experienced disruptions in clinic and antiretroviral therapy (ART) access. METHODS Using the Cost-effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent HIV microsimulation model, we evaluated 3 scenarios: 1) Clinic: in-person care; 2) Telehealth: virtual visits, without CD4 or viral load monitoring for 12 months, followed by return to usual care; and 3) Interruption: complete care interruption with no ART access or laboratory monitoring for 6 months (maximum clinic closure time), followed by return to usual care for 80%. We assigned higher 1-year retention (87% vs 80%) and lower cost/visit ($49 vs $56) for Telehealth vs Clinic. We modeled 2 YHIV cohorts with non-perinatal (YNPHIV) and perinatal (YPHIV) HIV, which differed by mean age (22 vs 16 years), sex at birth (85% vs 47% male), starting CD4 count (527/μL vs 635/μL), ART, mortality, and HIV-related costs. We projected life months (LMs) and costs/100 YHIV over 10 years. RESULTS Over 10 years, LMs in Clinic and Telehealth would be similar (YNPHIV: 11 350 vs 11 360 LMs; YPHIV: 11 680 LMs for both strategies); costs would be $0.3M (YNPHIV) and $0.4M (YPHIV) more for Telehealth than Clinic. Interruption would be less effective (YNPHIV: 11 230 LMs; YPHIV: 11 620 LMs) and less costly (YNPHIV: $1.3M less; YPHIV: $0.2M less) than Clinic. Higher retention in Telehealth led to increased ART use and thus higher costs. CONCLUSIONS Telehealth could be as effective as in-person care for some YHIV, at slightly increased cost. Short interruptions to ART and laboratory monitoring may have negative long-term clinical implications.
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Affiliation(s)
- Isaac Ravi Brenner
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kit N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Clare F Flanagan
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tyra Dark
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Mary Dooley
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wei Li Adeline Koay
- Division of Infectious Diseases, Children’s National Hospital, Washington, District of Columbia, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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Higgins DM, Riba A, Alderton L, Wendel KA, Scanlon J, Weise J, Gibson N, Obafemi O. Evaluation of the Impact and Outcomes of a Rapid Transition to Telehealth PrEP Delivery at a Sexual Health Clinic During the COVID-19 Pandemic. Sex Transm Dis 2023; 50:816-820. [PMID: 37820240 PMCID: PMC10668045 DOI: 10.1097/olq.0000000000001872] [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: 10/13/2023]
Abstract
BACKGROUND Increasing human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) use is a critical part of ending the HIV epidemic. In response to the COVID-19 pandemic, many PrEP services transitioned to a telehealth model (telePrEP). This report evaluates the effect of COVID-19 and the addition of telePrEP on delivery of PrEP services at the Denver Sexual Health Clinic (DSHC), a regional sexual health clinic in Denver, CO. METHODS Before COVID-19, DSHC PrEP services were offered exclusively in-clinic. In response to the pandemic, after March 15, 2020, most PrEP initiation and follow-up visits were converted to telePrEP. A retrospective analysis of DSHC PrEP visits compared pre-COVID-19 (September 1, 2019 to March 15, 2020) to post-COVID-19 (March 16, 2020 to September 30, 2020) visit volume, demographics, and outcomes. RESULTS The DSHC completed 689 PrEP visits pre-COVID-19 and maintained 96.8% (n = 667) of this volume post-COVID-19. There were no differences in client demographics between pre-COVID-19 (n = 341) and post-COVID-19 PrEP start visits (n = 283) or between post-COVID-19 in-clinic (n = 140) vs telePrEP start visits (n = 143). There were no differences in 3- to 4-month retention rates pre-COVID-19 (n = 17/43) and post-COVID-19 (n = 21/43) ( P = 0.52) or between in-clinic (n = 12/21) and telePrEP clients (n = 9/22) in the post-COVID-19 window ( P = 0.37). Also, there were no significant differences in lab completion rates between in-clinic (n = 140/140) and telePrEP clients (n = 138/143) ( P = 0.06) and prescription fill rates between in-clinic (n = 115/136) and telePrEP clients (n = 116/135) in the post-COVID-19 window ( P = 0.86). CONCLUSIONS Implementation of TelePrEP enabled the DSHC to sustain PrEP services during the COVID-19 pandemic without significant differences in demographics, engagement, or retention in PrEP services.
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Affiliation(s)
- David M. Higgins
- Public Health Institute at Denver Health, Denver, CO
- Department of Preventive Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Adrean Riba
- Public Health Institute at Denver Health, Denver, CO
| | - Lucy Alderton
- Public Health Institute at Denver Health, Denver, CO
| | - Karen A. Wendel
- Public Health Institute at Denver Health, Denver, CO
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Julia Weise
- Public Health Institute at Denver Health, Denver, CO
| | - Nathan Gibson
- Public Health Institute at Denver Health, Denver, CO
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Benito-Garcia E, Vega J, Daza EJ, Lee WN, Kennedy A, Chantelot JM. Patient and Physician Perspectives on the Use of a Connected Ecosystem for Diabetes Management: International Cross-Sectional Observational Study. JMIR Form Res 2023; 7:e47145. [PMID: 38032701 PMCID: PMC10722356 DOI: 10.2196/47145] [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: 03/13/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Collaboration between people with type 2 diabetes (T2DM) and their health care teams is important for optimal control of the disease and outcomes. Digital technologies could potentially tie together several health care-related devices and platforms into connected ecosystems (CES), but attitudes about CES are unknown. OBJECTIVE We surveyed convenience samples of patients and physicians to better understand which patient characteristics are associated with higher likelihoods of (1) participating in a potential CES program, as self-reported by patients with T2DM and (2) clinical benefit from participation in a potential CES program, as reported by physicians. METHODS Adults self-reporting a diagnosis of T2DM and current insulin use (n=197), and 33 physicians whose practices included ≥20% of such patients, were enrolled in the United States, France, and Germany. We surveyed both groups about the likelihood of patient participation in a CES. We then examined the associations between patients' clinical and sociodemographic characteristics and this likelihood. We also described characteristics of patients likely to clinically benefit from CES use, according to physicians. RESULTS Compared with patients in Germany and France, US patients were younger (mean age 45.3 [SD 11.9] years vs 61.9 [SD 9.2] and 65.8 [SD 9.4] years, respectively), more often female, more highly educated, and more often working full-time. In all, 51 (44.7%) US patients, 16 (36.4%) German patients, and 18 (46.3%) French patients indicated strong interest in a CES program, and 115 (78.7%) reported currently using ≥1 connected device or app. However, physicians believed that only 11.3%-19.2% of their patients were using connected devices or apps to manage their disease. Physicians also reported infrequently recommending or prescribing connected devices to their patients, although ≥80% (n=28) of them thought that a CES could help support their patients in managing their disease. The factors most predictive of patient likelihood of participating in a CES program were cost, inclusion of medication reminders, and linking blood glucose levels to behaviors such as eating and exercise. In all countries, the most common patient expectations for a CES program were that it could help them eat more healthfully, increase their physical activity, increase their understanding of how blood glucose relates to behavior such as exercise and eating, and reduce stress. Physicians thought that newly diagnosed patients, sicker patients-those who had been hospitalized for diabetes, were currently using insulin, or who had any comorbid condition-and patients who were nonadherent to treatment were most likely to benefit from CES use. CONCLUSIONS In this study, there was a high degree of interest in the future use of CES, although additional education is needed among both patients with T2DM and their physicians to achieve the full potential of such systems to improve self-management and clinical care for the disease.
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Affiliation(s)
| | - Julio Vega
- Evidation Health, Inc, San Mateo, CA, United States
| | - Eric J Daza
- Evidation Health, Inc, San Mateo, CA, United States
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11
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Ha S, Ho SH, Bae YH, Lee M, Kim JH, Kim JH, Lee J. Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study. J Med Internet Res 2023; 25:e50029. [PMID: 38015589 PMCID: PMC10716768 DOI: 10.2196/50029] [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: 07/07/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. OBJECTIVE This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. METHODS The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. RESULTS Among the participants, "disability welfare information and related institutional linkage" was the highest priority. Three of the 14 user interface sketches the participants created were related to "providing educational content." The 11 heuristic evaluation experts identified "focusing on a single task" as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. CONCLUSIONS In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity.
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Affiliation(s)
- Sandeul Ha
- Department of Nursing, Kyung-Hee University Medical Center, Seoul, Republic of Korea
| | - Seung Hee Ho
- Rehabilitation Research Institute, Korea National Rehabilitation Center, Seoul, Republic of Korea
| | - Young-Hyeon Bae
- Rehabilitation Research Institute, Korea National Rehabilitation Center, Seoul, Republic of Korea
| | - Minyoung Lee
- Department of Holistic Integrative Healing Studies, Seoul Cyber University, Seoul, Republic of Korea
| | - Ju Hee Kim
- Rehabilitation Research Institute, Korea National Rehabilitation Center, Seoul, Republic of Korea
| | - Ju Han Kim
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jisan Lee
- Department of Nursing, Gangneung-Wonju National University, Wonju, Gangwon State, Republic of Korea
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12
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Yelverton V, Gass SJ, Amoatika D, Cooke C, Ostermann J, Natafgi N, Hair NL, Olatosi B, Owens OL, Qiao S, Li X, Derrick C, Weissman S, Albrecht H. The Future of Telehealth in Human Immunodeficiency Virus Care: A Qualitative Study of Patient and Provider Perspectives in South Carolina. AIDS Patient Care STDS 2023; 37:459-468. [PMID: 37862076 PMCID: PMC10616939 DOI: 10.1089/apc.2023.0176] [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: 10/21/2023] Open
Abstract
To ensure care continuity during the COVID-19 pandemic, telehealth has been widely implemented in human immunodeficiency virus (HIV) care. However, participation in and benefits from telehealth were unequal. This study aims to assess the willingness of people living with HIV (PWH) and HIV care providers to use telehealth and perceptions of the future role of telehealth. In-depth interviews with 18 PWH and 10 HIV care providers from South Carolina assessed their willingness to use telehealth, their perspectives on the future of telehealth in HIV care, and recommendations to improve telehealth. Interviews were analyzed using thematic analysis. Most PWH were female (61%), Black/African American (67%), and non-Hispanic (78%). Most PWH (61%) and all providers had used telehealth for HIV care. Most PWH and all providers reported being willing to use or (re-)consider telehealth HIV care services in the future. Providers suggested that telehealth is most suitable for routine HIV care encounters and for established, clinically stable, generally healthy PWH. Attitudes toward telehealth were heterogeneous, with most interviewees valuing telehealth similarly or superior to in-person care, yet >20% perceiving it less valuable. Recommendations to improve telehealth included multilevel strategies to address challenges across four domains: technology, the virtual nature of telehealth, administrative processes, and the sociodemographic profile of PWH. Telehealth in HIV care is here to stay; however, it may not yet be suitable for all PWH and all care encounters. Decision processes related to telehealth versus in-person care need to involve providers and PWH. Existing telehealth options require multilevel adjustments addressing persistent challenges.
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Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Salome-Joelle Gass
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Christopher Cooke
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nicole L. Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Otis L. Owens
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Caroline Derrick
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
| | - Helmut Albrecht
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
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13
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Holmes Fee C, Hicklen RS, Jean S, Abu Hussein N, Moukheiber L, de Lota MF, Moukheiber M, Moukheiber D, Anthony Celi L, Dankwa-Mullan I. Strategies and solutions to address Digital Determinants of Health (DDOH) across underinvested communities. PLOS DIGITAL HEALTH 2023; 2:e0000314. [PMID: 37824481 PMCID: PMC10569606 DOI: 10.1371/journal.pdig.0000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Healthcare has long struggled to improve services through technology without further widening health disparities. With the significant expansion of digital health, a group of healthcare professionals and scholars from across the globe are proposing the official usage of the term "Digital Determinants of Health" (DDOH) to explicitly call out the relationship between technology, healthcare, and equity. This is the final paper in a series published in PLOS Digital Health that seeks to understand and summarize current knowledge of the strategies and solutions that help to mitigate the negative effects of DDOH for underinvested communities. Through a search of English-language Medline, Scopus, and Google Scholar articles published since 2010, 345 articles were identified that discussed the application of digital health technology among underinvested communities. A group of 8 reviewers assessed 132 articles selected at random for the mention of solutions that minimize differences in DDOH. Solutions were then organized by categories of policy; design and development; implementation and adoption; and evaluation and ongoing monitoring. The data were then assessed by category and the findings summarized. The reviewers also looked for common themes across the solutions and evidence of effectiveness. From this limited scoping review, the authors found numerous solutions mentioned across the papers for addressing DDOH and many common themes emerged regardless of the specific community or digital health technology under review. There was notably less information on solutions regarding ongoing evaluation and monitoring which corresponded with a lack of research evidence regarding effectiveness. The findings directionally suggest that universal strategies and solutions can be developed to address DDOH independent of the specific community under focus. With the need for the further development of DDOH measures, we also provide a framework for DDOH assessment.
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Affiliation(s)
- Casey Holmes Fee
- Healthcare Consultant, Newton, Massachusetts, United States of America
| | - Rachel Scarlett Hicklen
- Research Medical Library, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sidney Jean
- Massachusetts Executive Office of Health and Human Services, Boston, Massachusetts, United States of America
- Simmons University, Boston, Massachusetts, United States of America
| | - Nebal Abu Hussein
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lama Moukheiber
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | | | - Mira Moukheiber
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Dana Moukheiber
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Leo Anthony Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Division of Pulmonary, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Irene Dankwa-Mullan
- Marti Health, Atlanta, Georgia, United States of America
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
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14
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Pritchett JC, Borah BJ, Dholakia R, Moriarty JP, Ahn HH, Huang M, Khera N, Wilshusen L, Dronca RS, Ticku J, Leppin AL, Tilburt JC, Paludo J, Haddad TC. Patient- and Provider-Level Factors Associated With Telehealth Utilization Across a Multisite, Multiregional Cancer Practice From 2019 to 2021. JCO Oncol Pract 2023; 19:750-758. [PMID: 37335959 PMCID: PMC10538894 DOI: 10.1200/op.23.00118] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE In response to the COVID-19 pandemic, many cancer practices rapidly adopted telehealth services. However, there is a paucity of data regarding ongoing telehealth visit utilization beyond this initial response. The purpose of this study was to assess changes in variables associated with telehealth visit utilization over time. METHODS This is a cross-sectional, year-over-year, retrospective analysis of telehealth visits conducted across a multisite, multiregional cancer practice in the United States. Multivariable models examined the association of patient- and provider-level variables with telehealth utilization across outpatient visits conducted over three 8-week periods from July to August in 2019 (n = 32,537), 2020 (n = 33,399), and 2021 (n = 35,820). RESULTS The rate of telehealth utilization increased from <0.01% (2019) to 11% (2020) to 14% (2021). The most significant patient-level factors associated with increased telehealth utilization included nonrural residence and age ≤65 years. Among patients residing in rural settings, video visit utilization rates were significantly lower and phone visit utilization rates were significantly higher compared with patients from nonrural residences. Regarding provider-level factors, widening differences in telehealth utilization were observed at tertiary versus community-based practice settings. Increased telehealth utilization was not associated with duplicative care as per-patient and per-physician visit volumes in 2021 remained consistent with prepandemic levels. CONCLUSION We observed continuous expansion in telehealth visit utilization from 2020 to 2021. Our experiences suggest that telehealth can be integrated into cancer practices without evidence of duplicative care. Future work should examine sustainable reimbursement structures and policies to ensure accessibility of telehealth as a means to facilitate equitable, patient-centered cancer care.
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Affiliation(s)
- Joshua C. Pritchett
- Department of Oncology, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Bijan J. Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ruchita Dholakia
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - James P. Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Hannah H. Ahn
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ming Huang
- Department of AI and Informatics, Mayo Clinic, Rochester, MN
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | | | | | - Aaron L. Leppin
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Deceased
| | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Tufia C. Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN
- Center for Digital Health, Mayo Clinic, Rochester, MN
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15
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Chan J, DiTullio DJ, Pagan Pirallo P, Foote M, Knutsen D, Kottkamp AC, McPherson TD, Mukherjee V, Pitts R, Wallach A, Wong M, Mazo D, Mgbako O. Implementation and early outcomes of a telehealth visit model to deliver tecovirimat for mpox infection in New York City. J Telemed Telecare 2023:1357633X231194796. [PMID: 37632124 DOI: 10.1177/1357633x231194796] [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: 08/27/2023]
Abstract
The 2022 mpox outbreak in New York City posed challenges to rapidly scaling up treatment capacity. We describe a telehealth treatment model launched during this outbreak that facilitated healthcare provider treatment capacity, and was able to adhere to a Centers for Disease Control and Prevention (CDC)-sponsored expanded access investigational new drug (EA-IND) protocol for tecovirimat. Sixty-nine patients were evaluated and prescribed tecovirimat for mpox through telehealth visits at NYC Health + Hospitals/Bellevue and NYU Langone Health from June to August 2022. Thirty-two (46.4%) were previously diagnosed with HIV. Forty-four (63.8%) reported full recovery, with the remainder lost to follow-up. Most patients (n = 60, 87.0%) attended at least one follow-up visit (either in person or through telehealth) after starting treatment. We observed favorable treatment outcomes, with no serious adverse events, hospitalizations, or deaths related to mpox. While equitable access to telehealth remains a limitation that needs to be addressed, this telehealth model enabled a rapid scale-up of tecovirimat prescription during the mpox outbreak, and should be considered as an important tool used to respond to future infectious disease outbreaks.
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Affiliation(s)
- Justin Chan
- NYC Health + Hospitals/Bellevue, New York, NY, USA
- NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Mary Foote
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Dorothy Knutsen
- NYC Health + Hospitals/Bellevue, New York, NY, USA
- NYU Grossman School of Medicine, New York, NY, USA
- NYU Langone Health, New York, NY, USA
| | | | - Tristan D McPherson
- NYU Grossman School of Medicine, New York, NY, USA
- New York City Department of Health and Mental Hygiene, New York, NY, USA
- NYU Langone Health, New York, NY, USA
| | - Vikramjit Mukherjee
- NYC Health + Hospitals/Bellevue, New York, NY, USA
- NYU Grossman School of Medicine, New York, NY, USA
| | - Robert Pitts
- NYC Health + Hospitals/Bellevue, New York, NY, USA
- NYU Grossman School of Medicine, New York, NY, USA
| | - Andrew Wallach
- NYC Health + Hospitals/Bellevue, New York, NY, USA
- NYU Grossman School of Medicine, New York, NY, USA
| | - Marcia Wong
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Dana Mazo
- NYU Grossman School of Medicine, New York, NY, USA
- NYU Langone Health, New York, NY, USA
| | - Ofole Mgbako
- NYC Health + Hospitals/Bellevue, New York, NY, USA
- NYU Grossman School of Medicine, New York, NY, USA
- NYU Langone Health, New York, NY, USA
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16
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Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
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Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
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17
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Pritchett JC, Patt D, Thanarajasingam G, Schuster A, Snyder C. Patient-Reported Outcomes, Digital Health, and the Quest to Improve Health Equity. Am Soc Clin Oncol Educ Book 2023; 43:e390678. [PMID: 37290027 DOI: 10.1200/edbk_390678] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The theme of the 2023 American Society of Clinical Oncology Annual Meeting is Partnering With Patients: The Cornerstone of Cancer Care and Research. As we aim to partner with patients to improve their health care, digital tools have the potential to enhance patient-centered cancer care and make clinical research more accessible and generalizable. Using electronic patient-reported outcomes (ePROs) to collect patients' reports of symptoms, functioning, and well-being facilitates patient-clinician communication and improves care and outcomes. Early studies suggest that racial and ethnic minority populations, older patients, and patients with less education may benefit even more from ePRO implementation. Clinical practices looking to implement ePROs can refer to the resources of the PROTEUS Consortium (Patient-Reported Outcomes Tools: Engaging Users & Stakeholders). Beyond ePROs, in response to the COVID-19 pandemic, cancer practices have rapidly adopted other digital tools (eg, telemedicine, remote patient monitoring). As implementation grows, we must be aware of the limitations of these tools and implement them in ways to promote optimal function, access, and ease of use. Infrastructure, patient, provider, and system-level barriers need to be addressed. Partnerships across all levels can inform development and implementation of digital tools to meet the needs of diverse groups. In this article, we describe how we use ePROs and other digital health tools in cancer care, how digital tools can expand access to and generalizability of oncology care and research, and prospects for broader implementation and use.
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Affiliation(s)
- Joshua C Pritchett
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Oncology, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Debra Patt
- Texas Oncology, Dallas Texas and Dell Medical School at The University of Texas at Austin, Austin, TX
| | | | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH
| | - Claire Snyder
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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18
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Wood BR, Stekler JD. Could Home Human Immunodeficiency Virus Self-Testing Ever Become a Game Changer? Clin Infect Dis 2023; 76:1681-1684. [PMID: 36645800 DOI: 10.1093/cid/ciad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
Could home human immunodeficiency virus (HIV) self-testing make a major difference in identifying persons with undiagnosed HIV in the United States? We argue that approval of new self-test assays for home use would help but must be combined with extensive investment in community outreach and linkage to care to make an impact.
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Affiliation(s)
- Brian R Wood
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, Washington, USA
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19
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Ward MK, Aleite S, Sheehan DM, Li T, Gbadamosi SO, Jean-Gilles M, Ladner RA, Trepka MJ. Self-reported Nonadherence to Antiretroviral Therapy Among Miami-Dade Ryan White Program Clients During the COVID-19 Pandemic: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:198-206. [PMID: 36607312 PMCID: PMC10062022 DOI: 10.1097/jnc.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 01/07/2023]
Abstract
This study examined factors associated with self-reported ART nonadherence during the COVID-19 pandemic among Miami-Dade County Ryan White HIV/AIDS Program (RWHAP) clients. A cross-sectional survey was conducted from October 2020-January 2021 in English, Spanish, and Haitian Creole. The survey included questions on self-reported ART adherence, HIV care access (compared to before the pandemic), social and economic pandemic impacts, and demographics. We carried out descriptive bivariate analyses and weighted logistic regression to estimate unadjusted and adjusted odds ratios (aORs) for self-reported nonadherence. 12.7% of participants reported ART nonadherence. Adjusting for age, sex, race/ethnicity, and nativity, factors associated with nonadherence included greater difficulty accessing an HIV doctor compared with before the COVID-19 pandemic (aOR=3.6, 95% CI: 1.4–9.2) and experiencing financial impacts due to the pandemic (aOR=4.2, 95% CI: 1.5–12.2). Ensuring RWHAP clients maintain access to HIV medical care providers and receive support for financial shocks are critical to sustaining ART adherence.
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Affiliation(s)
- Melissa K Ward
- Melissa K. Ward, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and Research Center in Minority Institutions, Florida International University, Miami, Florida, USA. Stephanie Aleite, BA, is an MSW Student, School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Diana M. Sheehan, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Research Center in Minority Institutions, and Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA. Tan Li, PhD, is an Associate Professor, Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Semiu O. Gbadamosi, PhD, MBBS, MPH, was a PhD Candidate, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Michèle Jean-Gilles, PhD, is a Research Associate Professor, Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Robert A. Ladner, PhD, is President, Behavioral Science Research Corporation, Miami, Florida, USA. Mary Jo Trepka, MD, MSPH, is a Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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20
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El-Nahal WG, Chander G, Jones JL, Fojo AT, Keruly JC, Manabe YC, Moore RD, Gebo KA, Lesko CR. Telemedicine Use Among People With HIV in 2021: The Hybrid-Care Environment. J Acquir Immune Defic Syndr 2023; 92:223-230. [PMID: 36730830 PMCID: PMC9969325 DOI: 10.1097/qai.0000000000003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Telemedicine use for the care of people with HIV (PWH) significantly expanded during the COVID-19 pandemic. During 2021, vaccine uptake increased and patients were encouraged to resume in-person care, resulting in a mixture of in-person and telemedicine visits. We studied how different patient populations used telemedicine in this hybrid-care environment. METHODS Using observational data from patients enrolled in the Johns Hopkins HIV Clinical Cohort, we analyzed all in-person and telemedicine HIV primary care visits completed in an HIV clinic from January 1st, 2021, to December 31st, 2021. We used log-binomial regression to investigate the association between patient characteristics and the probability of completing a telemedicine versus in-person visit and the probability of completing a video versus telephone visit. RESULTS A total of 5518 visits were completed by 1884 patients; 4282 (77.6%) visits were in-person, 800 (14.5%) by phone, and 436 (7.9%) by video. The relative risk (RR) of completing telemedicine vs. in-person visits was 0.65 (95% Confidence Interval (CI): 0.47, 0.91) for patients age 65 years or older vs. age 20-39 years; 0.84 (95% CI: 0.72, 0.98) for male patients vs. female patients; 0.81 (95% CI: 0.66, 0.99) for Black vs. White patients; 0.62 (95% CI: 0.49, 0.79) for patients in the highest vs. lowest quartile of Area Deprivation Index; and 1.52 (95% CI: 1.26, 1.84) for patients >15 miles vs. <5 miles from clinic. CONCLUSIONS In the second year of the pandemic, overall in-person care was used more than telemedicine and significant differences persist across subgroups in telemedicine uptake.
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Affiliation(s)
- Walid G. El-Nahal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joyce L. Jones
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony T. Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeanne C. Keruly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yukari C. Manabe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Demaerschalk BM, Hollander JE, Krupinski E, Scott J, Albert D, Bobokalonova Z, Bolster M, Chan A, Christopherson L, Coffey JD, Edgman-Levitan S, Goldwater J, Hayden E, Peoples C, Rising KL, Schwamm LH. Quality Frameworks for Virtual Care: Expert Panel Recommendations. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 7:31-44. [PMID: 36619179 PMCID: PMC9811201 DOI: 10.1016/j.mayocpiqo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Given the significant advance of virtual care in the past year and half, it seems timely to focus on quality frameworks and how they have evolved collaboratively across health care organizations. Massachusetts General Hospital's (MGH) Center for TeleHealth and Mass General Brigham's (MGB) Virtual Care Program are committed to hosting annual symposia on key topics related to virtual care. Subject matter experts across the country, health care organizations, and academic medical centers are invited to participate. The inaugural MGH/MGB Virtual Care Symposium, which focused on rethinking curriculum, competency, and culture in the virtual care era, was held on September 2, 2020. The second MGH/MGB Virtual Care Symposium was held on November 2, 2021, and focused on virtual care quality frameworks. Resultant topics were (1) guiding principles necessary for the future of virtual care measurement; (2) best practices deployed to measure quality of virtual care and how they compare and align with in-person frameworks; (3) evolution of quality frameworks over time; (4) how increased adoption of virtual care has impacted patient access and experience and how it has been measured; (5) the pitfalls and barriers which have been encountered by organizations in developing virtual care quality frameworks; and (6) examples of how quality frameworks have been applied in various use cases. Common elements of a quality framework for virtual care programs among symposium participants included improving the patient and provider experience, a focus on achieving health equity, monitoring success rates and uptime of the technical elements of virtual care, financial stewardship, and clinical outcomes. Virtual care represents an evolution in the access to care paradigm that helps keep health care aligned with other modern industries in digital technology and systems adoption. With advances in health care delivery models, it is vitally important that the quality measurement systems be adapted to include virtual care encounters. New methods may be necessary for asynchronous transactions, but synchronous virtual visits and consults can likely be accommodated in traditional quality frameworks with minimal adjustments. Ultimately, quality frameworks for health care will adapt to hybrid in-person and virtual care practices.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science and Center for Digital Health, Mayo Clinic, Phoenix, AZ,Correspondence: Address to Bart M. Demaerschalk, MD, M.Sc., Mayo Clinic College of Medicine and Science and Center for Digital Health Mayo Clinic, Phoenix, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elizabeth Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | | | - Daniel Albert
- Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Marcy Bolster
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Albert Chan
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Laura Christopherson
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jordan D. Coffey
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Susan Edgman-Levitan
- The John D. Stoekle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, MA
| | | | - Emily Hayden
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - Kristin L. Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA
| | - Lee H. Schwamm
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
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22
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Coffey JD, Christopherson LA, Williams RD, Gathje SR, Bell SJ, Pahl DF, Manka L, Blegen RN, Maniaci MJ, Ommen SR, Haddad TC. Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management. Front Digit Health 2022; 4:1052408. [PMID: 36588748 PMCID: PMC9794766 DOI: 10.3389/fdgth.2022.1052408] [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: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Numerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues. Methods Mayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning. Results Since its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member. Conclusions The Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future.
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Affiliation(s)
- Jordan D. Coffey
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Correspondence: Jordan D. Coffey
| | | | - Ryan D. Williams
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Integrity & Compliance Office, Mayo Clinic, Rochester, MN, United States
| | - Shelby R. Gathje
- Research Administrative Services, Mayo Clinic, Rochester, MN, United States
| | - Sarah J. Bell
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Dominick F. Pahl
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - R. Nicole Blegen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Michael J. Maniaci
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Steve R. Ommen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Tufia C. Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Oncology, Mayo Clinic, Rochester, MN, United States
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23
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Quinn K, John S, Hirshfield S, Algiers O, O'Neil A, Petroll A, Walsh J. Challenges to meeting the HIV care needs of older adults in the rural South. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100113. [PMID: 36620181 PMCID: PMC9815493 DOI: 10.1016/j.ssmqr.2022.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
People living with HIV in rural parts of the Southern United States face poor outcomes along the HIV care continuum. Additionally, over half of people with diagnosed HIV are age 50 and older. Older adults living with HIV in the rural South often have complex health and social needs associated with HIV, aging, and the rural environment. Research is needed to understand what support organizations and clinics need in providing care to this population. This qualitative study examines the challenges health and social service providers face in caring for older patients living with HIV. In 2020-2021, we interviewed 27 key informants who work in organizations that provide care to older adults with HIV in the seven states with high rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. Our findings highlight how racism and poverty; culture, politics, and religion; and a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the South. Rural health and social service providers need structural-level changes to improve their care and services.
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Affiliation(s)
- K.G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S.A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S. Hirshfield
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY, 11203, United States
| | - O. Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - A. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Wauwatosa, WI, 53226, United States
| | - A.E. Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - J.L. Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
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Zhang S, Xue W, Boorman EP, Ruvalcaba E, David M, Lanzkron SM, Eakin MN. Accessible Care with High Patient Satisfaction: Telemedicine Use in Sickle Cell Disease. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shu Zhang
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wingel Xue
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Pickering Boorman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mandy David
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophie Miriam Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Nuttall Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Habel MA, Sullivan P, Hall C, Aral S. Remote Health: Optimizing the Delivery of Sexual Health Care. Sex Transm Dis 2022; 49:S1-S6. [PMID: 35312660 PMCID: PMC10197151 DOI: 10.1097/olq.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa A Habel
- From the Centers for Disease Control and Prevention, Division of STD Prevention
| | | | | | - Sevgi Aral
- From the Centers for Disease Control and Prevention, Division of STD Prevention
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26
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Telemedicine Experience for PrEP Care among PrEP-Eligible Women and Their Primary Care Providers during the First Year of the COVID-19 Pandemic in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7100280. [PMID: 36288021 PMCID: PMC9611465 DOI: 10.3390/tropicalmed7100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
(1) Background: During the two-year-long siege from the COVID-19 pandemic, a significant proportion of doctor visits transitioned from in-person to virtual. Scare evidence is available to assess the quality of patient-provider communication via the platform of telemedicine, especially for PrEP care within primary care settings. (2) Methods: Participants included 18 primary care providers and 29 PrEP-eligible women. Through content analysis and thematic analysis, facilitators and barriers embedded at different levels of telemedicine were identified and assessed. (3) Results: Women and providers reported pros and cons regarding their telemedicine experiences during the initial wave of COVID-19. Both groups of participants agreed that telemedicine visits were more convenient, efficient, and comfortable than in-person visits. However, without face-to-face interactions, some women felt less empathy, caring, and connected with their providers during virtual visits. Health providers expressed concerns with telemedicine, including patients’ privacy, lack of intimacy between patients and providers, and delayed lab work. (4) Conclusions: Our data indicate multi-level factors may affect telemedicine experience among PrEP-eligible women and health providers. Participants expressed concerns that may further entrench these long-existing health disparities in healthcare. Proactive efforts from policymakers, health professionals, researchers, and stakeholders are urgently required to tackle identified barriers and to pave the way for the new infrastructure that ensures health equity in society.
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27
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HIV Care Meets Telehealth: a Review of Successes, Disparities, and Unresolved Challenges. Curr HIV/AIDS Rep 2022; 19:446-453. [PMID: 36063284 PMCID: PMC9442586 DOI: 10.1007/s11904-022-00623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review This review summarizes the current state of telehealth utilization in HIV care delivery by highlighting successes, gaps, and unresolved challenges related to access, disparities, care providers in and standardization of policies and protocol. Recent Findings Telehealth adoption in HIV care delivery in the USA has been successful. Despite this success, racial minority groups, older adults, and individuals with low telehealth literacy report low preference, dissatisfaction, and experience poorer health outcomes than other groups. Lack of broadband access, compatible devices, standardization, and government regulations of telehealth in HIV care contribute to poor patient-provider experience and utilization. Summary Telehealth remains a valuable tool in HIV care. However, disparities exist in access and health outcomes. Telehealth literacy, broadband access, protecting patients’ data, policies, and standardized protocols are critical in sustaining telehealth for HIV care. Further research is needed on preferences and how specific telehealth platforms influence HIV treatment outcomes.
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El-Nahal WG, Shen NM, Keruly JC, Jones JL, Fojo AT, Manabe YC, Moore RD, Gebo KA, Chander G, Lesko CR. Time Between Viral Loads for People With HIV During the COVID-19 Pandemic. J Acquir Immune Defic Syndr 2022; 91:109-116. [PMID: 35617019 PMCID: PMC9388538 DOI: 10.1097/qai.0000000000003026] [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: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, patients experienced significant care disruptions, including laboratory monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV (PWH) associated with the pandemic. SETTING AND METHODS This was an observational analysis of VLs of PWH in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time varying): prepandemic (January 1, 2019-March 15, 2020); pandemic laboratory closed (March 16-July 12, 2020); and pandemic laboratory open (July 13-December 31, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (≤200 copies/mL). We also calculated cumulative incidence of a nonsuppressed VL following a suppressed index VL, and of resuppression following a loss of viral suppression. RESULTS Compared with prepandemic, hazard ratios for next VL check were 0.34 (95% CI: 0.30 to 0.37, laboratory-closed) and 0.73 (CI: 0.68 to 0.78, laboratory-open) for suppressed patients, and 0.56 (CI: 0.42 to 0.79, laboratory-closed) and 0.92 (95% CI: 0.76 to 1.10, laboratory-open) for nonsuppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic laboratory-open (4%) and prepandemic (4%) period. The hazard of resuppression following the loss of suppression was lower during the pandemic laboratory-open versus the prepandemic period (hazard ratio: 0.68, 95% CI: 0.50 to 0.92). CONCLUSIONS Early pandemic restrictions and laboratory closure significantly delayed VL monitoring. Once the laboratory reopened, nonsuppressed patients resumed normal monitoring. Suppressed patients still had a delay but no significant loss of suppression.
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Affiliation(s)
- Walid G. El-Nahal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicola M. Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanne C. Keruly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joyce L. Jones
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony T. Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yukari C. Manabe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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29
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Experiences with Telemedicine for HIV Care During the COVID-19 Pandemic: A Mixed-Methods Study. AIDS Behav 2022; 26:2099-2111. [PMID: 35064390 PMCID: PMC8782707 DOI: 10.1007/s10461-021-03556-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/14/2022]
Abstract
To characterize perspectives and experiences with telemedicine during the COVID-19 pandemic, we conducted a mixed-methods study in two HIV clinics in the US Northeast. Among surveyed patients with HIV (PWH) who had a telemedicine appointment (n = 205), 42.4% perceived telemedicine visits as useful during the pandemic. PWH and clinical staff identified benefits of telemedicine: (1) ability to engage and re-engage patients in care; (2) perceived patient-centeredness and flexibility; (3) opportunity to engage family and multidisciplinary care team members; and (4) opportunity to enhance telemedicine use proficiency through practice and support. Identified barriers included: (1) technical challenges; (2) privacy concerns; (3) loss of routine clinical experiences and interactions; (4) limited objective patient remote monitoring; and (5) reimbursement concerns. Efforts to optimize telemedicine for HIV care should consider strategies to improve technology support for PWH, flexible options to access care, additional platforms to allow patient remote monitoring, and appropriate billing and reimbursement methods.
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30
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Evans KN, Hassan R, Townes A, Buchacz K, Smith DK. The Potential of Telecommunication Technology to Address Racial/Ethnic Disparities in HIV PrEP Awareness, Uptake, Adherence, and Persistence in Care: A Review. AIDS Behav 2022; 26:3878-3888. [PMID: 35614366 PMCID: PMC9131988 DOI: 10.1007/s10461-022-03715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective in preventing new HIV infection, but uptake remains challenging among Black and Hispanic/Latino persons. The purpose of this review was to understand how studies have used electronic telecommunication technology to increase awareness, uptake, adherence, and persistence in PrEP care among Black and Hispanic/Latino persons and how it can reduce social and structural barriers that contribute to disparities in HIV infection. Of the 1114 articles identified, 10 studies were eligible. Forty percent (40%) of studies focused on Black or Hispanic/Latino persons and 80% addressed social and structural barriers related to PrEP use such as navigation or access to PrEP. Mobile health designs were more commonly used (50%) compared to telehealth (30%) and e-health (20%) designs. There is a need to increase the development of telecommunications interventions that address the needs of Black and Hispanic/Latino persons often challenged with uptake and adherent use of PrEP.
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Baim-Lance A, Angulo M, Chiasson MA, Lekas HM, Schenkel R, Villarreal J, Cantos A, Kerr C, Nagaraja A, Yin MT, Gordon P. Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State. BMC Health Serv Res 2022; 22:609. [PMID: 35524251 PMCID: PMC9073813 DOI: 10.1186/s12913-022-08010-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/28/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Older persons living with HIV (PLWH) need routine healthcare to manage HIV and other comorbidities. This mixed methods study investigated digital equity, constituted as access, use and quality, of HIV and specialty telehealth services for PLWH > 50 years during the initial wave of the COVID-19 pandemic when services transitioned to remote care. METHODS A survey of closed and open-ended questions was administered to 80 English (N = 63) and Spanish (N = 17) speaking PLWH receiving HIV care at an Academic Medical Center (N = 50) or a Federally Qualified Health Center (N = 30) in New York State. Quantitative analyses examined characteristics predicting telehealth use and visit quality. Qualitative analyses utilized thematic coding to reveal common experiences. Results were integrated to deepen the interpretation. RESULTS Telehealth access and use were shaped by multiple related and unstable factors including devices and connectivity, technology literacy, and comfort including privacy concerns. Participants demonstrated their substantial effort to achieve the visit. The majority of patients with a telehealth visit perceived it as worse than an in-person visit by describing it as less interpersonal, and resulting in poorer outcomes, particularly participants with less formal education. Technology was not only a barrier to access, but also influenced perceptions of quality. CONCLUSIONS In the COVID-19 pandemic initial wave, barriers to using telehealth were unequally distributed to those with more significant access and use challenges. Beyond these barriers, examining the components of equity indicate further challenges replicating in-person care using telehealth formats for older PLWH. Work remains to establish telehealth as both equitable and desirable for this population.
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Affiliation(s)
- Abigail Baim-Lance
- Geriatric Research Education and Clinical Center (GRECC), James J Peters VA Medical Center, 130 W. Kingsbridge Rd, 4A-17, Bronx, VA, 10468, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Matthew Angulo
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mary Ann Chiasson
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Helen-Maria Lekas
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Grossman School of Medicine, New York University, New York, NY, USA
| | - Rachel Schenkel
- Department of Family Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Jason Villarreal
- Comprehensive Health Program, New York-Presbyterian Hospital, New York, NY, USA
| | - Anyelina Cantos
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Michael T Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
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Spinelli MA, Le Tourneau N, Glidden DV, Hsu L, Hickey MD, Imbert E, Arreguin M, Jain JP, Oskarsson JJ, Buchbinder SP, Johnson MO, Havlir D, Christopoulos KA, Gandhi M. Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis. Clin Infect Dis 2022; 75:e947-e954. [PMID: 35245934 PMCID: PMC9129130 DOI: 10.1093/cid/ciac179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND After coronavirus disease 2019 (COVID-19) shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net human immunodeficiency virus (HIV) clinic in San Francisco, particularly among people living with HIV (PLWH) who are experiencing homelessness. We sought to determine if proactive outreach to provide social services, scaling up of in-person visits, and expansion of housing programs could reverse this decline. METHODS We assessed VS 24 months before and 13 months after SIP using mixed-effects logistic regression followed by interrupted time series (ITS) analysis to examine changes in the rate of VS per month. Loss to follow-up (LTFU) was assessed via active clinic tracing. RESULTS Data from 1816 patients were included; the median age was 51 years, 12% were female, and 14% were experiencing unstable housing/homelessness. The adjusted odds of VS increased 1.34 fold following institution of the multicomponent strategies (95% confidence interval [CI], 1.21-1.46). In the ITS analysis, the odds of VS continuously increased 1.05 fold per month over the post-intervention period (95% CI, 1.01-1.08). Among PLWH who previously experienced homelessness and successfully received housing support, the odds of VS were 1.94-fold higher (95% CI, 1.05-3.59). The 1-year LTFU rate was 2.8 per 100 person-years (95% CI, 2.2-3.5). CONCLUSIONS The VS rate increased following institution of the multicomponent strategies, with a lower LFTU rate compared with prior years. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing programs, will be needed to support VS among underserved populations during the COVID-19 pandemic.
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Affiliation(s)
- Matthew A Spinelli
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Noelle Le Tourneau
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Ling Hsu
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Matthew D Hickey
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Elizabeth Imbert
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Mireya Arreguin
- Correspondence: M. A. Spinelli, 995 Potrero Avenue, Ward 84, San Francisco, CA 94110 ()
| | - Jennifer P Jain
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jon J Oskarsson
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Susan P Buchbinder
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA,San Francisco Department of Public Health, San Francisco, California, USA,Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, USA
| | - Mallory O Johnson
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, USA
| | - Diane Havlir
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
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El-Nahal WG, Shen NM, Keruly JC, Jones JL, Fojo AT, Lau B, Manabe YC, Moore RD, Gebo KA, Lesko CR, Chander G. Telemedicine and visit completion among people with HIV during the coronavirus disease 2019 pandemic compared with prepandemic. AIDS 2022; 36:355-362. [PMID: 34711737 PMCID: PMC8795480 DOI: 10.1097/qad.0000000000003119] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Telemedicine became the primary mode of delivering care during the COVID-19 pandemic. We describe the impact of telemedicine on access to care for people with HIV (PWH) by comparing the proportion of PWH engaged in care prior to and during the COVID-19 pandemic. DESIGN AND METHODS We conducted an observational analysis of patients enrolled in the Johns Hopkins HIV Clinical Cohort, a single-center cohort of patients at an urban HIV subspecialty clinic affiliated with an academic center. Due to the COVID-19 pandemic, the clinic transitioned from in-person to mostly telemedicine visits. We compared patients receiving care in two time periods. The prepandemic period included 2010 people with at least one visit scheduled between 1 September 2019 and 15 March 2020. The pandemic period included 1929 people with at least one visit scheduled between 16 March 2020 and 30 September 2020. We determined the proportion of patients completing at least one of their scheduled visits during each period. RESULTS Visit completion increased significantly from 88% prepandemic to 91% during the pandemic (P = 0.008). Visit completion improved significantly for patients age 20-39 (82 to 92%, P < 0.001), women (86 to 93%, P < 0.001), Black patients (88 to 91%, P = 0.002) and patients with detectable viremia (77 to 85%, P = 0.06) during the pandemic. Only 29% of people who completed at least one telemedicine visit during the pandemic did so as a video (versus telephone) visit. CONCLUSION During the pandemic when care was widely delivered via telemedicine, visit completion improved among groups with lower prepandemic engagement but most were limited to telephone visits.
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Affiliation(s)
- Walid G El-Nahal
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanne C Keruly
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Joyce L Jones
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Getachew E, Woldeamanuel Y, Manyazewal T. Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia. Front Digit Health 2022; 4:821390. [PMID: 35295619 PMCID: PMC8918491 DOI: 10.3389/fdgth.2022.821390] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background There is a high level of concern that low-income countries lack the capacity and readiness to effectively adopt, implement, and scale up digital health interventions (DHIs). We aimed to assess the infrastructure and human resource capacity and readiness of healthcare facilities to adopt and implement any new DHI for tuberculosis (TB) and HIV care and treatment in Addis Ababa, Ethiopia. Method We carried out a cross-sectional, mixed-methods study in 14 public healthcare facilities that provide TB and HIV care and treatment services. Providers' perceived readiness to adopt and implement digital health was assessed using a self-administered questionnaire designed based on an adapted eHealth readiness assessment model that covers six domains: core readiness, organizational cultural readiness, value proposition readiness, technological readiness, regulatory policy readiness, and operational resource readiness. The infrastructure and human resource capacity were assessed on-site using a tool adapted from the Technology Infrastructure Checklist. Internal consistency was assessed using Cronbach's alpha, and the significant relationship between the composite variables was assessed using Pearson's correlation coefficients (r). Result We assessed 14 facilities on-site and surveyed 60 TB and HIV healthcare providers. According to Cronbach's alpha test, all the six technology acceptance domains had a value of >0.8, suggesting a strong interrelatedness between the measuring items. The correlation between technological readiness and operational resource readiness was significant (r = 0.8). The providers perceived their work environment as good enough in electronic data protection, while more efforts are needed in planning, training, adapting, and implementing digital health. Of the 14 facilities, 64.3% lack the plan to establish a functional local area network, and 43% lack skilled staff on payroll to provide maintenance of computers and other digital technologies. Conclusion Like many developing countries, there was a modest infrastructure and human resource capacity and readiness of public healthcare facilities in Addis Ababa, Ethiopia, to nurture and strengthen DHIs across the TB and HIV cascades of care. Technological and operational resource readiness, including funding and a Well-trained workforce, are essential for successful implementation and use of digital health against the two infectious diseases of global importance in such settings.
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Affiliation(s)
- Emnet Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Sullivan PS, Woodyatt CR, Kouzouian O, Parrish KJ, Taussig J, Conlan C, Phillips H. America's HIV Epidemic Analysis Dashboard: Protocol for a Data Resource to Support Ending the HIV Epidemic in the United States. JMIR Public Health Surveill 2022; 8:e33522. [PMID: 35142639 PMCID: PMC8874801 DOI: 10.2196/33522] [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: 10/08/2021] [Accepted: 11/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Ending the HIV Epidemic (EHE) plan aims to end the HIV epidemic in the United States by 2030. Having timely and accessible data to assess progress toward EHE goals at the local level is a critical resource to achieve this goal. Objective The aim of this paper was to introduce America’s HIV Epidemic Analysis Dashboard (AHEAD), a data visualization tool that displays relevant data on the 6 HIV indicators provided by the Centers for Disease Control and Prevention. AHEAD can be used to monitor progress toward ending the HIV epidemic in local communities across the United States. Its objective is to make data available to stakeholders, which can be used to measure national and local progress toward 2025 and 2030 EHE goals and to help jurisdictions make local decisions that are grounded in high-quality data. Methods AHEAD displays data from public health data systems (eg, surveillance systems and census data), organized around the 6 EHE indicators (HIV incidence, knowledge of HIV status, HIV diagnoses, linkage to HIV medical care, viral HIV suppression, and preexposure prophylaxis coverage). Data are displayed for each of the EHE priority areas (48 counties in Washington, District of Columbia, and San Juan, Puerto Rico) which accounted for more than 50% of all US HIV diagnoses in 2016 and 2017 and 7 primarily southern states with high rates of HIV in rural communities. AHEAD also displays data for the 43 remaining states for which data are available. Data features prioritize interactive data visualization tools that allow users to compare indicator data stratified by sex at birth, race or ethnicity, age, and transmission category within a jurisdiction (when available) or compare data on EHE indicators between jurisdictions. Results AHEAD was launched on August 14, 2020. In the 11 months since its launch, the Dashboard has been visited 26,591 times by 17,600 unique users. About one-quarter of all users returned to the Dashboard at least once. On average, users engaged with 2.4 pages during their visit to the Dashboard, indicating that the average user goes beyond the informational landing page to engage with 1 or more pages of data and content. The most frequently visited content pages are the jurisdiction webpages. Conclusions The Ending the HIV Epidemic plan is described as a “whole of society” effort. Societal public health initiatives require objective indicators and require that all societal stakeholders have transparent access to indicator data at the level of the health jurisdictions responsible for meeting the goals of the plan. Data transparency empowers local stakeholders to track movement toward EHE goals, identify areas with needs for improvement, and make data-informed adjustments to deploy the expertise and resources required to locally tailor and implement strategies to end the HIV epidemic in their jurisdiction.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cory R Woodyatt
- Oregon Health & Science University, Portland, OR, United States
| | - Oskian Kouzouian
- Office of Infectious Disease and HIV/AIDS Policy, US Department of Health and Human Services, Washington, DC, United States
| | | | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Harold Phillips
- Office of Infectious Disease and HIV/AIDS Policy, US Department of Health and Human Services, Washington, DC, United States
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HIV Patients’ Tracer for Clinical Assistance and Research during the COVID-19 Epidemic (INTERFACE): A Paradigm for Chronic Conditions. INFORMATION 2022. [DOI: 10.3390/info13020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The health emergency linked to the SARS-CoV-2 pandemic has highlighted problems in the health management of chronic patients due to their risk of infection, suggesting the need of new methods to monitor patients. People living with HIV/AIDS (PLWHA) represent a paradigm of chronic patients where an e-health-based remote monitoring could have a significant impact in maintaining an adequate standard of care. The key objective of the study is to provide both an efficient operating model to “follow” the patient, capture the evolution of their disease, and establish proximity and relief through a remote collaborative model. These dimensions are collected through a dedicated mobile application that triggers questionnaires on the basis of decision-making algorithms, tagging patients and sending alerts to staff in order to tailor interventions. All outcomes and alerts are monitored and processed through an innovative e-Clinical platform. The processing of the collected data aims into learning and evaluating predictive models for the possible upcoming alerts on the basis of past data, using machine learning algorithms. The models will be clinically validated as the study collects more data, and, if successful, the resulting multidimensional vector of past attributes will act as a digital composite biomarker capable of predicting HIV-related alerts. Design: All PLWH > 18 sears old and stable disease followed at the outpatient services of a university hospital (n = 1500) will be enrolled in the interventional study. The study is ongoing, and patients are currently being recruited. Preliminary results are yielding monthly data to facilitate learning of predictive models for the alerts of interest. Such models are learnt for one or two months of history of the questionnaire data. In this manuscript, the protocol—including the rationale, detailed technical aspects underlying the study, and some preliminary results—are described. Conclusions: The management of HIV-infected patients in the pandemic era represents a challenge for future patient management beyond the pandemic period. The application of artificial intelligence and machine learning systems as described in this study could enable remote patient management that takes into account the real needs of the patient and the monitoring of the most relevant aspects of PLWH management today.
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Detecting Natural Hazard-Related Disaster Impacts with Social Media Analytics: The Case of Australian States and Territories. SUSTAINABILITY 2022. [DOI: 10.3390/su14020810] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Natural hazard-related disasters are disruptive events with significant impact on people, communities, buildings, infrastructure, animals, agriculture, and environmental assets. The exponentially increasing anthropogenic activities on the planet have aggregated the climate change and consequently increased the frequency and severity of these natural hazard-related disasters, and consequential damages in cities. The digital technological advancements, such as monitoring systems based on fusion of sensors and machine learning, in early detection, warning and disaster response systems are being implemented as part of the disaster management practice in many countries and presented useful results. Along with these promising technologies, crowdsourced social media disaster big data analytics has also started to be utilized. This study aims to form an understanding of how social media analytics can be utilized to assist government authorities in estimating the damages linked to natural hazard-related disaster impacts on urban centers in the age of climate change. To this end, this study analyzes crowdsourced disaster big data from Twitter users in the testbed case study of Australian states and territories. The methodological approach of this study employs the social media analytics method and conducts sentiment and content analyses of location-based Twitter messages (n = 131,673) from Australia. The study informs authorities on an innovative way to analyze the geographic distribution, occurrence frequency of various disasters and their damages based on the geo-tweets analysis.
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Kharono B, Kaggiah A, Mugo C, Seeh D, Guthrie BL, Moreno M, John-Stewart G, Inwani I, Ronen K. Mobile technology access and use among youth in Nairobi, Kenya: implications for mobile health intervention design. Mhealth 2022; 8:7. [PMID: 35178438 PMCID: PMC8800198 DOI: 10.21037/mhealth-21-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/20/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Social media can be used to support the health of underserved youth beyond clinical settings. Young people are avid users of social media, but estimates of smartphone access among youth in sub-Saharan Africa are lacking, making it difficult to determine context-appropriateness of online and social media interventions. METHODS We conducted a cross-sectional observational survey assessing technology access and use among youth aged 14-24 receiving general outpatient or human immunodeficiency virus (HIV) care in three hospitals in Nairobi, Kenya. Correlates of smartphone access and social media use were evaluated by Poisson regression. RESULTS Of 600 youth, 301 were receiving general outpatient care and 299 HIV care. Median age was 18 years. Overall, 416 (69%) had access to a mobile phone and 288 (48%) to a smartphone. Of those with smartphones, 260 (90%) used social media. Smartphone access varied by facility (40% at the sub-county hospital vs. 55% at the national referral hospital, P=0.004) and was associated with older age [65% in 20-24-year-old vs. 37% in 14-19-year-old, adjusted prevalence ratio (aPR) 1.58, 95% CI: 1.30-1.92], secondary vs. primary education (aPR 2.59, 95% CI: 1.76-3.81), and HIV vs. general outpatient care (aPR 1.18, 95% CI: 1.01-1.38). Social media use was similarly associated with facility, older age, higher education, and male gender. CONCLUSIONS These data suggest that smartphone-based and social media interventions are accessible in Nairobi, Kenya, in the general population and youth living with HIV, and most appropriate for older youth. Intervention developers and policymakers should consider smartphone and social media interventions as candidates for youth health programs, while noting that heterogeneity of access between and within communities requires tailoring to the specific intervention context to avoid excluding the most vulnerable youth.
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Affiliation(s)
- Brenda Kharono
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Anne Kaggiah
- Department of Paediatrics and Child Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Cyrus Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Paediatrics and Child Health, Kenyatta National Hospital, Nairobi, Kenya
| | - David Seeh
- Department of Paediatrics and Child Health, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Megan Moreno
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Departments of Epidemiology, Medicine, Pediatrics, University of Washington, Seattle, WA, USA
| | - Irene Inwani
- Department of Paediatrics and Child Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, USA
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Trepka MJ, Ward MK, Ladner RA, Sheehan DM, Li T, Ibarra C, Gbadamosi SO, Ibañez GE, Jean-Gilles M. HIV Care Access During the COVID-19 Pandemic as Perceived by Racial/Ethnic Minority Groups Served by the Ryan White Program, Miami-Dade County, Florida. J Int Assoc Provid AIDS Care 2022; 21:23259582221084536. [PMID: 35243926 PMCID: PMC8899832 DOI: 10.1177/23259582221084536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Ryan White Program (RWP) in Miami-Dade County, Florida made several modifications to keep HIV care accessible during the COVID-19 Pandemic, including expanding telehealth services, increasing access to HIV medications, and waiving required lab tests for service recertification. We assessed ease of access to medical providers, medical case managers, and antiretroviral medications during the COVID-19 Pandemic among 298 Non-Hispanic Black, Hispanic, and Haitian people with HIV (PWH) served by the RWP Part A, Miami-Dade County, Florida using a telephone-administered survey between October 2020 and January 2021. Overall, most clients reported similar or better access compared to before the Pandemic. Use of videocalls to communicate with HIV medical providers varied by race/ethnicity: Hispanics (49.6%), Non-Hispanic Blacks (37.7%), and Haitian clients (16.0%). Results suggest the modifications helped maintain access to care during an unprecedented health crisis. Permanently adopting many of these modifications should be considered to continue to facilitate access to care.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
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Haynes N, Ezekwesili A, Nunes K, Gumbs E, Haynes M, Swain J. "Can you see my screen?" Addressing Racial and Ethnic Disparities in Telehealth. CURRENT CARDIOVASCULAR RISK REPORTS 2021; 15:23. [PMID: 34900074 PMCID: PMC8647517 DOI: 10.1007/s12170-021-00685-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
Purpose of Review Telehealth is an innovative approach with great potential to bridge the healthcare delivery gap, especially for underserved communities. While minority populations represent a target audience that could benefit significantly from this modern solution, little of the existing literature speaks to its acceptability, accessibility, and overall effectiveness in underserved populations. Here, we review the various challenges and achievements of contemporary telehealth and explore its impact on care delivery as an alternative or adjunct to traditional healthcare delivery systems. Recent Findings Given the COVID-19 pandemic, there has been a rapid acceleration in telemedicine adoption. Recent studies of telemedicine utilization during the pandemic reveal stark disparities in telemedicine modality use based on race, socioeconomic status, geography, and age. Summary While telehealth has great potential to overcome healthcare obstacles, the digital divide stands as a challenge to equitable telehealth and telemedicine adoption. Achieving health equity in telehealth will require the mobilization of resources, financial incentives, and political will among hospital systems, insurance companies, and government officials.
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Affiliation(s)
- Norrisa Haynes
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA USA
| | - Agnes Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kathryn Nunes
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA
| | - Edvard Gumbs
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA USA
| | | | - JaBaris Swain
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA USA
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Koay WLA, Prabhakar S, Neilan A, Meyers J, Lee N, Rakhmanina N. Brief Report: Supporting Access to HIV Care for Children and Youth During the COVID-19 Pandemic With Telemedicine and Rideshare. J Acquir Immune Defic Syndr 2021; 88:384-388. [PMID: 34710072 PMCID: PMC8547581 DOI: 10.1097/qai.0000000000002792] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/18/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, we scaled up telemedicine and rideshare services for clinic and laboratory visits for pediatric and adolescent patients with HIV. SETTING HIV subspecialty program for patients aged 0-24 years at Children's National Hospital, Washington, DC. METHODS Using the χ2 and Wilcoxon rank sum tests, we compared demographics, visit and laboratory data, and rideshare usage among patients who scheduled telemedicine at least once (telemedicine) versus those who never scheduled telemedicine (no-telemedicine) during the pandemic (April-September 2020). We compared the number and proportion of scheduled and completed clinic visits before the pandemic (April-September 2019) with those during the pandemic. RESULTS We analyzed 178 pediatric and adolescent patients with HIV (median age 17.9 years, 89.3% Black, 48.9% male patients, 78.7% perinatally infected), of whom 70.2% and 28.6% used telemedicine and rideshare, respectively. Telemedicine patients scheduled more visits (236 vs 179, P < 0.0001) and completed a similar proportion of visits (81.8% vs 86.0%, P = 0.3805) compared with no-telemedicine patients. Laboratory testing rates (81.3% versus 98.5%, P = 0.0005) were lower in telemedicine patients compared with no-telemedicine patients. Rideshare usage (12.4% versus 26.5%, P = 0.0068) was lower in telemedicine versus no-telemedicine patients. During the pandemic, most of the patients (81.0%) had HIV RNA <200 copies/mL. The total number of completed visits and the proportion of visits completed were similar before and during the pandemic. CONCLUSION Most of the pediatric and adolescent patients with HIV used telemedicine and maintained HIV RNA <200 copies/mL during the pandemic. Despite rideshare usage, laboratory testing rates were lower with telemedicine compared with in-person visits.
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Affiliation(s)
- Wei Li A Koay
- Department of Infectious Diseases, Children's National Hospital, Washington, DC
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Supriya Prabhakar
- Department of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Anne Neilan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA; and
| | - Joanna Meyers
- Department of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Nara Lee
- Department of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Natella Rakhmanina
- Department of Infectious Diseases, Children's National Hospital, Washington, DC
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
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42
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Thomas-Jacques T, Jamieson T, Shaw J. Telephone, video, equity and access in virtual care. NPJ Digit Med 2021; 4:159. [PMID: 34795356 PMCID: PMC8602296 DOI: 10.1038/s41746-021-00528-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/07/2021] [Indexed: 01/26/2023] Open
Abstract
Current public health measures catalyzed a large shift to virtual care, resulting in a great uptake in telephone and video-enabled care. While pre-pandemic public healthcare funding rarely covered the telephone as a reimbursable care delivery model, it has proven a crucial offering for many populations. As the new standard of virtual service delivery is being solidified, simple technological solutions that provide access to care must continue to be supported. This paper explores an important consequence of relying on complex technologies as the new standard of virtual care: the risk of exacerbating health disparities by enabling a deeper digital divide for marginalized populations.
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Affiliation(s)
- Tyla Thomas-Jacques
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, University of Toronto, Toronto, Canada.
| | - Trevor Jamieson
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, University of Toronto, Toronto, Canada.,Department of Medicine, Unity Health Toronto, Toronto, Canada
| | - James Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, University of Toronto, Toronto, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, Canada
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Wood BR, Lan KF, Tao Y, Mose EY, Aas E, Budak JZ, Dhanireddy S, Kim HN. Visit Trends and Factors Associated With Telemedicine Uptake Among Persons With HIV During the COVID-19 Pandemic. Open Forum Infect Dis 2021; 8:ofab480. [PMID: 34754884 PMCID: PMC8500015 DOI: 10.1093/ofid/ofab480] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/21/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, clinicians in outpatient HIV practices began to routinely offer telemedicine (video and/or phone visits) to replace in-person appointments. Video visits are preferred over phone visits, but determinants of video visit uptake in HIV care settings have not been well described. METHODS Trends in type of encounter (face-to-face, video, and phone) before and during the pandemic were reviewed for persons with HIV (PWH) at an urban, academic, outpatient HIV clinic in Seattle, Washington. Logistic regression was used to assess factors associated with video visit use including sociodemographic characteristics (age, race, ethnicity, language, insurance status, housing status) and electronic patient portal login. RESULTS After an initial increase in video visits to 30% of all completed encounters, the proportion declined and plateaued at ~10%. A substantial proportion of face-to-face visits were replaced by phone visits (~50% of all visits were by phone early in the pandemic, now stable at 10%-20%). Logistic regression demonstrated that older age (>50 or >65 years old compared with 18-35 years old), Black, Asian, or Pacific Islander race (compared with White race), and Medicaid insurance (compared with private insurance) were significantly associated with never completing a video visit, whereas history of patient portal login was significantly associated with completing a video visit. CONCLUSIONS Since the pandemic began, an unexpectedly high proportion of telemedicine visits have been by phone instead of video. Several social determinants of health and patient portal usage are associated with video visit uptake.
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Affiliation(s)
- Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
| | | | - Yuan Tao
- Harborview Medical Center, Seattle, Washington, USA
| | - Eric Y Mose
- Harborview Medical Center, Seattle, Washington, USA
| | - Erin Aas
- Telehealth Services, University of Washington, Seattle, Washington, USA
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
| | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
| | - H Nina Kim
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Harborview Medical Center, Seattle, Washington, USA
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Lee JL, Foschini L, Kumar S, Juusola J, Liska J, Mercer M, Tai C, Buzzetti R, Clement M, Cos X, Ji L, Kanumilli N, Kerr D, Montanya E, Müller-Wieland D, Ostenson CG, Skolnik N, Woo V, Burlet N, Greenberg M, Samson SI. Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial. NPJ Digit Med 2021; 4:138. [PMID: 34535755 PMCID: PMC8448887 DOI: 10.1038/s41746-021-00508-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.
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Affiliation(s)
- J L Lee
- Evidation Health, San Mateo, CA, USA.,Emory University, Atlanta, GA, USA
| | | | - S Kumar
- Evidation Health, San Mateo, CA, USA
| | - J Juusola
- Evidation Health, San Mateo, CA, USA
| | | | - M Mercer
- Sanofi Pasteur, Swiftwater, PA, USA
| | - C Tai
- Evidation Health, San Mateo, CA, USA
| | - R Buzzetti
- Sapienza University of Rome, Rome, Italy
| | - M Clement
- University of British Columbia, Armstrong, British Columbia, Canada
| | - X Cos
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary and Hospital Innovation Department, Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - L Ji
- Peking University People's Hospital, Beijing, China
| | | | - D Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - E Montanya
- Hospital Universitari Bellvitge-IDIBELL, CIBERDEM and University of Barcelona, Barcelona, Spain
| | | | | | - N Skolnik
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Woo
- University of Manitoba, Winnipeg, Canada
| | - N Burlet
- Sanofi, Paris, France.,Kyowa Kirin International, Marlow, United Kingdom
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Coffey JD, Christopherson LA, Glasgow AE, Pearson KK, Brown JK, Gathje SR, Sangaralingham LR, Carmona Porquera EM, Virk A, Orenstein R, Speicher LL, Bierle DM, Ganesh R, Cox DL, Blegen RN, Haddad TC. Implementation of a multisite, interdisciplinary remote patient monitoring program for ambulatory management of patients with COVID-19. NPJ Digit Med 2021; 4:123. [PMID: 34389787 PMCID: PMC8363637 DOI: 10.1038/s41746-021-00490-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
Established technology, operational infrastructure, and nursing resources were leveraged to develop a remote patient monitoring (RPM) program for ambulatory management of patients with COVID-19. The program included two care-delivery models with different monitoring capabilities supporting variable levels of patient risk for severe illness. The primary objective of this study was to determine the feasibility and safety of a multisite RPM program for management of acute COVID-19 illness. We report an evaluation of 7074 patients served by the program across 41 US states. Among all patients, the RPM technology engagement rate was 78.9%. Rates of emergency department visit and hospitalization within 30 days of enrollment were 11.4% and 9.4%, respectively, and the 30-day mortality rate was 0.4%. A multisite RPM program for management of acute COVID-19 illness is feasible, safe, and associated with a low mortality rate. Further research and expansion of RPM programs for ambulatory management of other acute illnesses are warranted.
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Affiliation(s)
| | | | - Amy E Glasgow
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kristina K Pearson
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - Julie K Brown
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - Shelby R Gathje
- Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN, USA
| | | | | | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Leigh L Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Dennis M Bierle
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Debra L Cox
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | | | - Tufia C Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.
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46
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Puthenpura V, Du N, Hauptman L, Porto AF. Disparities in Telehealth Utilization Within Pediatric Gastroenterology: One Academic Center's Experience. J Pediatr Gastroenterol Nutr 2021; 73:217-222. [PMID: 34016884 DOI: 10.1097/mpg.0000000000003167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES While the use of telemedicine has accelerated significantly with the recent pandemic, it has also magnified disparities in access to telemedicine. This study aims to look at telemedicine utilization patterns within a large pediatric gastroenterology practice. METHODS A retrospective study of ambulatory care visits within Yale-New Haven Hospital's pediatric gastroenterology practice during the peak expansion of the telemedicine program was conducted. Zip code-level socioeconomic data were obtained using the Distressed Communities Index. A multivariate logistic regression to evaluate disparities between the use of video versus telephone visits was computed, and unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were obtained. RESULTS A total of 1273 clinic visits were included in analysis. The majority of the patients listed English as their preferred language, had private insurance, and identified as non-Hispanic White. When adjusting for co-variates, having public insurance/Medicaid was associated with decreased odds of having video over telephone visits (adjusted odds ratio [aOR] 0.60; 95% CI 0.44-0.80). Those whose primary language was not English continued to have a statistically significant decreased odds of using video visits (Spanish aOR 0.24; 95% CI 0.13-0.44; other aOR 0.29; 95% CI 0.12-0.72). Within the adjusted multivariate logistic regression, race/ethnicity and SES were, however, no longer found to have a statistically significant decreased odds of video visits. CONCLUSIONS The accelerated implementation of telemedicine within pediatric gastroenterology has given rise to disparities in its use. Further studies are needed to understand these disparities and develop interventions to lessen this gap in usage.
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Affiliation(s)
| | - Nan Du
- Boston Children's Hospital, Boston, MA
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47
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Shaw J, Brewer LC, Veinot T. Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review. JMIR Form Res 2021; 5:e23233. [PMID: 33739931 PMCID: PMC8023377 DOI: 10.2196/23233] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. OBJECTIVE The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. METHODS We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. RESULTS We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. CONCLUSIONS We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post-COVID-19 reality.
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Affiliation(s)
- James Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | | | - Tiffany Veinot
- School of Information, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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48
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine—Past, Present, and Future. Curr HIV/AIDS Rep 2021. [DOI: https://doi.org.10.1007/s11904-021-00543-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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49
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine—Past, Present, and Future. Curr HIV/AIDS Rep 2021. [DOI: https:/doi.org.10.1007/s11904-021-00543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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50
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Su S, Du L, Jiang S. Learning from the past: development of safe and effective COVID-19 vaccines. Nat Rev Microbiol 2021; 19:211-219. [PMID: 33067570 PMCID: PMC7566580 DOI: 10.1038/s41579-020-00462-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/29/2023]
Abstract
The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has elicited an equally rapid response aiming to develop a COVID-19 vaccine. These efforts are encouraging; however, comprehensive efficacy and safety evaluations are essential in the development of a vaccine, and we can learn from previous vaccine development campaigns. In this Perspective, we summarize examples of vaccine-associated disease enhancement in the history of developing vaccines against respiratory syncytial virus, dengue virus, SARS-CoV and Middle East respiratory syndrome coronavirus, which highlight the importance of a robust safety and efficacy profile, and present recommendations for preclinical and clinical evaluation of COVID-19 vaccine candidates as well as for vaccine design and optimization.
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Affiliation(s)
- Shan Su
- Key Laboratory of Medical Molecular Virology (MOE/MOH/CAM), School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Lanying Du
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology (MOE/MOH/CAM), School of Basic Medical Sciences, Fudan University, Shanghai, China.
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA.
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