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Civelek Y, Oakes A, Robinson M, Chi W. Distribution of a Remote Medical Exam Device Associated with an Increase in Telehealth Use. Telemed J E Health 2024; 30:e1197-e1202. [PMID: 38016132 DOI: 10.1089/tmj.2023.0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Background: The COVID-19 pandemic accelerated telehealth adoption, but its effects on care quality and costs remain unclear. This study evaluates a remote patient monitoring device's impact on utilization and spending. Methods: A large insurer launched a pilot program involving 2,880 households, representing 6,731 members in three states. Administrative claims data compared participant households to a matched group lacking necessary contact information for participation. Results: Participants had a 0.19 per member (p = 0.03) increase in telehealth visits and a 0.19 per member (p = 0.08) decrease in outpatient in-person visits relative to nonparticipants during the post 6-month period. No significant differences were observed in total outpatient and emergency department visits or total spending. Subgroup analyses revealed a significant reduction in telehealth visits followed by in-person outpatient visits in households with younger children (-9.1%; p < 0.05). Conclusion: This evaluation suggests that remote devices may boost telehealth utilization without increasing costs.
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Affiliation(s)
- Yasin Civelek
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
| | - Allison Oakes
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
| | - Michael Robinson
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
| | - Winnie Chi
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
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Elsener M, Santana Felipes RC, Sege J, Harmon P, Jafri FN. Telehealth-based transitional care management programme to improve access to care. BMJ Open Qual 2023; 12:e002495. [PMID: 37940335 PMCID: PMC10632879 DOI: 10.1136/bmjoq-2023-002495] [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: 07/11/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The transition from hospital to home is a vulnerable time for patients and families that can be improved through care coordination and structured discharge planning. LOCAL PROBLEM Our organisation aimed to develop and expand a programme that could improve 30-day readmission rates on overall and disease-specific populations by assessing the impact of a telehealth outreach by a registered nurse (RN) after discharge from an acute care setting on 30-day hospital readmission. METHODS This is a prospective observational design conducted from May 2021 to December 2022 with an urban, non-academic, acute care hospital in Westchester County, New York. Outcomes for patients discharged home following inpatient hospitalisation were analysed within this study. We analysed overall and disease-specific populations (congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia (PNA)) as compared with a 40-month prestudy cohort. INTERVENTIONS Patients were identified in a non-random fashion meeting criterion of being discharged home after an inpatient admission. Participants received a telephonic outreach by an RN within 72 hours of discharge. Contacted patients were asked questions addressing discharge instructions, medication access, follow-up appointments and social needs. Patients were offered services and resources based on their individual needs in response to the survey. RESULTS 68.2% of the 24 808 patients were contacted to assess and offer services. Median readmission rates for these patients were 1.2% less than the prestudy cohort (11.0% to 9.8%). Decreases were also noted for disease-specific conditions (CHF (14.3% to 9.1%), COPD (20.0% to 13.4%) and PNA (14.9% to 14.0%)). Among those in the study period, those that were contacted between 24 and 48 hours after discharge were 1.2 times less likely to be readmitted than if unable to be contacted (254/3742 (6.8%) vs 647/7866 (8.2%); p=0.005). CONCLUSIONS Using a multifaceted telehealth approach to improve patient engagement and access reduced 30-day hospital readmission for patients discharged from the acute care setting.
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Affiliation(s)
- Michelle Elsener
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | | | - Jonathan Sege
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Priscilla Harmon
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Farrukh N Jafri
- Emergency Department, White Plains Hospital, White Plains, New York, USA
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3
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Tyler N, Hodkinson A, Planner C, Angelakis I, Keyworth C, Hall A, Jones PP, Wright OG, Keers R, Blakeman T, Panagioti M. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2344825. [PMID: 38032642 PMCID: PMC10690480 DOI: 10.1001/jamanetworkopen.2023.44825] [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] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ioannis Angelakis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Institute of Population Health, Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Alex Hall
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | | | | | - Richard Keers
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tom Blakeman
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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Grauer A, Cornelius T, Abdalla M, Moise N, Kronish IM, Ye S. Impact of early telemedicine follow-up on 30-Day hospital readmissions. PLoS One 2023; 18:e0282081. [PMID: 37216362 PMCID: PMC10202267 DOI: 10.1371/journal.pone.0282081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/08/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Telemedicine is increasing in popularity but the impact of this shift on patient outcomes has not been well described. Prior data has shown that early post-discharge office visits can reduce readmissions. However, it is unknown if routine use of telemedicine visits for this purpose is similarly beneficial. MATERIALS AND METHODS We conducted a retrospective observational study using electronic health records data to assess if the rate of 30-day hospital readmissions differed between modality of visit for primary care or cardiology post-discharge follow-up visits. RESULTS Compared to discharges with completed in-person follow-up visits, the adjusted odds of readmission for those with telemedicine follow-up visits was not significantly different (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.61 to 1.51, P = 0.86). CONCLUSIONS Our study showed that 30-day readmission rate did not differ significantly according to the modality of visit. These results provide reassurance that telemedicine visits are a safe and viable alternative for primary care or cardiology post-hospitalization follow-up.
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Affiliation(s)
- Anne Grauer
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Ian M. Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, United States of America
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Gazda NP, Vest TA, Peek GK, Eckel SF. A new perspective: Practice-enhancing publications about the ambulatory care medication-use process in 2020. Am J Health Syst Pharm 2022; 79:1697-1727. [PMID: 35764076 DOI: 10.1093/ajhp/zxac177] [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: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE This article identifies, prioritizes, and summarizes published literature on the ambulatory care medication-use process (ACMUP) from calendar year 2020 that can impact ambulatory pharmacy practice. SUMMARY The medication-use process is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing and collaborative practice, accessing care, adherence, and monitoring and quality. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. A PubMed search covering calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 9,433 articles. A thorough review identified 65 potentially practice-enhancing articles: 14 for transitions of care, 19 for prescribing and collaborative practice, 10 for adherence, 6 for accessing care, and 16 for monitoring and quality. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why each article is important. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article is the first to define and evaluate the currently published literature pertinent to the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.
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Affiliation(s)
| | - Tyler A Vest
- Duke University Hospital, Durham, NC, and University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Grayson K Peek
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, and University of North Carolina Medical Center, Chapel Hill, NC, USA
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Khanna S, Lett J, Lattimer C, Tillotson G. Transitions of care in Clostridioides difficile infection: a need of the hour. Therap Adv Gastroenterol 2022; 15:17562848221078684. [PMID: 35251308 PMCID: PMC8891823 DOI: 10.1177/17562848221078684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
Clostridioides difficile infection (CDI) is a complex disease that by virtue of both its initial virulence and proclivity toward recurrent episodes causes a high morbidity, mortality, and financial burden. This burden is felt by patients and their families as well as the U.S. healthcare system. Recurrent CDI episodes can occur in 25-65% of patients, with a cycle of multiple recurrences in a single patient contributing to the complexity of care. Patients with or suspected of having CDI will receive treatment and their care will be managed across multiple healthcare settings and will include many different levels of healthcare workers. The understanding of this infection is essential for all who are involved in the care of these patients. A well-structured and implemented Transition of Care process can ease the burden on the healthcare system, patients, and their families; reduce the cost of care; and improve patient outcomes. We review the development of Transitions of Care processes, resource guides, and their relevance to improving the management of CDI.
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Affiliation(s)
- Sahil Khanna
- Department of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - James Lett
- National Transitions of Care Coalition, Washington, DC, USA
| | - Cheri Lattimer
- National Transitions of Care Coalition, Norfolk, VA, USA
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Albritton J, Ortiz A, Wines R, Booth G, DiBello M, Brown S, Gartlehner G, Crotty K. Video Teleconferencing for Disease Prevention, Diagnosis, and Treatment : A Rapid Review. Ann Intern Med 2022; 175:256-266. [PMID: 34871056 DOI: 10.7326/m21-3511] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Video teleconferencing (VTC) as a substitute for in-person health care or as an adjunct to usual care has increased in recent years. PURPOSE To assess the benefits and harms of VTC visits for disease prevention, diagnosis, and treatment and to develop an evidence map describing gaps in the evidence. DATA SOURCES Systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library from 1 January 2013 to 3 March 2021. STUDY SELECTION Two investigators independently screened the literature and identified 38 randomized controlled trials (RCTs) meeting inclusion criteria. DATA EXTRACTION Data abstraction by a single investigator was confirmed by a second investigator; 2 investigators independently rated risk of bias. DATA SYNTHESIS Results from 20 RCTs rated low risk of bias or some concerns of bias show that the use of VTC for the treatment and management of specific diseases produces largely similar outcomes when used to replace or augment usual care. Nine of 12 studies where VTC was intended to replace usual care and 5 of 8 studies where VTC was intended to augment usual care found similar effects between the intervention and control groups. The remaining 6 included studies (3 intended to replace usual care and 3 intended to augment usual care) found 1 or more primary outcomes that favored the VTC group over the usual care group. Studies comparing VTC with usual care that did not involve in-person care were more likely to favor the VTC group. No studies evaluated the use of VTC for diagnosis or prevention of disease. Studies that reported harms found no differences between the intervention and control groups; however, many studies did not report harms. No studies evaluated the effect of VTC on health equity or disparities. LIMITATIONS Studies that focused on mental health, substance use disorders, maternal care, and weight management were excluded. Included studies were limited to RCTs with sample sizes of 50 patients or greater. Component analyses were not conducted in the studies. CONCLUSION Replacing or augmenting aspects of usual care with VTC generally results in similar clinical effectiveness, health care use, patient satisfaction, and quality of life as usual care for areas studied. However, included trials were limited to a handful of disease categories, with patients seeking care for a limited set of purposes. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Jordan Albritton
- RTI International, Research Triangle Park, North Carolina (J.A., A.O., R.W., G.B., S.B., K.C.)
| | - Alexa Ortiz
- RTI International, Research Triangle Park, North Carolina (J.A., A.O., R.W., G.B., S.B., K.C.)
| | - Roberta Wines
- RTI International, Research Triangle Park, North Carolina (J.A., A.O., R.W., G.B., S.B., K.C.)
| | - Graham Booth
- RTI International, Research Triangle Park, North Carolina (J.A., A.O., R.W., G.B., S.B., K.C.)
| | | | - Stephen Brown
- RTI International, Research Triangle Park, North Carolina (J.A., A.O., R.W., G.B., S.B., K.C.)
| | | | - Karen Crotty
- RTI International, Research Triangle Park, North Carolina (J.A., A.O., R.W., G.B., S.B., K.C.)
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Bailey A, Mallow J, Theeke L. Perceived Self-Efficacy, Confidence, and Skill Among Factors of Adult Patient Participation in Transitional Care: A Systematic Review of Quantitative Studies. SAGE Open Nurs 2022; 8:23779608221074658. [PMID: 35111928 PMCID: PMC8801722 DOI: 10.1177/23779608221074658] [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: 05/05/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on participation in care. Mismanagement of care during already risky care-transitions further increases adverse care outcomes. Understanding factors of patient participation in transitional care in an adult population can help guide ways to reduce this burden. METHODS A systematic review of the literature guided by the PRISMA method was conducted to identify factors of patient participation in transitional care. Quantitative studies in which patient participation was measured as an outcome variable and related statistics reported, and data were collected from an adult sample, were included. Two authors independently reviewed, critiqued, and synthesized the articles, and later categorized study variables according to identified trends. RESULTS Twelve studies across international and multidisciplinary backgrounds were identified. Across studies, efforts were largely based on understanding or improving patient self-management of care during transitions. The majority of studies were experimental and care interventions grounded in patient and healthcare team partnerships, delivered beyond the hospital setting. An array of measures was used to quantify patient participation. Factors of patient participation in transitional care included higher perceived levels of self-efficacy, confidence, and skills to participate in care. CONCLUSION The results of this study suggest patient participation in transitional care is largely based on perceptions of self-efficacy, confidence, and skill. Patient-centric transitional care interventions targeting these factors and delivered beyond the hospital setting may improve care outcomes. Implications and direction for further studies includes conceptual clarity, the study of a broader-reaching patient population demographic, and use of multidisciplinary interventions. Outcome variables should remain focused on patient perception of care involvement and participation and expanded to include variables such as functional abilities and social determinants of health.
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Affiliation(s)
- Andrea Bailey
- School of Nursing, West Virginia University, Morgantown, WV,
USA
| | - Jennifer Mallow
- School of Nursing, West Virginia University, Morgantown, WV,
USA
| | - Laurie Theeke
- School of Nursing, West Virginia University, Morgantown, WV,
USA
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Kim HJ, Tomaszewski M, Zhao B, Lam E, Enns R, Bressler B, Moosavi S. OUP accepted manuscript. J Can Assoc Gastroenterol 2022; 5:203-207. [PMID: 36193346 PMCID: PMC9384003 DOI: 10.1093/jcag/gwac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Aim Methods Results Conclusions
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Affiliation(s)
- Hyun Jae Kim
- Correspondence: Hyun Jae Kim, MD, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 1906-7388 Kingsway, Burnaby, BC V3N 0G9, Canada, e-mail:
| | - Marcel Tomaszewski
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Billy Zhao
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Lam
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Enns
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarvee Moosavi
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Telemedicine, which provides safe, equitable, patient-centered care, has gained significant momentum in recent years. Success using telemedicine has been seen across diverse groups of patients for a variety of diagnoses, including older adults and gynecology patients. In response to the coronavirus disease 2019 pandemic, federal and local governments have issued provisions to improve reimbursement and accessibility to telemedicine. In urogynecology, virtual care is growing in popularity, along with a growing body of literature in support of this method of providing care. Providers should use clinical judgment and existing data to guide them on which clinical conditions are appropriate for virtual care.
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Affiliation(s)
- Miriam C Toaff
- PGY-3, Obstetrics and Gynecology, New York Medical College, 19 Bradhurst Avenue, Hawthorne, NY 10532, USA
| | - Cara L Grimes
- Obstetrics and Gynecology and Urology, New York Medical College, 19 Bradhurst Avenue, Hawthorne, NY 10532, USA.
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Schoebel V, Wayment C, Gaiser M, Page C, Buche J, Beck AJ. Telebehavioral Health During the COVID-19 Pandemic: A Qualitative Analysis of Provider Experiences and Perspectives. Telemed J E Health 2021; 27:947-954. [PMID: 34028302 DOI: 10.1089/tmj.2021.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Due to the COVID-19 pandemic and prompted by recent federal and state policy shifts impacting behavioral health care delivery, the use of telebehavioral health has rapidly increased. This qualitative study describes behavioral health provider perspectives on the use of telebehavioral health before and during the pandemic and how policy changes impacted access to and utilization of behavioral health services in Michigan. Materials and Methods: A convenience sample of 31 licensed and nonlicensed behavioral health providers operating in Michigan participated in semi-structured interviews between July and August 2020. Interviews were audio-recorded, transcribed, and analyzed by using inductive methods. Results: The thematic analysis resulted in four overarching themes: (1) increased access to care; (2) maintenance of quality of care; (3) minimal privacy concerns; and (4) client and provider satisfaction. Discussion: During and post-pandemic, providers need flexibility to determine whether in-person or telebehavioral health services, including audio-only, best meet client needs. Providers identified several populations for which telebehavioral health was less accessible: clients with serious mental illness and substance use disorder, those with no broadband Internet access, children, and older adults. Additional training in telebehavioral health service provision can positively impact quality of care. Conclusion: Policies that support reimbursement parity and expand provider use of telebehavioral health services should be maintained after the COVID-19 pandemic ends to avoid imposing barriers to accessing behavioral health care barriers post-pandemic.
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Affiliation(s)
- Victoria Schoebel
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caitlyn Wayment
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Maria Gaiser
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Cory Page
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jessica Buche
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Angela J Beck
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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Rasschaert M, Vanclooster P, Mertens T, Roelant E, Lesage K, Prenen H, Verlinden A, van Brussel I, Ravelingien J, Janssens A, Van Dam P, Peeters M. The tele-transition of toxicity management in routine oncology care during the severe acute respiratory syndrome (SARS-CoV-2) pandemic. Br J Cancer 2021; 124:1366-1372. [PMID: 33558713 PMCID: PMC8039036 DOI: 10.1038/s41416-020-01235-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/29/2020] [Accepted: 12/08/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Telehealth modalities were introduced during the SARS-CoV-2 pandemic to assure continuation of cancer care and maintain social distance. METHODS This is a retrospective cohort analysis of our telehealth expansion programme. We adapted two existing patient-reported outcome (PRO) telemonitoring tools that register and (self-)manage toxicities to therapy, while screening for SARS-CoV-2-related symptoms. Outpatients from a tertiary cancer centre were enrolled. The adapted PRO interface allowed for uniform registration of SARS-CoV-2-related symptoms and effective triage of patients at home where we also implemented systematic throat washings, when available. RESULTS Three hundred and sixty patients registered to the telemonitoring systems from March 13 to May 15, 2020. Four prespecified SARS-CoV-2 alarms resulted in three patients with positive PCR testing. Other Covid-19 symptoms (fever 5× and cough 2×) led to pretreatment triage resulting in 1 seroconversion after initial negative testing. One of the 477 throat washings proved positive. CONCLUSIONS The rapid adoption of an amended PRO (self-)registrations and toxicity management system was feasible and coordinated screening for Covid-19. Continued clinical cancer care was maintained, with significant decreased waiting time. The systemic screening with throat washings offered no real improvement.
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Affiliation(s)
- Marika Rasschaert
- Department of Oncology, Antwerp University Hospital Antwerp, Antwerp, Belgium.
| | | | - Tim Mertens
- Department of Oncology, Antwerp University Hospital Antwerp, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trials Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Katrien Lesage
- Department of Information and Communication Technology, Antwerp University Hospital, Antwerp, Belgium
| | - Hans Prenen
- Department of Oncology, Antwerp University Hospital Antwerp, Antwerp, Belgium
| | - Anke Verlinden
- Department of Haematology, Antwerp University Hospital, Antwerp, Belgium
| | | | | | - Annelies Janssens
- Department of Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Peter Van Dam
- Unit of Gynecologic Oncology, Department of Obstetrics & Gynecology, Antwerp University Hospital, Antwerp, Belgium
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital Antwerp, Antwerp, Belgium
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14
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Shachar C, Engel J, Elwyn G. Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues. JAMA 2020; 323:2375-2376. [PMID: 32421170 DOI: 10.1001/jama.2020.7943] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Carmel Shachar
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, Massachusetts
| | - Jaclyn Engel
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Glyn Elwyn
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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