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Xie Y, He W, Wan Y, Luo H, Cai Y, Gong W, Liu S, Zhong D, Hu W, Zhang L, Li J, Zhao Q, Lv S, Li C, Zhang Z, Li C, Chen X, Huang W, Wang Y, Xu D. Validity of patients' online reviews at direct-to-consumer teleconsultation platforms: a protocol for a cross-sectional study using unannounced standardised patients. BMJ Open 2023; 13:e071783. [PMID: 37164474 PMCID: PMC10173992 DOI: 10.1136/bmjopen-2023-071783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION As direct-to-consumer teleconsultation (hereafter referred to as 'teleconsultation') has gained popularity, an increasing number of patients have been leaving online reviews of their teleconsultation experiences. These reviews can help guide patients in identifying doctors for teleconsultation. However, few studies have examined the validity of online reviews in assessing the quality of teleconsultation against a gold standard. Therefore, we aim to use unannounced standardised patients (USPs) to validate online reviews in assessing both the technical and patient-centred quality of teleconsultations. We hypothesise that online review results will be more consistent with the patient-centred quality, rather than the technical quality, as assessed by the USPs. METHODS AND ANALYSIS In this cross-sectional study, USPs representing 11 common primary care conditions will randomly visit 253 physicians via the three largest teleconsultation platforms in China. Each physician will receive a text-based and a voice/video-based USP visit, resulting in a total of 506 USP visits. The USP will complete a quality checklist to assess the proportion of clinical practice guideline-recommended items during teleconsultation. After each visit, the USP will also complete the Patient Perception of Patient-Centeredness Rating. The USP-assessed results will be compared with online review results using the intraclass correlation coefficient (ICC). If ICC >0.4 (p<0.05), we will assume reasonable concordance between the USP-assessed quality and online reviews. Furthermore, we will use correlation analysis, Lin's Coordinated Correlation Coefficient and Kappa as supplementary analyses. ETHICS AND DISSEMINATION This study has received approval from the Institutional Review Board of Southern Medical University (#Southern Medical Audit (2022) No. 013). Results will be actively disseminated through print and social media, and USP tools will be made available for other researchers. TRIAL REGISTRATION The study has been registered at the China Clinical Trials Registry (ChiCTR2200062975).
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Affiliation(s)
- Yunyun Xie
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Wenjun He
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuting Wan
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Huanyuan Luo
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistic, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Wenjie Gong
- School of Public Health, Central South University, Changsha, China
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siyuan Liu
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Dongmei Zhong
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wenping Hu
- Department of Social Medicine and Health Management, Lanzhou University, Lanzhou, Gansu Province, China
| | - Lanping Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jiaqi Li
- School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Qing Zhao
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Sensen Lv
- School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Chunping Li
- School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhang Zhang
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Changchang Li
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoshan Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wangqing Huang
- School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yutong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dong Xu
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
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Mold F, Cooke D, Ip A, Roy P, Denton S, Armes J. COVID-19 and beyond: virtual consultations in primary care-reflecting on the evidence base for implementation and ensuring reach: commentary article. BMJ Health Care Inform 2021; 28:bmjhci-2020-100256. [PMID: 33436372 PMCID: PMC7804830 DOI: 10.1136/bmjhci-2020-100256] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Debbie Cooke
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Athena Ip
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | | | | | - Jo Armes
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Mold F, Hendy J, Lai YL, de Lusignan S. Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Med Inform 2019; 7:e13042. [PMID: 31793888 PMCID: PMC6918214 DOI: 10.2196/13042] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Jane Hendy
- Brunel Business School, Brunel University London, Uxbridge, United Kingdom
| | - Yi-Ling Lai
- Faculty of Business and Law, University of Portsmouth, Portsmouth, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
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Schreiweis B, Pobiruchin M, Strotbaum V, Suleder J, Wiesner M, Bergh B. Barriers and Facilitators to the Implementation of eHealth Services: Systematic Literature Analysis. J Med Internet Res 2019; 21:e14197. [PMID: 31755869 PMCID: PMC6898891 DOI: 10.2196/14197] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods For this study, a twofold approach was applied. First, we gathered experts’ current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers.
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Affiliation(s)
- Björn Schreiweis
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany.,Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany
| | - Monika Pobiruchin
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Veronika Strotbaum
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,Zentrum für Telematik und Telemedizin GmbH, Bochum, Germany
| | - Julian Suleder
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,ERNW Research GmbH, Heidelberg, Germany
| | - Martin Wiesner
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Björn Bergh
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
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Lanham HJ, Leykum LK, Pugh JA. Examining the Complexity of Patient-Outpatient Care Team Secure Message Communication: Qualitative Analysis. J Med Internet Res 2018; 20:e218. [PMID: 29997107 PMCID: PMC6060302 DOI: 10.2196/jmir.9269] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communicating both routine and nonroutine issues, and the implications of these differences in use are less well understood. OBJECTIVE The purpose of this study was to examine secure messaging use to extend current knowledge of how this tool is being used in outpatient care settings and generate new research questions to improve our understanding of the role of secure messaging in the patient-provider communication toolbox. METHODS We conducted an in-depth qualitative analysis of secure message threads in 12 US Department of Veterans Affairs outpatient clinics in south Texas. We analyzed 70 secure message threads with a total of 179 unique communications between patients and their outpatient teams for patterns in communication and secure message content. We used theories from information systems and complexity science in organizations to explain our observations. RESULTS Analysis identified content relating to 3 main themes: (1) information management, (2) uncertainty management, and (3) patient safety and engagement risks and opportunities. Within these themes, we identified 2 subcategories of information management (information exchange and problem solving), 2 subcategories of uncertainty management (relationship building and sensemaking), and 3 subcategories of patient safety and engagement risks and opportunities (unresolved issues, tone mismatch, and urgent medical issues). Secure messages were most often used to communicate routine issues (eg, information exchange and problem solving). However, the presence of subcategories pertaining to nonroutine issues (eg, relationship building, sensemaking, tone mismatch, urgent issues, and unresolved issues) requires attention, particularly for improving opportunities in outpatient care settings using secure messaging. CONCLUSIONS Patients use secure messaging for both routine and nonroutine purposes. Our analysis sheds light on potentially new patient safety concerns, particularly when using secure messaging to address some of the more complex issues patients are communicating with providers. Secure messaging is an asynchronous communication information system operated by patients and providers who are often characterized as having significant differences in knowledge, experience and expectations. As such, justification for its use beyond routine purposes is limited-yet this occurs, presenting a multifaceted dilemma for health care organizations. Secure messaging use in outpatient care settings may be more nuanced, and thus more challenging to understand and manage than previously recognized. New information system designs that acknowledge the use of secure messaging for nonroutine and complex health topics are needed.
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Affiliation(s)
- Holly Jordan Lanham
- Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, TX, United States.,Veterans Evidence Based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Luci K Leykum
- Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, TX, United States.,Veterans Evidence Based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Jacqueline A Pugh
- Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States.,Veterans Evidence Based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, United States
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Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians. Telemed J E Health 2017; 24:268-276. [PMID: 28805545 DOI: 10.1089/tmj.2017.0161] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. INTRODUCTION Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. MATERIALS AND METHODS Nationally representative randomly sampled survey of 5,000 FPs. RESULTS Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. DISCUSSION Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. CONCLUSION Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.
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Affiliation(s)
- Anuradha Jetty
- 1 Robert Graham Center , Washington, District of Columbia
| | - Miranda A Moore
- 2 Department of Family and Preventive Medicine, Emory University , Atlanta, Georgia
| | - Megan Coffman
- 1 Robert Graham Center , Washington, District of Columbia
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Shah BR. Innovating in the Delivery of Diabetes Care. Can J Diabetes 2015; 39:441-2. [PMID: 26498220 DOI: 10.1016/j.jcjd.2015.09.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada..
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