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S., Eric Anderson, Pinder Jim, M. Dameff Elizabeth, Manassian Armond, and Kim-Liang Chuah. "A Comparative Expected Value Analysis Study to Determine the Cost Benefit or Cost Effectiveness of Early Discharge, Medical Transport, Home Health as Well as Home Care Devices, Services and Technologies in The United States." Account and Financial Management Journal 08, no. 09 (2023): 3208–15. https://doi.org/10.5281/zenodo.8385114.
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Abstract It was found that Amazon products (Alexa™, Echo™, Halo™), EMRs, fire extinguishers, genome sequencing test, on-line pharmacies, remote patient monitoring, provided economic value, while emergency medical service membership programs<strong>, </strong>fire alarm subscription services, helicopter emergency medical services, home fire insurance policies, home fire sprinklers, and home security systems were not found to have provided economic value. Tele-health (virtual office visits) would provide economic value if most tele-health visits replaced existing in-person visits and the low cost virtual didn’t drive demand for unnecessary visits. Robotic surgery technologies provide economic value if fully utilized (high patient demand to reduce overhead costs per procedure) in a facility with little excess capacity as long as it did not compete with non-robotic surgical offerings at the present facility. AEDs provide economic value if appropriately placed in high demand locales based on future probability of use.
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Jiang, Angela, Reem Kashlan, Christine Joseph, Amy Tang, and Henry Lim. "Disparities in Access to Teledermatology During the COVID-19 Pandemic in Detroit, Michigan." SKIN The Journal of Cutaneous Medicine 5, no. 6 (2021): 639–48. http://dx.doi.org/10.25251/skin.5.6.6.
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Background: Teledermatology became a necessary modality for dermatologic patient care during the COVID-19 pandemic. Due to disparities in access to technology, “The Digital Divide” refers to worsening health care disparities despite telemedicine’s best efforts to improve access. Methods: Retrospective chart review was performed of all patients who were scheduled to be seen in dermatology during the first wave of pandemic (March 27, 2020 to April 27, 2020). Demographic characteristics of patients who pursued virtual visits was compared with those who did not. Results: Compared to patients who canceled office visits, patients who completed virtual visit appointments were more likely to be younger (mean age 37.8 versus 45.5 years), female (68.7% versus 62.9%, p=0.01), unmarried (68.7% versus 61.0%, p<0.01). Of the diagnoses rendered during virtual visits, 53.3% were associated with dermatoses. Conclusions: Patient populations above the age of 65 were less likely to complete a video visit, regardless of socioeconomic factors. Future policies must take marginalized populations into account to improve ease of access to technological services.
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Sarmiento, Kathleen, Samuel Kuna, Eilis Boudreau, et al. "814 VHA’s TeleSleep Program improves rural Veteran access to sleep care through expansion of telehealth networks." Sleep 44, Supplement_2 (2021): A317—A318. http://dx.doi.org/10.1093/sleep/zsab072.811.
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Abstract Introduction Rurality is a known contributor to health disparities, including Sleep medicine. Over 1 million (&gt;350,000 rural, &gt;650,000 non-rural) Veterans who received care from VHA in 2020 have obstructive sleep apnea (OSA). VHA’s Office of Rural Health (ORH) TeleSleep Program (FY17-20) aimed to increase access to sleep care for rural veterans by establishing telehealth services at 12 hubs and 63 spokes across the country. The TeleSleep program has three components: (1) Telemedicine; (2) Home Sleep Apnea Testing (HSAT); and (3) REVAMP (Remote Veterans Apnea Management Platform), a web-application for comprehensive sleep apnea care. Methods Each of the three TeleSleep components was evaluated independently using specific metrics. We report here on the impact of leveraging telemedicine to improve access to sleep care. Patient care encounters are defined by VA-specific stop codes and are thus identifiable as telehealth or in-person visits. Data used in the evaluation were obtained from the VA Corporate Data Warehouse. Results During FY20, 33,743 rural Veterans had 74,458 sleep encounters within the TeleSleep network. Visits included in-person care, virtual initial and follow up visits, electronic consultations, asynchronous telehealth (remote monitoring of PAP data and HSAT), remote PAP initiation by video or phone, and email exchanges between patients and providers. Between FY17-20, the number of rural Veterans seen for sleep-related disorders at TeleSleep sites tripled (from 10,702 to 33,743), and the number of encounters for sleep-related disorders more than doubled (from 32,894 to 74,458). In FY20, 72% (up from 53% in FY18) of rural Veterans at the TeleSleep hubs or spokes had at least one virtual sleep visit. This was significantly higher than non-TeleSleep VA sites where only 64% of rural Veterans had virtual visits (72% vs. 64%; p&lt;0.001). In addition, the proportion of Veterans who had face-to-face only visits (28% at TeleSleep sites vs. 36% at non-TeleSleep sites; p&lt;0.001) indicates that the TeleSleep program was highly successful in promoting virtual (instead of face-to-face) visits. Conclusion The ORH TeleSleep Program has improved access to comprehensive sleep care for rural Veterans by increasing the proportion and type of sleep visits conducted virtually vs. in person. Support (if any) Funding provided by VHA Office of Rural Health
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Bruxvoort, Katia J., Zoe Bider-Canfield, Joan A. Casey, et al. "Outpatient Urinary Tract Infections in an Era of Virtual Healthcare: Trends From 2008 to 2017." Clinical Infectious Diseases 71, no. 1 (2019): 100–108. http://dx.doi.org/10.1093/cid/ciz764.
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Abstract Background Urinary tract infections (UTIs) occur commonly, but recent data on UTI rates are scarce. It is unknown how the growth of virtual healthcare delivery affects outpatient UTI management and trends in the United States. Methods From 1 January 2008 to 31 December 2017, UTIs from outpatient settings (office, emergency, and virtual visits) were identified from electronic health records at Kaiser Permanente Southern California using multiple UTI definitions. Annual rates estimated by Poisson regression were stratified by sex, care setting, age, and race/ethnicity. Annual trends were estimated by linear or piecewise Poisson regression. Results UTIs occurred in 1 065 955 individuals. Rates per 1000 person-years were 53.7 (95% confidence interval [CI], 50.6–57.0) by diagnosis code with antibiotic and 25.8 (95% CI, 24.7–26.9) by positive culture. Compared to office and emergency visits, UTIs were increasingly diagnosed in virtual visits, where rates by diagnosis code with antibiotic increased annually by 21.2% (95% CI, 16.5%–26.2%) in females and 29.3% (95% CI, 23.7%–35.3%) in males. Only 32% of virtual care diagnoses had a culture order. Overall, UTI rates were highest and increased the most in older adults. Rates were also higher in Hispanic and white females and black and white males. Conclusions Outpatient UTI rates increased from 2008 to 2017, especially in virtual care and among older adults. Virtual care is important for expanding access to health services, but strategies are needed in all outpatient care settings to ensure accurate UTI diagnosis and reduce inappropriate antibiotic treatment.
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Fan, Timothy, Alan D. Workman, Lauren E. Miller, et al. "The Impact of COVID-19 on Otolaryngology Community Practice in Massachusetts." Otolaryngology–Head and Neck Surgery 165, no. 3 (2021): 424–30. http://dx.doi.org/10.1177/0194599820983732.
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Objectives Coronavirus disease 2019 (COVID-19) significantly affected many health care specialties, including otolaryngology. In response to governmental policy changes, many hospitals and private practices in Massachusetts canceled or postponed nonurgent office visits and elective surgeries. The objective of this study was to quantify the impact of COVID-19 on the provision and practice trends of otolaryngology services for 10 private practices in Massachusetts. Study Design Retrospective review. Setting Multipractice study for community practices in Massachusetts. Methods Electronic billing records from 10 private otolaryngology practices in Massachusetts were obtained for the first 4 months of 2019 and 2020. Questionnaires from these otolaryngology practices were collected to assess financial and staffing impact of COVID-19. Results The local onset of the COVID-19 pandemic had a significant decrease of 63% of visits in comparison to equivalent weeks in 2019. Virtual visits overtook in-person visits over time. A greater decline in operating room (OR) procedures than for office procedures was recorded. Ninety percent of practices reduced working hours, and 80% furloughed personnel. Seventy percent of practices applied for the Paycheck Protection Program (PPP). Conclusion COVID-19 has had a multifaceted impact on private otolaryngology practices in Massachusetts. A significant decline in provision of otolaryngology services aligned with the Massachusetts government’s public health policy changes. The combination of limited personnel and personal protective equipment, as well as suspension of nonessential office visits and surgeries, led to decrease in total office visits and even higher decrease in OR procedures.
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Entezarjou, Artin, Susanna Calling, Tapomita Bhattacharyya, et al. "Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study." JMIR Medical Informatics 9, no. 3 (2021): e25473. http://dx.doi.org/10.2196/25473.
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Background Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking. Objective The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits. Methods Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated. Results Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively. Conclusions The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits. Trial Registration ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887
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Hutchison, Kimberly N., Jennifer Sweeney, Christine Bechtel, and Brian Park. "Reimagining Relationship-Based Health Care in a Post-COVID World." Journal of Patient Experience 8 (January 1, 2021): 237437352199862. http://dx.doi.org/10.1177/2374373521998622.
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The US health care system has a long history of discouraging the creation and maintenance of meaningful relationships between patients and providers. Fee-for-service payment models, the 1-directional, paternalistic approach of care providers, electronic health records, anddocumentation requirements, all present barriers to the development of meaningful relationships in clinic visits. As patients and providers adopt and experiment with telemedicine and other systems changes to accommodate the impact of Coronavirus disease 2019, there is an opportunity to reimagine visits entirely—both office-based and virtual—and leverage technology to transform a unidirectional model into one that values relationships as critical facilitators of health and well-being for both patients and providers.
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Johnson, Kristen, Kayla Burns, Lisa Dumkow, Megan Yee, and Nnaemeka Egwuatu. "2076. Comparison of Diagnosis and Prescribing Practices between Virtual Visits and Office Visits for Sinusitis within a Primary Care Network." Open Forum Infectious Diseases 6, Supplement_2 (2019): S700. http://dx.doi.org/10.1093/ofid/ofz360.1756.
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Abstract Background The majority of antibiotics prescribed in the outpatient setting result from upper respiratory tract infections; however, these infections are often viral. Virtual visits (VV) have emerged as a popular alternative to office visits (OV) for sinusitis complaints and are an important area for stewardship programs to target for intervention. Methods A retrospective cohort study was conducted utilizing the outpatient electronic medical record for Mercy Health Physician Partners (MHPP) and Zipnosis database for VV to compare diagnosis and prescribing between OV and VV for sinusitis. VV consisted of an online questionnaire for patients to complete, which was then sent to a provider to evaluate electronically without face-to-face interaction. Adult patients were included with a diagnosis code for sinusitis during the 6-month study period from January to June 2018. The primary objective was to compare rates of appropriate diagnosis of viral vs. bacterial sinusitis between OV and VV, based on national guideline recommendations. Secondary objectives were to compare the appropriateness of antibiotic prescribing and supportive therapy prescribing between OV and VV, as well as 24-hour, 7-day and 30-day re-visits. Results A total of 350 patients were included in the study (OV n = 175, VV n = 175). Appropriate diagnosis per national guidelines was 45.7% in OV compared with 69.1% in the VV group (P < 0.001). Additionally, patients that completed VV were less likely to receive antibiotic prescriptions (OV 94.3%, VV 68.6%, P < 0.001). Guideline-concordant antibiotic prescribing was similar between groups (OV 60.6%, VV 58.3%, P = 0.70) and both visit types had a median duration of treatment of 10 days (P = 0.88). Patients that completed VV were more likely to re-visit for sinusitis within 24 hours (OV 1.7%, VV 8%, P = 0.006) and within 30-days (OV 7.4%, VV 14.9%, P = 0.027). In multivariate logistic regression the only factor independently associated with 24-hour re-visit was patient self-request for antibiotics (OR 0.20, 95% CI 0.06–0.68). Conclusion Appropriate diagnosis of sinusitis was more likely in the VV group, which shows that VV provides a good platform to target outpatient antimicrobial prescribing. These findings support opportunities for antimicrobial stewardship intervention in both OV and VV. Disclosures All authors: No reported disclosures.
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Görges, Matthias, Kathy L. Rush, Lindsay Burton, et al. "Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team Perspectives." Applied Clinical Informatics 12, no. 01 (2021): 041–48. http://dx.doi.org/10.1055/s-0040-1721397.
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Abstract Background Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas. Objectives The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers. Methods We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges. Results Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1–38) years and had used an electronic medical record for 7.0 (1–20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team). Conclusion Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits.
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Rokicki-Parashar, Jesse, Anuradha Phadke, Cati Brown-Johnson, et al. "Transforming Interprofessional Roles During Virtual Health Care: The Evolving Role of the Medical Assistant, in Relationship to National Health Profession Competency Standards." Journal of Primary Care & Community Health 12 (January 2021): 215013272110042. http://dx.doi.org/10.1177/21501327211004285.
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Introduction: Medical assistants (MAs) were once limited to obtaining vital signs and office work. Now, MAs are foundational to team-based care, interacting with patients, systems, and teams in many ways. The transition to Virtual Health during the COVID-19 pandemic resulted in a further rapid and unique shift of MA roles and responsibilities. We sought to understand the impact of this shift and to place their new roles in the context of national professional competency standards. Methods: In this qualitative, grounded theory study we conducted semi-structured interviews with 24 MAs at 10 primary care sites at a major academic medical center on their experiences during the shift from in-person to virtual care. MAs were selected by convenience sample. Coding was done in Dedoose version 8.335. Consensus-based inductive and deductive approaches were used for interview analysis. Identified MA roles were compared to national MA, Institute of Medicine, physician, and nursing professional competency domains. Results: Three main themes emerged: Role Apprehension, Role Expansion, and Adaptability/Professionalism. Nine key roles emerged in the context of virtual visits: direct patient care (pre-visit and physical care), panel management, health systems ambassador, care coordination, patient flow coordination, scribing, quality improvement, and technology support. While some prior MA roles were limited by the virtual care shift, the majority translated directly or expanded in virtual care. Identified roles aligned better with Institute of Medicine, physician, and nursing professional competencies, than current national MA curricula. Conclusions: The transition to Virtual Health decreased MA’s direct clinical work and expanded other roles within interprofessional care, notably quality improvement and technology support. Comparison of the current MA roles with national training program competencies identified new leadership and teamwork competencies which could be expanded during MA training to better support MA roles on inter-professional teams.
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Albon, Dana, Lacrecia Thomas, Lindsay Hoberg, et al. "Cystic fibrosis learning network telehealth innovation lab during the COVID-19 pandemic: a success QI story for interdisciplinary care and agenda setting." BMJ Open Quality 11, no. 2 (2022): e001844. http://dx.doi.org/10.1136/bmjoq-2022-001844.
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IntroductionThe Cystic Fibrosis Foundation chronic care guidelines recommend monitoring clinical status of a patient with cystic fibrosis (CF) through quarterly interdisciplinary visits. At the beginning of the COVID-19 pandemic, the Cystic Fibrosis Learning Network (CFLN) designed and initiated a telehealth (TH) innovation lab (TH ILab) to support transition from the classic CF care model of quarterly in-person office visits to a care model that included TH.AimThe specific aims of the TH ILab were to increase the percentage of virtual visits with interdisciplinary care (IDC) from 60% to 85% and increase the percentage of virtual visits in which patients and families participated in shared agenda setting (AS) from 52% to 85% by 31 December 2020.MethodsThe model for improvement methodology was used to determine the ILab aims, theory, interventions and measures. In the testing phase of the ILab, data related to process and outcome measures as well as learnings from plan–do–study–act cycles were collected, analysed and shared weekly with the TH ILab teams. Participating centres created processes for IDC and AS for TH visits and developed and shared quality improvement tools specific to their local context with other centres during the ILab weekly meetings and via a secure CFLN-maintained platform.ResultsBoth specific aims were achieved ahead of the expected target date. By August 2020, 85% of the TH ILab visits provided IDC and 92% of patients were seen for CF care by teams from the TH ILab that participated in AS.ConclusionShared learning through a collaborative, data-driven process in the CFLN TH ILab rapidly led to standardised TH IDC and AS, which achieved reliable and sustainable processes which could be reproduced by other networks.
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Atwood, Charles, Eilis Boudreau, Kathleen Sarmiento, et al. "1058 Experience of VA Telesleep Medicine Following the COVID Pandemic." SLEEP 47, Supplement_1 (2024): A454—A455. http://dx.doi.org/10.1093/sleep/zsae067.01058.
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Abstract Introduction The VA Telesleep Enterprise Wide Initiative (EWI) operated from 2017 through 2023 and focused on increasing sleep medicine care to rural Veterans. Part of the Telesleep EWI was promotion of telehealth visits to improve access to sleep medicine care for rural Veterans. This report examines the significant growth of telesleep visits during the COVID-19 pandemic and the strong sustainment in Telesleep care in EWI sites post-pandemic. EWI sites participated in weekly clinical support meetings and best practices sharing to foster uptake and improvement of telesleep clinical work. Non EWI sites did not have access this support network. Methods Data regarding clinical visits for sleep medicine at a national level were obtained from the VA Corporate Data Warehouse by trained and experienced data analysts. Data from 2019 through fiscal year 2023 were obtained which spans the pre-pandemic to the post-pandemic time frame. The data were analyzed by medical center based on whether the site was part of the Telesleep EWI or not part of the EWI. In this report only rural Veterans were analyzed. Results From 2019 to 2023, for rural Veterans, the proportion of total sleep medicine visits performed using telehealth modalities increased from 25% to 56% for sites in the Telesleep EWI compared to 16% to 36% in the non EWI sites. Comparing Telesleep visits at the peak of pandemic in 2021-22 to post-pandemic 2023, Telesleep visits peaked at 61% and decreased to 56% in 2023 for the EWI sites and peaked at 52% and decreased to 36% in non EWI sites. Conclusion The COVID -19 pandemic resulted in rapid changes in healthcare delivery for many clinical services including sleep medicine. Post-COVID-19 many clinicians returned to previous care delivery models. In VA, where telesleep medicine virtual care was strongly supported in the EWI, sites showed greater sustainment of virtual care compared to non EWI sites. We speculate that ongoing support of clinicians through training and expert support in the EWI accounted for this better sustainment of virtual care. Support (if any) VA Office of Rural Health; VA Office of Connected Care; VA HSR&D Merit Review
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Tevaarwerk, Amye J., Thevaa Chandereng, Travis Osterman, et al. "Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey." JCO Oncology Practice 17, no. 9 (2021): e1318-e1326. http://dx.doi.org/10.1200/op.21.00195.
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PURPOSE: The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer. METHODS: The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution. RESULTS: Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic. CONCLUSION: Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.
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Vaz, Louise, Tamara Wagner, Bryan Cochran, and Mark Lovgren. "Pilot of a Home Telehealth Platform in a Pediatric OPAT Program." Open Forum Infectious Diseases 4, suppl_1 (2017): S333. http://dx.doi.org/10.1093/ofid/ofx163.789.
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Abstract Background Patients discharged with outpatient parenteral or prolonged oral antibiotic (OPAT) require monitoring to ensure optimal clinical outcomes. Advances in technology have allowed novel approaches for clinical interactions. We sought to develop a new home telehealth platform for a subsection of pediatric OPAT patients. Methods We used an existing infrastructure developed by our hospital telemedicine program to pilot the electronic home visit. A process was established to create a virtual connection at a pre-designated time using a HIPPA-secured web-based platform. Clinic staff performed a pre-visit technology check. Electronic Medical Record (EMR) scheduling platforms were created and the parent was coached on how to download and execute the necessary software. A virtual clinic was established between provider and family. Documentation occurred in the EMR with specific language and modifier codes for billing accuracy identified by the telemedicine team. Patients were selected based on medical complexity and travel time greater than 2 hours to our institution. Results Two pediatric OPAT patients completed the pilot in Spring 2017 for treatment of 1) CLABSI with retained line and 2) chronic ulcer with osteomyelitis. Three visits between the OPAT ID provider, located in her office, and the patient, located at home, were successfully piloted with video and voice. A routine clinic visit was conducted with a parent-driven physical exam. A clinical note was documented in the EMR with specific telemedicine templates. This platform also allowed for multi-disciplinary visits with a hospitalist and home health nurse to address a central line related issue with ID provider present. Total time for each visit was under 20 minutes. Conclusion We were able to demonstrate feasibility and functionality of this novel platform to conduct a billable OPAT clinic visit in a patient’s home. Health system infrastructure was a necessary and vital component to execution of the virtual clinic. Specific patient groups may benefit from this provider-patient interface. The use of telemedicine in OPAT may serve as a new platform for improving provider efficiency, lowering health system costs, and achieving greater patient satisfaction. Disclosures All authors: No reported disclosures.
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Matisāne, Linda, Linda Paegle, Lāsma Akūlova, and Ivars Vanadziņš. "Challenges for Workplace Risk Assessment in Home Offices—Results from a Qualitative Descriptive Study on Working Life during the First Wave of the COVID-19 Pandemic in Latvia." International Journal of Environmental Research and Public Health 18, no. 20 (2021): 10876. http://dx.doi.org/10.3390/ijerph182010876.
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Epidemiological restrictions due to the COVID-19 pandemic have raised legal and practical questions related to the provision of workplace risk assessment in home offices of teleworkers. The objective of this qualitative study was to analyze practical experience of employers and occupational safety and health experts performing workplace risk assessment in Latvia during the first wave of the COVID-19 pandemic. Our findings suggest that employers have not sufficiently implemented their legal obligations related to workplace risk assessment which can result in an increased number of physical and mental health problems of teleworkers in the short term and in the future. Work from home has shown how different working conditions can be for the same type of work (office work); therefore, the promotion of personalized workplace risk assessment should be encouraged. Even if virtual workplace visits using photos and videos are not the traditional way the workplace risk assessment should be done, it is effective; workers who report that their employers assessed their working conditions report fewer health effects. The experience of workers in participation in workplace risk assessment for telework might change the level and role of worker participation in the management of health and safety hazards at work in general.
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Ledwoń, Anna, Paweł Dębski, Przemysław Jędrusik, et al. "An Attempt to Use Virtual Reality as a Tool to Reduce Patient Anxiety During Dental Treatment." Journal of Clinical Medicine 13, no. 22 (2024): 6832. http://dx.doi.org/10.3390/jcm13226832.
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Background/Objectives: Dental fear and anxiety are prevalent issues in both children and adult patients, often leading to avoidance of dental care and deterioration in overall health. While virtual reality (VR) has been increasingly studied as a distraction tool in pediatric dentistry, its effectiveness among adults remains under-researched. This study aims to evaluate the impact of VR distraction on reducing anxiety and physiological stress indicators in adult dental patients. Methods: The study was conducted in a private dental office in Dobrodzień, Poland, involving 90 adult dental patients divided into three groups: two experimental (VR1 and VR2) and one control (C), with 30 patients each. Patients in the VR1 group experienced VR distraction during the first visit, and the second visit was conventional; the VR2 group experienced this in reverse; and the control group underwent traditional treatment in both visits. Physiological parameters (heart rate, saturation, and stress) and psychological anxiety levels (MDAS and STAI-X1) were measured at three time points during each visit. Results: Significant reductions in heart rate and stress levels were observed after VR exposure compared to the control group. VR also demonstrated a significant effect in decreasing anxiety levels (based on STAI-X1) during the visit with VR distraction. No significant changes were found in the saturation levels across the groups. Conclusions: The use of VR as a distraction tool during dental procedures effectively reduces physiological stress and anxiety in adult patients, suggesting its potential as a valuable tool in managing dental anxiety. Further research is recommended to explore the long-term benefits and patient satisfaction with VR-based interventions in dental care.
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Litton, Gregory J., John Librett, Mark Kosinski, Regina Rendas-Baum, and Jessica Gentile. "Health resource utilization expenditures in oncology within a virtual primary cancer survivor care clinic." Journal of Clinical Oncology 42, no. 16_suppl (2024): e13785-e13785. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e13785.
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e13785 Background: Unprecedented cancer treatment efficacy has led to high rates of disease sequelae. Lancet recently declared the failure to care for the human dimensions of cancer treatment a "humanitarian crisis." To address this humanitarian crisis, real-world economic evidence can improve patient access to whole person care through insurance reimbursement policies. Methods: We implemented a virtual primary cancer survivor care clinic that follows ASCO and NCCN guidelines for cancer survivors with emphasis on mental health, nutrition, physical activity, and sleep optimization. Our clinic utilizes medical oncologists, physician associates, mental health therapists, registered dietitians, and occupational therapists. Patient reported outcomes (PRO) monitor health status and inform treatment pathways. To reduce test fatigue, we use the SF12 Vitality Enhanced scale (SF12v2). The SF12v2 measures physical functioning, activities of daily living, pain, vitality, social functioning, and mental health. Total medical expenditures (MEs) is the sum of payments for hospital inpatient events, emergency room visits, home care, prescribed medicines, office-based and out-patient visits, and medical equipment. Patient SF12v2 summary scores predict a patient's total MEs. A one-point better physical component summary score and mental component summary score are associated with 2% lower MEs; 3 and 5 point score increases are associated with 10% and 18% lower MEs. Results: Patients were referred from a Utah community oncology clinic, other medical clinics, or self-referred (N=99). The mean patient age was 52 years. 84% were female, 16% were male. At enrollment, 35% had started treatment, 21% were on post treatment aromatase therapy or adjuvant hormonal therapy, 65% were post treatment. Baseline PRO reveal significant disease burden: 82% report poor mental health; 72% report poor physical health; 79% report poor cognitive health; 83% report sleep disorders. For patients who completed at least three PRO measurement time points (n=54): 91% had a positive clinical outcome for mental health; 70% had a positive clinical outcome for physical health; 89% had a positive clinical outcome for cognitive health; 76% had a positive clinical outcome for sleep health. As a result of these extraordinary outcomes, 74% of patients had lower predicted MEs. The average predicted reduction in MEs was 16% with an average annual savings of $1,629.49. Conclusions: Cancer is associated with high disease sequelae and high MEs. We believe this is the first study that reports real-world clinical evidence and predicts MEs for patients enrolled in a virtual primary cancer survivor care clinic. Real-world evidence demonstrates both clinically significant improvements in HRQoL and reductions in patient MEs. These results can inform insurance reimbursement policies, ensuring equitable access to cancer survivor care.
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Von Isenburg, Megan. "Undergraduate Student Use of the Physical and Virtual Library Varies according to Academic Discipline." Evidence Based Library and Information Practice 5, no. 1 (2010): 129. http://dx.doi.org/10.18438/b83046.
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A Review of: 
 Bridges, L.M. (2008). Who is not using the library? A comparison of undergraduate academic disciplines and library use. portal: Libraries and the Academy, 8(2), 187-196.
 
 Objective – To determine differences in undergraduate students' use of the physical library and virtual library by academic disciplines.
 
 Design – Online multiple-choice survey followed by focus groups and secondary online survey with open-ended questions.
 
 Setting – Oregon State University (OSU), a land-grant university with over 19,000 students located in Corvallis, Oregon, United States.
 
 Subjects – A random sample of 22% (n = 3,227) of the undergraduate population (n = 14,443), drawn by the registrar's office. Distance education and students at branch campuses were not included. From this pool, 949 usable survey responses (29% of the sample) were collected. The respondent demographics proved to be reasonably equivalent to those of the total undergraduate population in terms of class standing (freshman, sophomore, junior, or senior) and academic discipline.
 
 Methods – The study consisted of three phases. In phase one, an email invitation with a link to the four-item multiple choice online survey was sent to students in the sample population. Results were analyzed using Pearson chi-square tests to determine goodness of fit between the following variables: class standing and library visits, class standing and virtual library use, academic college and library visits, and academic college and virtual library use. When significant dependence was detected, researchers examined relationships between the specific groups (e.g., freshman and sophomore) and library use, and also compared each group to one another using odds ratios and by constructing 95% confidence intervals. 
 
 Phase two was intended to gather qualitative information from the 275 infrequent or non-users of the library in focus groups. However, researchers invited the 95 students in this group who had indicated a willingness to be contacted for further study, and only five students participated. The author therefore does not report on this limited data. 
 
 In phase three, researchers invited the 95 students who had self-reported as infrequent or non-users of the library and who had indicated a willingness to be contacted for further study to complete an online survey consisting of 36 open-ended questions. 38 students responded. Much of the data for phase three is reported on in a separate research article (Vondracek, 2007).
 
 Main Results – Results from phase one are reported in detail: in response to the question of how often undergraduates visit the physical library, 24.6% visited several times a year, 29.6% visited several times a month, 34% visited several times a week, 7.7% visited once or more per day, and 4% reported that they did not visit at all. Response to how often undergraduate students use the online library resources or website from outside the library were: 37.7% use them several times a year, 32.8% use them several times a month, 12% used them several times a week, 1.3% used them once or more per day, and 16.2% reported that they did not use them at all.
 
 No significant relationships were found between class standing and visits to the physical library or class standing and virtual library use.
 
 Researchers determined a significant relationship between academic college and visits to the physical library (p=0.003): College of Agriculture students were significantly less likely to visit the library than students from the Colleges of Health and Human Sciences, Liberal Arts, and Sciences.
 
 Researchers also determined a significant relationship between academic college and virtual library use (p=0.008): students in the College of Engineering were significantly less likely to use the virtual library resources than students in the College of Liberal Arts.
 
 The survey from phase three of this study asked students further questions about their library use and relevant results are discussed in this article. Five students from the College of Agriculture responded to the survey and all five students noted that they study at home. When asked about where they go for help with research, three reported that they ask a friend or peer, one noted a professor and the fifth did not respond to the question. Four engineering students responded to this survey; when asked about where they carry out online research, two responded that they use Google, one responded that he/she uses the library, and the fourth noted that he/she uses a building on campus.
 
 Conclusion – This study determined that College of Agriculture students were less likely to use the physical library than their counterparts in the Colleges of Health and Human Sciences, Liberal Arts, and Sciences, and that College of Engineering students were less likely to use the virtual library resources than students in the College of Liberal Arts.
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Milani, Richard, Pavan Chava, Jonathan Wilt, et al. "Improving Management of Type 2 Diabetes Using Home-Based Telemonitoring: Cohort Study." JMIR Diabetes 6, no. 2 (2021): e24687. http://dx.doi.org/10.2196/24687.
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Background Diabetes is present in 10.5% of the US population and accounts for 14.3% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes including glycemic control and clinical events tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. Objective This study aims to evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care. Methods We evaluated glycemic control and other diabetes-related measures after 1 year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, hemoglobin A1c (HbA1c), creatinine, estimated glomerular filtration rate, and insulin use in a usual care group after 1 year. Digital medicine patients completed questionnaires online, received medication management and lifestyle recommendations from a clinical pharmacist or advanced practice provider and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth-enabled glucose meter that transmitted data directly to the electronic medical record. Results After 1 year, usual care patients demonstrated no significant changes in HbA1c (mean 7.3, SE 1.7 to mean 7.3, SE 1.6; P=.41) or changes in the proportion of patients with HbA1c≥9.0 (n=117, 15% to n=113, 14%; P=.51). Digital medicine patients demonstrated improvements in HbA1c (mean 7.3, SE 1.5 to mean 6.9, SE 1.2; P<.001) and significant changes in the proportion of patients with HbA1c≥9.0 (n=107, 14% to n=49, 6%; P<.001), diabetes distress (n=198, 26% to n=122, 16%; P<.001), and hypoglycemic episodes (n=313, 41.1% to n=91, 11.9%; P<.001). Conclusions A digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. The use of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy.
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Tomaszewski, M., B. Zhao, H. Kim, R. A. Enns, B. Bressler, and S. Moosavi. "A88 PATIENT AND PHYSICIAN PERSPECTIVE OF TELE-HEALTH IN GASTROENTEROLOGY." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (2021): 59–60. http://dx.doi.org/10.1093/jcag/gwab002.086.
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Abstract Background Given the social distancing measures employed to reduce the transmission of SARS-CoV-2, tele-health has rapidly expanded and is now routinely used in new patient encounters and in follow up appointments across Canada. Aims To determine the patient and physician perspective towards tele-health in a gastroenterology outpatient setting. Methods An anonymous voluntary online survey was distributed to patients who had previously undergone at least one tele-health visit in a tertiary care gastroenterology outpatient setting. A separate online survey was distributed to gastroenterologists practising across Canada. Results A total of 181 patients from British Columbia (59.8% female) completed the survey. The tele-health appointment was the first visit for 21.8% of patients. Appointments occurred by phone call alone (61.4%) or by video and audio software (38.6%) and started within 5 minutes of the scheduled time in 75% of visits. Patient satisfaction with the tele-health visit was high (8.54 on a scale of 0–10; 0 completely dissatisfied, 10 extremely satisfied; IQR 8–10). Most patients did not perceive a difference in likelihood of compliance compared to a non-tele-health visit (90.6%), were not concerned about the lack of physical exam during a tele-health visit (82.4%) and did not with-hold information they would have revealed in person (88.7%). After the COVID-19 pandemic, some patients would prefer tele-heath visits (39.2%), whereas others would prefer in office visits (28.5%) and the remainder were indifferent (32.3%). Post-pandemic, most patients would prefer tele-health for follow up visits (68.4%), over tele-health for all possible visits (27.9%) or no tele-health visits (3.8%). A total of 25 Canadian gastroenterologists (28.0% female; 60% academic practice, 40% community practice) completed a separate survey. Regarding the lack of physical exam in tele-health, 44% of physicians believed this did not affect the quality of their assessment, whereas some physicians believed it had either minimally (48%) or greatly (8%) impaired the quality of their assessment. Almost all physicians (96%) perceived that patients either appreciate tele-health as much as or more than in office visits. Post-pandemic, most physicians (96%) supported a hybrid model of both tele-health and in office visits. Appointments for follow up of benign endoscopic pathology results (96%), follow up visits (92%), consultations prior to endoscopy (76%) were deemed to be most appropriate for tele-health. Follow up of malignant pathology results (24%) and consultations for new patients (32%) were thought to be less appropriate for tele-health visits. Conclusions Patient and physician satisfaction with tele-health in a Canadian outpatient gastroenterology setting is high. Most patients and physicians wish for tele-health to remain available in the post-pandemic setting. Funding Agencies Gastrointestinal Research Institute, Vancouver, British Columbia
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McCrady, Emma, Julie Strychowsky, and Jessica Woolfson. "149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic." Paediatrics & Child Health 26, Supplement_1 (2021): e102-e104. http://dx.doi.org/10.1093/pch/pxab061.117.
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Abstract Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw &lt;10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with &gt; 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing &lt; 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.
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Nowlin, Andrea, Kristina Lai, Alexander Maillis, Patricia Waters, Beatrice Gee, and Peter A. Lane. "Healthcare Utilization Among Children and Adolescents with Sickle Cell Disease during the COVID-19 Pandemic." Blood 136, Supplement 1 (2020): 30–31. http://dx.doi.org/10.1182/blood-2020-136151.
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Background Early experience with the COVID-19 pandemic showed disproportionately high morbidity and mortality among individuals with certain chronic medical conditions. Individuals with sickle cell disease (SCD) are at high risk for pulmonary and other complications including acute chest syndrome (ACS) and have high rates of hospitalization from other viral respiratory infections, raising concern that COVID-19 would be associated with higher morbidity, mortality and health care utilization among those with SCD. Public health interventions such as social distancing, avoidance of large group activities, and widespread use of masks have been shown to reduce the transmission of COVID-19 in the general population but have been inconsistently implemented. In Georgia, COVID-19 restrictions, including school closures, were implemented in mid-March, and on-site school instruction was replaced by virtual instruction for the remainder of the school year. At our institution, most routine, non-urgent outpatient clinic visits were cancelled or postponed from mid-March through May in order to minimize COVID-19 exposure risk. Efforts to initiate the use of telemedicine as an alternative to in-person office visits were rapidly instituted. We hypothesized that adherence to public health restrictions, especially sheltering in place, would be high among patients and families with SCD, and sought to measure the impact of COVID pandemic on healthcare utilization in children and adolescents with SCD in the Atlanta area. Methods The SCD Program at Children's Healthcare of Atlanta (CHOA) provides comprehensive outpatient, emergency and inpatient services at 3 locations in metropolitan Atlanta. CHOA's Sickle Cell Clinical Database (SCCD) contains prospectively collected demographic, diagnostic, treatment and other clinical information on all patients with SCD beginning in 2010, including all outpatient clinic, emergency department (ED) and inpatient hospital utilization. To assess the impact of COVID-19 on healthcare utilization, we tracked clinic, ED and inpatient utilization for the 4-month period (March through June) 2020 compared with the same 4-month period in 2018 and 2019. Results The figure shows utilization patterns for each four-month period from 2018-2020. As expected, face to face outpatient clinic visits fell dramatically from February to April 2020 (-25% in March, -64% in April) and then returned to pre-COVID levels by June. The addition of telemedicine visits raised total outpatient visits in June 2020 to above pre-COVID levels. Total utilization during the 4-month period in 2020 were compared to the mean for the same periods in 2018 and 2019. Face to face clinic visits decreased from 2971.5 to 2023 (-32%), ED visits from 1,217 to 687 (-44%), and total inpatient admissions from 699 to 410 (-41%). Admissions with a primary discharge diagnosis of pain decreased from a mean of 407 in 2018-2019 to 173 (-57%), fever/infection from 67.5 to 40 (-41%), and ACS from 101 to 75 (-26%). Patients with chronic pain and/or history of high utilization (&gt;5 admissions in a given year) showed decreases in utilization similar to all other patients. Summary These data describe the significant changes in utilization among pediatric patients with SCD during the COVID-19 pandemic. Face to face outpatient clinic visits decreased during March and April but returned to pre-COVID levels in June. Unexpectedly, ED and inpatient hospital utilization for acute illness decreased dramatically through April and remained low through June. In March there was a significant decrease in the clinic setting due to a large number of cancelled or rescheduled outpatient visits, despite many being rescheduled as telemedicine visits. However, the largest unexpected decrease was seen in emergency department visits and hospitalizations for acute events, specifically fever and pain events. It is also important to note the decreased utilization of patients with chronic pain who are typically high utilizers. During clinic encounters, families mentioned that less stress from school, reduced respiratory infections, and better medication adherence with parents at home, were possible contributors to reduced sickle cell symptoms while sheltering in place. These observations will guide the development of a patient survey with the goal of obtaining qualitative data to explain the reasons for decreased utilization during the pandemic. Figure Disclosures Lane: FORMA Therapeutics: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees.
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Dixon, Ronald, Howard Zisser, Nathan Barleen, et al. "Participation in a Virtual Diabetes Clinic Improves Glycemic Control in Adults with Type 2 Diabetes." Iproceedings 5, no. 1 (2019): e15258. http://dx.doi.org/10.2196/15258.
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Background Telemedicine for people with type 2 diabetes (T2D) has the potential to positively impact self-management behaviors and improve health outcomes. The Onduo Virtual Diabetes Clinic (VDC) is a comprehensive telehealth program for people with T2D that combines mobile app technology, remote personalized lifestyle coaching from certified diabetes educators and health coaches, connected devices including blood glucose meters and continuous glucose monitoring systems, and clinical support from board certified endocrinologists. Objective To describe the VDC care delivery model and present preliminary data on change in glycemic control in program participants with up to 6 months of follow-up. Methods Adults ≥18 years of age with T2D and who were members of sponsoring health plans and employers throughout the US were eligible to participate. Those who elected to enroll downloaded the VDC app to their smartphone, provided demographic and clinical information, completed an onboarding survey, and were mailed a self-management kit that included a connected blood glucose meter, test strips and a home glycosylated hemoglobin (HbA1c) testing kit. Participants interacted with their care team primarily through the VDC app, with occasional phone calls, and by synchronous video consultations with endocrinologists, as clinically appropriate. Change in glycemic control in participants who completed a baseline survey from February 2018 through December 31, 2018, with an initial HbA1c measurement within 30 days of enrollment and a follow-up measurement between 90 and 180 days after baseline was analyzed. Results Participants (n=740) were (mean ± SD): 53.8 ± 8.8 years of age, 62% female, BMI 35.6 ± 8.5, initial HbA1c 7.7% ± 1.8, 31.0% were on insulin and 25.9% were on sulfonylureas at baseline, and 30.0% lived in a rural area. HbA1c decreased significantly by 2.3% ± 1.9, 0.7% ± 1.0 and 0.2% ± 0.8 across the baseline categories of >9.0%, 8.0% to 9.0% and 7.0% to <8.0%, respectively (all P<.001). Within these categories, HbA1c improved in 91.9%, 77.3% and 63.5% of participants. For the group with an initial HbA1c >9.0%, HbA1c decreased from 10.7% ± 1.4 to 8.3% ± 1.5, and when stratified by HbA1c ≥8.0% the mean decrease in HbA1c was 1.5%, from 9.5% ± 1.5 to 8.0% ± 1.3, with 84.5% of participants demonstrating improvement. Participants with an initial HbA1c <7.0% who were meeting treatment targets at baseline, HbA1c 6.3% ± 0.4, continued to maintain this level of glycemic control at follow-up, HbA1c 6.4% ± 0.6 (ns). Conclusions Participation in the VDC was associated with a significant improvement in HbA1c in adults with T2D who were not meeting treatment targets, with the greatest improvement observed in those with an initial HbA1c >9.0%. Importantly, the majority of program participants experienced an improvement in glycemic control. Our findings suggest that the VDC program is an effective approach to support individuals with T2D and their clinicians in diabetes management between office visits.
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Putri, Farahdilla Aribowo, Didik Tamtomo, and Hanung Prasetya. "Meta Analysis: Patient’s Satisfaction with the Outpatient’s Telemedicine Service." Journal of Health Policy and Management 09, no. 02 (2024): 224–36. http://dx.doi.org/10.26911/thejhpm.2024.09.02.08.
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Background: Telemedicine is a combination of information and communication technology with medical science to provide health services that are not limited to space and can be done remotely (PB IDI, 2020). Patient satisfaction is referred to as the most integral element in the successful implementation of telemedicine (Ploog et al, 2022). This study aims to compare the satisfaction level of outpatients between telemedicine visits and regular face-to-face visits using meta-analysis. Subjects and Method: This study used a systematic review and meta-analysis based on pico as follows, population: outpatient polyclinic, intervention: telemedicine services, comparison: standard care, outcome: patient satisfaction. Data were obtained from the PubMed, Google Scholar, Springerlink, National Center for Biotechnology Information, MEDLINE, Cochrane Library, and Science Direct databases published from 2020 – 2022. The keywords used in the article search were “telemedicine”, “telehealth”, “ virtual care”, “online follow up care”, “telemedicine vs in office” “telemedicine vs conventional”, “patient satisfaction”, “patient experience”, and “randomized clinical trial.” The inclusion criteria were in the form of a full paper article using a randomized clinical trial design, the subjects were outpatients, new patients and follow-up patients, had a control group that assessed standard services, the study outcomes used the mean SD. Article selection used the PRISMA flowchart and the results were analyzed using Review Manager 5.3 software. Results: A meta-analysis of 10 articles from Hong Kong, Turkey, Germany, Austria, the Netherlands, Ireland and the United States with a sample size of 1412 outpatient polyclinics showed that outpatient polypatients who received telemedicine services had an average satisfaction level of 0.38 points. higher than standard service (SMD= 0.38; 95% CI= -0.01 to 0.77; p= 0.060). The meta-analysis of this study showed significant heterogeneity of effect estimates between studies (I² = 69%; p<0.001), so the analysis used was the Random Effect Model (REM). Conclusion: Patients who received telemedicine services experienced an average satisfaction level of 0.38 higher than patients who received standard services (SMD= 0.38; 95% CI= -0.01 to 0.77; p= 0.060). Keywords: Telemedicine, Patient satisfaction, Meta-analysis
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Khairat, Saif, Phillip McDaniel, Matthew Jansen, Tia Francis, Barbara Edson, and Robert Gianforcaro. "Analysis of Social Determinants and the Utilization of Pediatric Tele–Urgent Care During the COVID-19 Pandemic: Cross-sectional Study." JMIR Pediatrics and Parenting 4, no. 3 (2021): e25873. http://dx.doi.org/10.2196/25873.
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Background Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective This research aims to compare the overall use of tele–urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods We conducted a cross-sectional analysis of pediatric tele–urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele–urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results Of 584 tele–urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 North Carolina zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% (56/317) of the tele–urgent care visits originated from. The majority (215/317, 67.8%) of tele–urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions The use of tele–urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele–urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19–confirmed cases and deaths compared to regions with a low concentration of vulnerable populations.
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Majithia, Amit R., Coco M. Kusiak, Amy Armento Lee, et al. "Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor–Driven Virtual Diabetes Clinic: Prospective Trial." Journal of Medical Internet Research 22, no. 8 (2020): e21778. http://dx.doi.org/10.2196/21778.
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Background The Onduo virtual diabetes clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote personalized lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices for intermittent use. Objective This prospective single-arm study evaluated glycemic outcomes associated with participation in the Onduo VDC for 4 months. Methods Adults aged ≥18 years with T2D and a baseline glycated hemoglobin (HbA1c) of ≥8% to ≤12% were enrolled from 2 primary care centers from February 2019 to October 2019. Participants were asked to engage at ≥1 time per week with their care team and to participate in a telemedicine consultation with a clinic endocrinologist for diabetes medication review. Participants were asked to use a RT-CGM device and wear six 10-day sensors (total 60 days of sensor wear) intermittently over the course of 4 months. The primary outcome was change in HbA1c at 4 months from baseline. Other endpoints included change in weight and in RT-CGM glycemic metrics, including percent time <70, 70-180, 181-250, and >250 mg/dL. Changes in blood pressure and serum lipids at 4 months were also evaluated. Results Participants (n=55) were 57.3 (SD 11.6) years of age, body mass index 33.7 (SD 7.2), and 40% (22/55) female. HbA1c decreased significantly by 1.6% (SD 1%; P<.001). When stratified by baseline HbA1c of 8.0% to 9.0% (n=36) and >9.0% (n=19), HbA1c decreased by 1.2% (SD 0.6%; P<.001) and 2.4% (SD 1.3%; P<.001), respectively. Continuous glucose monitoring–measured (n=43) percent time in range (TIR) 70-180 mg/dL increased by 10.2% (SD 20.5%; P=.002), from 65.4% (SD 23.2%) to 75.5% (SD 22.7%), which was equivalent to a mean increase of 2.4 hours TIR per day. Percent time 181-250 mg/dL and >250 mg/dL decreased by 7.2% (SD 15.4; P=.005) and 3.0% (SD 9.4; P=.01), respectively. There was no change in percent time <70 mg/dL. Mean weight decreased by 9.0 lb (SD 10.4; P<.001). Significant improvements were also observed in systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglycerides (P=.04 to P=<.001). Conclusions Participants in the Onduo VDC experienced significant improvement in HbA1c, increased TIR, decreased time in hyperglycemia, and no increase in hypoglycemia at 4 months. Improvements in other metabolic health parameters including weight and blood pressure were also observed. In conclusion, the Onduo VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialty care and advanced diabetes technology including RT-CGM. Trial Registration ClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381
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Artanian, Veronica, Valeria E. Rac, Heather J. Ross, and Emily Seto. "Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 9, no. 10 (2020): e19705. http://dx.doi.org/10.2196/19705.
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Background Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. Objective The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. Methods A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. Results Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. Conclusions This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. Trial Registration ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID) DERR1-10.2196/19705
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Iyer, Sowmya, Victoria Ngo, Marika Humber, Marisa Brodrick, Christine Gould, and Ranak Trivedi. "DEMENTIA CAREGIVER PERCEPTIONS OF TELE-DEMENTIA CARE FOR VETERANS DURING THE COVID-19 PANDEMIC." Innovation in Aging 6, Supplement_1 (2022): 554. http://dx.doi.org/10.1093/geroni/igac059.2096.
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Abstract The estimated 5 million persons living with dementia in the United States have been greatly impacted by the medical and psychosocial impacts of the COVID-19 pandemic, respite program closures, social isolation, and Veterans seen within the Veterans Health Administration system are particularly vulnerable. Telemedicine provides needed specialty dementia care to these patients with complex needs in their homes, and its uptake has increased during the pandemic. This qualitative, observational study explored informal caregivers’ perceptions of tele-dementia care for Veterans seen at 2 sites, Palo Alto and Cleveland, via semi-structured interviews. Twenty-five caregivers (Mean age = 67y, SD=12y, 88% women) were interviewed over telephone following a tele-dementia visit. Themes that emerged from the interviews were that tele-dementia visits: (1) saved caregivers 2.6h±1.5h (Range: 0.5 to 6h) of travel time, (2) required limited preparation compared to in-person visits, (3) mitigated COVID-19 risk and avoided needs for masking and social distancing, (4) avoided behavioral challenges during appointments, and (5) allowed participation from home with minimal disruption of routine. Caregivers described significant physical challenges that made leaving the home for appointments difficult including balance issues, incontinence, and difficulties getting into vehicle. Caregivers plan to continue using tele-dementia services beyond the pandemic due to the convenience. Taken together, these findings indicate that caregivers find tele-dementia care convenient, comfortable, helpful, and timesaving and highly satisfactory. A combination of both in-person and virtual visits would be an ideal future state. This study illustrates how caregivers experience virtual visits for dementia care and will shape future intervention design.
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Avalos, Lyndsay A., Nina Oberman, Lizeth Gomez, et al. "Group Multimodal Prenatal Care and Postpartum Outcomes." JAMA Network Open 7, no. 5 (2024): e2412280. http://dx.doi.org/10.1001/jamanetworkopen.2024.12280.
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ImportanceAn increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However, research is needed to evaluate outcomes of group multimodal prenatal care (GMPC), with groups delivered virtually in combination with individual in-person office appointments to collect vital signs and conduct other tests compared with individual multimodal prenatal care (IMPC) delivered through a combination of remotely delivered and in-person visits.ObjectiveTo compare postpartum outcomes between GMPC and IMPC.Design, Setting, and ParticipantsA frequency-matched longitudinal cohort study was conducted at Kaiser Permanente Northern California, an integrated health care delivery system. Participants included 424 individuals who were pregnant (212 GMPC and 212 frequency-matched IMPC controls (matched on gestational age, race and ethnicity, insurance status, and maternal age) receiving prenatal care between August 17, 2020, and April 1, 2021. Participants completed a baseline survey before 14 weeks’ gestation and a follow-up survey between 4 and 8 weeks post partum. Data analysis was performed from January 3, 2022, to March 4, 2024.ExposureGMPC vs IMPC.Main Outcome MeasuresValidated instruments were used to ascertain postpartum psychosocial outcomes (stress, depression, anxiety) and perceived quality of prenatal care. Self-reported outcomes included behavioral outcomes (breastfeeding initiation, use of long-acting reversible contraception), satisfaction with prenatal care, and preparation for self and baby care after delivery. Primary analyses included all study participants in the final cohort. Three secondary dose-stratified analyses included individuals who attended at least 1 visit, 5 visits, and 70% of visits. Log-binomial regression and linear regression analyses were conducted.ResultsThe final analytic cohort of 390 participants (95.6% follow-up rate of 408 singleton live births) was racially and ethnically diverse: 98 (25.1%) Asian/Pacific Islander, 88 (22.6%) Hispanic, 17 (4.4%) non-Hispanic Black, 161 (41.3%) non-Hispanic White, and 26 (6.7%) multiracial participants; median age was 32 (IQR, 30-35) years. In the primary analysis, after adjustment, GMPC was associated with a 21% decreased risk of perceived stress (adjusted risk ratio [ARR], 0.79; 95% CI, 0.67-0.94) compared with IMPC. Findings were consistent in the dose-stratified analyses. There were no significant differences between GMPC and IMPC for other psychosocial outcomes. While in the primary analyses there was no significant group differences in perceived quality of prenatal care (mean difference [MD], 0.01; 95% CI, −0.12 to 0.15) and feeling prepared to take care of baby at home (ARR, 1.09; 95% CI, 0.96-1.23), the dose-stratified analyses documented higher perceived quality of prenatal care (MD, 0.16; 95% CI, 0.01-0.31) and preparation for taking care of baby at home (ARR, 1.27; 95% CI, 1.13-1.43) for GMPC among those attending 70% of visits. No significant differences were noted in patient overall satisfaction with prenatal care and feeling prepared for taking care of themselves after delivery.ConclusionsIn this cohort study, equivalent and, in some cases, better outcomes were observed for GMPC compared with IMPC. Health care systems implementing multimodal models of care may consider incorporating virtual group prenatal care as a prenatal care option for patients.
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Shikdar, Sufana, Rabia Saleem, Joel Alcid, et al. "A longitudinal study assessing the impact of ongoing COVID-19 pandemic among hematology-oncology trainees." Journal of Clinical Oncology 40, no. 16_suppl (2022): 11033. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.11033.
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11033 Background: Hematology-Oncology (HO) trainees faced significant challenges due to the COVID-19 pandemic highlighted by a previous survey (Durani, Urshila, et al. "Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and Qualitative Assessment." JCO Oncology Practice (2021): OP-21). Despite the positive impact of effective vaccines, the pandemic is still ongoing; thus, the challenges remain. Our aim is to evaluate how well the trainees have adapted to changes in their clinical training environment after the early phase of the COVID-19 pandemic. Methods: A cross-sectional internet-based survey (Shih, Grace, et al. "The impact of the COVID‐19 pandemic on the education and wellness of US Pediatric Anesthesiology Fellows." Pediatric Anesthesia 31.3 (2021): 268-274) from December 10, 2021, to January 10, 2022, was obtained from the trainees enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited HO fellowship programs in the United States in their fourth (PGY4), fifth (PGY5), and sixth (PGY6) postgraduate year. Results: The survey was completed by 102 trainees. Demographics of the participants are reported in Table. Interestingly, 51% reported an impact of COVD-19 on their employment plans, primarily due to the inability to interview in person (24%, n=23). Trainees experienced several stressors due to the pandemic, including fear of getting sick from a patient (71%) or a coworker (66%). Approximately 27% (n=26) experienced mental health issues requiring additional care. Less than one-third of the trainees were concerned about clinical expertise and procedural skills. Trainees also felt that the change of conference to virtual format impacted their learning activities compared to in-person education (66%, n=64). Most trainees (52%, n=53) reported limited involvement in COVID-related research and journal club education. Most had access to socialization (59%, n=60), virtual office hours (70%, n=72), and telehealth visits (83%, n=85). Female trainees (18%) were more likely to seek mental health care than the male trainees (7.8%) (P=.02). Female trainees (33%) also reported facing more challenges in their employment plans compared to males (16%) (P=.003). Conclusions: Our study highlights the challenges experienced by hematology-oncology trainees with the ongoing COVID-19 pandemic and reveals the gender gap related to employment plans and seeking mental health care. [Table: see text]
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Avdagovska, Melita, Devidas Menon, and Tania Stafinski. "Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review." Journal of Medical Internet Research 22, no. 12 (2020): e24568. http://dx.doi.org/10.2196/24568.
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Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.
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Pang, Kittie, and Karen Fleming. "Advancing Primary Care Coalitions and Cultivating a People-Centered Healthcare System with SCOPE." International Journal of Integrated Care 25 (April 9, 2025): 560. https://doi.org/10.5334/ijic.icic24510.
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Primary Care is widely acknowledged as the cornerstone for authentic system integration in healthcare (Ontario Ministry of Health, 2022). Historically, however, collaboration with Primary Care has been hampered by fragmentation due to the absence of a unified Primary Care organization (Misra et al., 2020). Enter the Seamless Care Optimizing Patient Experience (SCOPE), a pioneering virtual interdisciplinary team designed to foster relationships and trust within the broader healthcare system. SCOPE functions as a barometer, alerting stakeholders to the specific needs of Primary Care. This article explores SCOPE's innovative role in connecting solo and small group practice primary care providers (PCPs), hospitals, and communities in Ontario. The effectiveness of team-based primary care models like SCOPE in enhancing patient outcomes and reducing Emergency Department visits and avoidable hospitalizations is substantiated by robust evidence (Pariser et al., 2020). The grassroots development of SCOPE involves a strategic partnership with Sunnybrook hospital, leveraging its support to address the unique needs and barriers faced by local PCPs. This includes enhancing access to specialists, home care, and system navigation. Detailed tracking of engagement with Sunnybrook SCOPE informs continuous improvement and expansion of SCOPE pathways. Communication channels, such as phone, email, social media, and office visits, facilitate comprehensive insight into PCPs' workflows and administrative challenges. Continuous feedback mechanisms, including surveys, interviews, and regular meetings with the Physician Advisory Group (PAG), contribute significantly to shaping SCOPE's evolution. As SCOPE expands across Ontario, gaps in standardized core offerings become apparent, necessitating a nuanced understanding of local contexts and Primary Care needs. This program evaluation employs Quality Improvement (QI) surveys and interviews to glean insights from both Sunnybrook SCOPE users and their patients. These highlight SCOPE's efficacy in addressing care needs while pinpointing areas for further investigation. QI interviews with SCOPE PCPs delve into reasons behind pathway usage, identify care barriers, and propose enhancements for future utilization. Findings emphasize the importance of bi-directional communication and co-design with stakeholders. Recognizing the absence of a universal approach to health system integration with Primary Care, SCOPE's commitment to adapting to local contexts makes it an adaptable model for international audiences. SCOPE's commitment to building trust through a community of practice, service-oriented approaches, and regular communication positions it as a progressive force in advancing primary care (Pariser et al., 2020). The next phase involves standardizing core elements across SCOPE sites and establishing a platform for PCPs to openly share challenges, fostering an environment of honest collaboration. In conclusion, SCOPE stands as a transformative initiative, navigating the intricate landscape of Primary Care, fostering collaboration, and contributing to the evolution of a people-centered healthcare system.
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Chaurasia, Aastha, Kiran Guleria, Richa Sharma, Alpana Singh, and Khan Amir Maroof. "Telemedicine in Postoperative Follow-Up Care After Major Elective Gynaecological Surgery in Low Resource Setting: A Feasibility Study." Journal of Surgery Care 4, no. 2 (2025): 01–13. https://doi.org/10.33140/jsc.04.02.06.
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Objectives: To assess the feasibility of ‘Tele-health Postoperative follow-up care Model’ in terms of provider, process and service recipient and to identify barriers, facilitators, robustness, safety and acceptability of the model. Design: Feasibility Study Setting: UCMS and GTB Hospital, Delhi, India Population: Patients admitted in gynaecology ward for major elective gynaecological surgery Methods: Women undergoing major elective gynaecological surgery from May 2023 to November 2024 were enrolled for follow-up using a telehealth model, consisting of virtual visits on days 7, 14, and 30, and a physical visit on day 42. Participants completed Modified Quality of Recovery-15 (QoR-15) forms and satisfaction questionnaires. Main Outcome Measures: Feasibility of telemedicine follow-up (virtual vs. physical visits), provider and recipient satisfaction scores, technological performance, barriers (connectivity issues, missed appointments), facilitators (time and cost savings), efficacy (successful care delivery, complications), safety, and acceptability (adherence, satisfaction, costs). Results: It was feasible to complete the ‘model’ follow-up in 60 patients with average number of 3.03 ± 0.18 virtual visits & 1.17 ± 0.41 physical visits respectively. Patient satisfaction was scored at (4.81/5) while provider satisfaction ranged from 4.73 to 4.95/5 through this model. In addition, patients saved on an average 205 minutes and 343.50 INR. Complications were encountered in 13.3% cases; majority managed successfully. 88.30% patients preferred a similar follow-up telehealth model in future. Modified QoR-15 score progressively increased throughout visits. Conclusion: Tele-health post-operative follow-up care model can be used as an upgradation to the existing postoperative services, even in low resource settings.
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Mehraeen, Esmaeil, SeyedAhmad SeyedAlinaghi, Mohammad Heydari, et al. "Telemedicine technologies and applications in the era of COVID-19 pandemic: A systematic review." Health Informatics Journal 29, no. 2 (2023): 146045822311674. http://dx.doi.org/10.1177/14604582231167431.
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Introduction Telemedicine services saw substantial surges in their use during the COVID-19 pandemic due to the lockdowns and characteristics of the pandemic. Therefore, the authors aimed to systematically review the telemedicine services provided during the COVID-19 pandemic and their potential applications. Methods The authors searched PubMed, Scopus, and Cochrane databases on September 14, 2021. Then, the retrieved records underwent two-step title/abstract and full-text screening processes, and the eligible articles were included for qualitative synthesis. Results The review of studies demonstrated that the telephone is listed 38 times, making it the most common technology used in telemedicine. Video conferencing is also mentioned in 29 articles, as well as other technologies: Mobile-health ( n = 15), Virtual reality ( n = 7). According to the findings of the present study, Tele-follow-up ( n = 24), Tele-consulting ( n = 20), Virtual visits (20), and Tele-monitoring ( n = 18) were the most widely used telemedicine applications. Conclusion Telemedicine has been an effective approach to COVID-19 management. Telemedicine technology is going to play a key role in the future of health medicine, patient consultation, and many other extended applications of health care in remote rural locations.
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Lousada, Isabelle, Robyn Himick, Jason Shore, Adam Sodowick, Lisa M. Mendelson, and Vaishali Sanchorawala. "Amyloidosis Appointment Companion: A Virtual Healthcare Tool to Optimize Shared Decision Making and Improve Patient Experience and Provider Satisfaction for Telehealth and in-Person Appointments." Blood 136, Supplement 1 (2020): 38–39. http://dx.doi.org/10.1182/blood-2020-139956.
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Systemic amyloidoses are a group of progressive and life-threatening rare diseases. Patients often feel overwhelmed by the complexities of symptoms, treatment options, and management of their care team. The Amyloidosis Appointment Companion (AAC) was created to help patients identify their goals of care, changes in their condition, as well as the challenges they are facing and share these with their health care providers (HCPs). The AAC has been developed to create a synergy between patients and their clinicians as it relates to not only their health and wellbeing but their overall life goals, and to guide discussion and development of their treatment plan. Here we report on the findings of the first 70 patients to use the AAC at the Amyloidosis Center of Boston University Medical Center (BUMC). The Amyloidosis Research Consortium (ARC) in collaboration with Patient Discovery, a virtual healthcare platform, created the AAC, a digital tool to guide patients through a personalized, interactive survey in order to capture their current status, treatment goals and preferences, correct misperceptions, frame decisions, and promote adherence to treatment plans. The tool was beta tested at 5 amyloidosis centers to assess dissemination and clinical integration strategies, decision-making processes, and communication. The tool launched at BUMC in January 2020, after being integrated into the appointment process as part of both in person and virtual telehealth visits via the Amyloid Center Office and included in the appointment scheduling workflow. Data collected via the tool is securely shared with BUMC by patients and entered into their charts. Additional telehealth-specific features were added to the AAC when the BUMC clinic added virtual appointments in response to COVID-19. This is a report of the findings from the first 70 patients utilizing the tool over a five-month time period. There was a completion rate of 82%, well above the industry standard for patient surveys of 41%. The average user age was 65 years (range, 24 to 86), and 41% (n=29) of patients used the AAC on a mobile device. Patients reported the following subtypes of amyloidosis: Patients spent an average of 16.5 minutes using the AAC prior to their appointment and completed the following tasks: Completing Clinic Intake FormsPreparing for Telehealth AppointmentsReconciling MedicationsCapturing Treatment Satisfaction and PreferencesSharing Goals of CareReporting Symptoms and Side EffectsCharting LabsReviewing Educational VideosReporting on Quality of Life Measures Of these 70 patients, 60% (n=42) patients reported slight to moderate levels of anxiety or depression and 69% (n=48) pain and 59% (n=41) restricted mobility. Two main types of reported goals of care were identified: 1) short term, isolated goals (such as attending a specific life event) and 2) long term, lifestyle goals (such as regaining exercise tolerance or living independently). Individualized to their responses, patients prioritized a list of topics to discuss with their clinicians, the most common topics were: 1. Understanding treatment options, 2. Learning more about my disease, 3. Managing my symptoms and side effects, 4. Concern my disease is progressing. Three providers within the Amyloidosis Center at BUMC independently reported enhanced satisfaction with outcome of appointments as a result of patients having used the AAC. The data patients shared led to greater efficiency during telehealth appointments in particular with the time saved on medicine reconciliation and vital signs, allowing more time during the appointment to focus on delivering personalized care. The AAC demonstrated improved patient to physician communication particularly during a time of increased telehealth visits. The AAC is a patient and provider centered tool that facilitates patient communication and involvement in decision making, as well as helping providers understand their patients' preferences and goals of care. The tool improves appointment efficiency in particular, reducing significantly the time taken up in a telehealth visit for medication reconciliation, obtaining vitals and in some cases, technical support. The tool emphasizes patient engagement to improve patient-provider communication. Furthermore, insights from these data provide powerful information that may help improve development of assistance programs, clinical trials, and research. Figure Disclosures Shore: Patient Discovery Solutions, Inc.: Current Employment, Current equity holder in private company. Sodowick:Patient Discovery Solutions, Inc.: Current Employment, Current equity holder in private company. Mendelson:Patient Discovery Solutions: Consultancy. Sanchorawala:Proclara: Other: advisory board; Caleum: Other: advisory board; Regeneron: Other: advisory board; Oncopeptide: Research Funding; Caelum: Research Funding; Prothena: Research Funding; Celgene: Research Funding; Takeda: Research Funding; Janssen: Research Funding; Abbvie: Other: advisory board; UpToDate: Patents & Royalties.
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Gleason, Emily, Elizabeth Tubridy, Leslie Andriani, et al. "Cost of care associated with utilization of telehealth in clinical trials." Journal of Clinical Oncology 41, no. 16_suppl (2023): e13682-e13682. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e13682.
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e13682 Background: Due to COVID-19 pandemic restrictions, telehealth was incorporated into standard oncologic care and clinical trials. Existing data show that telehealth in clinical trials is safe, feasible, and reduces barriers to participation. We sought to analyze whether telehealth changed the cost of care compared to traditional clinical trial operations. Methods: We conducted a retrospective cohort study of gynecologic oncology patients enrolled in therapeutic clinical trials at a NCCN designated cancer center, comparing health care reimbursement cost of care on trial pre-TELEhealth (9/30/2019 to 3/15/2020) with those during TELEhealth (3/16/2020 to 8/20/2020). Inclusion required trial enrollment during both study periods, at least 1 telehealth visit, and identifiable billing records. Health care costs were collected. Cost data included: 2020 Medicare reimbursements for procedures, provider billing, DRG for hospital admissions, drug average sales price, and GoodRx for outpatient prescriptions. Encounters unrelated to cancer care were excluded. Overall cost per patient and patient-per-month on trial were calculated for scheduled (per protocol) and unscheduled (non-protocol) encounters. Pairwise t-tests between pre-TELE and TELE periods were performed. Results: 28 patients were included (86% White, 7% Black, 6% other) with 26 (93%) ovarian, 1 (4%) uterine, and 1 (4%) concurrent ovarian/uterine cancer. The majority (89%) had stage 3 or 4 cancer at diagnosis. Overall care utilization was similar in pre-TELE and TELE periods, with 292 vs. 321 scheduled visits, and 31 vs. 37 unscheduled visits. Mean total cost per patient was similar in pre-TELE and TELE periods, including scheduled encounters ($15794.58 (SD 17719.92) vs. $20714.47 (SD 25338), p= 0.118) and unscheduled encounters ($759.96 (SD 2066.72) vs. $2911.71 (SD 6060.18), p=0.080). Per month on trial, mean cost per patient did not differ. No differences were seen in total scheduled or total unscheduled encounters, nor office visits, admissions, ED visits and outpatient procedures. Conclusions: Incorporation of telehealth in gynecologic cancer clinical trials did not increase cost of scheduled or unscheduled care. Telehealth is a critical component to decentralizing clinical trials, reducing barriers to trial participation and improving the value of cancer care. [Table: see text]
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Mertz, Kathryn, Samantha Baldinger, Jennifer RIvas, Amir Nikzad, Michael Scarpelli, and Blaine Greenwald. "GERIATRIC PSYCHIATRY OUTPATIENT REACTIONS TO A POST-COVID TRANSITION FROM VIRTUAL TO IN-PERSON CARE." Innovation in Aging 8, Supplement_1 (2024): 1068. https://doi.org/10.1093/geroni/igae098.3432.
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Abstract Because of social distancing/quarantining, the COVID-19 pandemic catalyzed necessary shifts to telepsychiatry in outpatient mental health settings. To enable access and reimbursement for elders, the Centers for Medicaid and Medicare Services (CMS) liberalized restrictive telemedicine regulations. In our Geriatric Psychiatry Clinic, in-person visits quickly shifted to virtual. Tele-video and audio-only services became universally operative between Spring 2020 through May 2023, when – with the public health emergency (PHE) ending - CMS determined hospital-based clinics were ineligible for the ‘facility fee’ if patients were seen virtually, so return to in-person care was strongly encouraged. Shortly thereafter, to determine impact, consecutive geriatric psychiatry clinic patients over a several days period were surveyed re: satisfaction with virtual versus in-person care, and about challenges experienced returning in-person. Of 134 patients surveyed, 43% had engaged in tele-video, 43% in audio-only, and 17% utilized both. Utilizing a 5 -point Likert scale (very unsatisfied = 1 to very satisfied = 5), virtual (video, audio or both) (mean = 4.1) and in-person (mean = 4.2) care did not differ (p-value = 0.82 [Wilcoxon signed-rank test]). Amongst challenges associated with returning to in-person, 75% identified medical issues as very difficult/difficult, 46% financial issues, 25% distance to clinic, 23% transportation concerns, and 16% caregiving responsibilities. Taken together, findings suggest that geriatric psychiatry outpatients are comparably satisfied with virtual and in-person visits, however notable proportions experienced challenges reverting to in-person, especially because of medical and financial issues. As such, continuing advocacy supporting virtual options in psychiatric care of elders is warranted.
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Kanwar, Vikrant, Puneet Khanduja, and Nisha Salaria. "Teledermatology: An Alternative Service Delivery Channel for Outpatient Care During COVID-19 Pandemic in a Tertiary Government Healthcare Facility in Rural Area." International Journal of Health Sciences and Research 13, no. 11 (2023): 317–21. http://dx.doi.org/10.52403/ijhsr.20231138.
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ackground: The pandemic of coronavirus disease of 2019 (COVID-19) has resulted in massive disruptions and changed the way we live. There has been extensive advocacy for social distancing norms and lockdowns which have largely impacted the outpatient healthcare delivery in hospitals. In recent past, there is a perceived urgent need of shifting from, in person visits to virtual care in the field of tele dermatology. This study reports the implementation and utilization of tele dermatology services during different phases of COVID-19 pandemic. Materials and Methods: This is a retrospective observational study that identified all in-person and teledermatology outpatient nonprocedural visits in the month of January and March 2020 (before Covid 19), May (during lockdown) and July (after lockdowns) 2020, at a single healthcare academic institution. Tele consult volumes were assessed weekly and consultation patterns were compared. Results: The results depict sharp 100% fall in physical in person dermatology consultations during lockdown and a complete 100% transitions towards the teledermatology and this trend continue even after lockdown where the tele-dermatology consultations were sought as 30% of total consultations. Discussion: In a relatively short time frame of 4 weeks during lockdown, a single healthcare center was able to dramatically shift to teledermatology visits to provide outpatient dermatology care and thereafter it becomes new normal way of getting consultation. Conclusions: This study depicts that teledermatology can be an alternative for outpatient dermatology care while the government delivery systems quickly adapt to new normal. There is a realized potential to expand tele-health services to improve access to healthcare for masses. Key words: Teledermatology, Telemedicine, Healthcare, COVID-19
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Sheshah, Eman, Khalid Kelis, Najim Abdulwahid, et al. "Diabetes telemedicine clinic implementation during the COVID-19 virus outbreak in Saudi Arabia." Journal of Diabetes, Metabolic Disorders & Control 8, no. 1 (2021): 47–52. http://dx.doi.org/10.15406/jdmdc.2021.08.00221.
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Background: Saudi Arabia implemented a nationwide lockdown to slow the spread of the COVID-19 after a global pandemic has been declared by the World Health Organization. Diabetes patients are one of the most vulnerable chronic illness groups to the complications of COVID-19 virus, thus the necessary to implement a tele-medicine clinic during the lockdown. Methods: A cross-sectional observational study, the study was done during the period from October to December 2020. We used convenience sampling to select participants who attended the clinics of the Diabetes Care Center at King Salman Hospital, Riyadh, Saudi Arabia. A total of 375 patients participated in the study. Results: The study included 375 participants around 60% were female participants. The age of almost one-third of them (33.9%) ranged between 51 and 60 years. Most of the participants were type 2 diabetic patients (85.3%), and lived in Riyadh city (97.6%). Vast majority of participants (99.5%) were follow-up patients and reported telemedicine visit by physicians (98.9%). Patients’ satisfaction questions showed that majority of the participants either strongly agreed or agreed with the statements that they were satisfied with the quality of the audio during the virtual visit (92%), use of telemedicine was essential in maintaining health during the COVID-19 outbreak (90.1%), the quality of the medical care provided during the virtual visit (88.3%), the clarity of the management plan discussed with the heath care practitioner during the virtual visit (87.7%), the tele-medicine visit was as good as a regular in person visit (81.5%). Also, majority of the participants recommend making diabetes tele-medicine clinic as an available option for patients with diabetes after the COVID-19 outbreak is over (81.5%). Conclusion: The COVID-19 pandemic has urged the transition from in person clinical visits to tele-medicine clinics and showed that it is feasible and effective to have the option of tele-medicine for diabetes clinics in Saudi Arabia. The majority of diabetic patients reported high levels of satisfaction with the tele-medicine clinic.
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Boudreau, Jacqueline, Jennifer Conti, Meaghan Kennedy, et al. "PERSPECTIVES OF CAREGIVERS OF RURAL, OLDER VETERANS ON TELEGERIATRICS CARE." Innovation in Aging 6, Supplement_1 (2022): 7–8. http://dx.doi.org/10.1093/geroni/igac059.023.
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Abstract Telemedicine is critical to extending healthcare’s reach to rural older adults with complex medical needs, yet concerns remain about feasibility and acceptability for this population and their caregivers. We interviewed 30 rural Veterans ≥65 years old and/or their caregivers (n=21) about their experiences with video or telephone visits as part of an evaluation of Virtual Geriatrics, a network of Veterans Affairs tele-geriatric care hubs. Interviews were recorded, transcribed, and analyzed using rapid qualitative analysis. Caregivers deemed telemedicine a convenient option that prevented burdensome travel to remote specialists, facilitated caregiver involvement in visits, and matched quality of in-person visits. Caregivers often managed technology, enabling their loved one to participate in video visits. Telephone visits, while convenient, sometimes caused missed physical cues and hearing challenges which led providers to lean on caregiver communication. Our findings suggest telemedicine is feasible and acceptable for delivery for geriatrics care among rural adults and their caregivers.
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Gieniec, Weronika, and Beata Jurkiewicz. "Patient satisfaction with tele-advice during the COVID-19 pandemic." Health Promotion & Physical Activity 17, no. 4 (2021): 25–29. http://dx.doi.org/10.5604/01.3001.0015.5520.
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Introduction: The coronavirus pandemic has shed a whole new light on telehealth, which has become an alternative for diagnosis, monitoring, treatment and support without physical contact between patient and healthcare professional. The aim of this study was to examine patient satisfaction with medical services provided with tele-advice during the Covid-19 pandemic. Material and methods: The study was conducted using our own questionnaire via Google Form that was correctly completed by 133 individuals between the ages of 18 and 76 years (mean 33.1 ± 13.1 years) who received medical services via tele-advice. Results: Patients with chronic conditions were statistically more likely to seek specialist services via tele-advice (p = 0.003). Slightly less than one-third of respondents (n = 39; 29.3%) were asked during the tele-advice to attend the clinic / office in person to complete the visit with a physical examination. The vast majority of subjects (n = 95; 71.4%) responded that their health status had not changed since the pandemic and the introduction of tele-advice. Nearly half (n = 64; 48.1%) believed that their health problem had been solved via tele-advice. Only 4.5% of the respondents (n = 6) strongly agreed with the statement that “tele-advice enables proper diagnosis and matching of effective treatment”, 18.0% (n = 24) tended to agree. The vast majority of respondents believed that everyone should be able to choose between tele-advice and a traditional medical visit (n = 121; 91.0%). Conclusions: The majority of people surveyed did not perceive a difference in their health since the pandemic and the introduction of tele-advice. Nearly half of respondents believed that their health problem had been resolved with a telemedicine consultation, with even fewer people convinced that “tele-advice allows for proper diagnosis and matching of effective treatment.” Patients would mostly like to have a choice between tele-visit and in-person visits, with no clear indication of the superiority of one or the other. Continuous improvement of current solutions will certainly contribute to increased patient satisfaction with the medical services provided.
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Taylor, Jennifer, Amanda Wright, and Michael Summers. "The pandemic silver lining: preparing osteopathic learners to address healthcare needs using telehealth." Journal of Osteopathic Medicine 122, no. 1 (2021): 15–20. http://dx.doi.org/10.1515/jom-2021-0162.
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Abstract Context During the COVID-19 pandemic, many clinicians quickly adapted their way of practicing patient care by offering telehealth and virtual office visits while simultaneously having to minimize direct patient care. The shift in direct clinical learning opportunities provided to third- and fourth-year medical students required a shift in the educational curriculum to develop learner skills around the appropriate use of telehealth in patient care. Objectives The aim of this project was to provide exposure to students so they could learn the telemedicine equipment and best practices, and how to identify infectious diseases to improve access to care and meet the needs of the patient. Methods In July and August of 2020, the Indiana Area Health Education Centers Program partnered with Marian University College of Osteopathic Medicine (MUCOM) to support a 1 day telehealth simulation (online curriculum, group lecture, and two standardized patient encounters) into their clerkship curriculum. We utilized a retrospective pretest-posttest to assess changes in learner knowledge around telehealth after the program. At the conclusion of the telehealth training program, students were asked to complete a retrospective pretest-posttest assessing their level of preparedness to utilize telehealth equipment, their preparedness to demonstrate “telehealth best practices” in a manner consistent with protecting patient (and data) privacy, their confidence to utilize telehealth for identification of infectious diseases, and their confidence to utilize telehealth to identify proper treatment plans. Results A total of 96 learners completed the program in 2020. Posttest results demonstrate a statistically significant (p<0.05) improvement for learners’ self-reported level of preparedness to utilize telehealth equipment, their preparedness to demonstrate “telehealth best practices” in a manner consistent with protecting patient (and data) privacy, their confidence to utilize telehealth for identification of infectious diseases, and their confidence to utilize telehealth to identify proper treatment plans. Conclusions Our telehealth curriculum involving a video, interactive learning session, and two standardized patient experiences provided osteopathic medical learners with realistic simulated case scenarios to work through in effort to improve their knowledge and self-efficacy around the utilization of telehealth in practice.
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Tefera, Gashaye M., Erin Robinson, and Geunhye Park. "Technology Use Among Older Adults to Manage their Health During a Global Pandemic." Innovation in Aging 5, Supplement_1 (2021): 737. http://dx.doi.org/10.1093/geroni/igab046.2741.
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Abstract Risk of severe COVID-19 illness increases with age, and older adults are more likely to be hospitalized and die from COVID-19 and related complications as compared to their younger counterparts. This reality, combined with pandemic-related lockdown and social distancing policies, has increased in-home isolation for older adults. This includes cancelling in-person healthcare appointments and conducting many appointments via tele-health. As older adults have had to quickly pivot to learning new technologies, little is known about their experiences with navigating virtual healthcare during the pandemic. Therefore, this qualitative study aims to address that gap. One-on-one interviews (N=29) were conducted with older adults (Mean age=71.5; 86% female) via phone/Zoom. Participants were asked about their healthcare experiences during the pandemic and the role technology played. Interviews were transcribed and thematically analyzed using Nvivo12 software. Findings demonstrate that participants used technology to schedule medical appointments, engage in virtual visits with their providers, set reminders to take medications, and undertake their daily exercise routine. Post-lockdown, some participants preferred in-person visits due to the nature of their diagnosis, personal preference, or unfamiliarity with the needed technology. Older adults encountered challenges including cancelled appointments, miscommunication with providers, and lack of skill to use technologies. Cancellation of appointments and postponement of treatments affected the health of some of the participants. Implications of this research can inform tele-health approaches with older patients, as well as provider communication and coordination of care. Leveraging technology for preventative health approaches can also assist older adults in ongoing health maintenance and promote well-being.
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Humber, Marika, Chalise Carlson, Marisa-Francesca Brodrick, et al. "EXPLORING THE IMPACT OF TELE-GERIATRIC MENTAL HEALTH SERVICES ON RURAL CAREGIVERS’ WELL-BEING." Innovation in Aging 8, Supplement_1 (2024): 381. https://doi.org/10.1093/geroni/igae098.1238.
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Abstract Rural caregivers may experience unique barriers to support including lack of services, transportation, and internet access. Within the Veterans Health Administration (VHA), a virtual geriatric psychiatry consultation service evolved to increase specialty mental health care access for rural older Veterans. Although the Veteran and their neurocognitive disorder (e.g., Alzheimer’s disease) and/or mental health condition (e.g., depression, PTSD) were the focus of the service, caregivers were also present at appointments. This study explored the impact of the service on rural caregivers in two VHA regions. The median age of patients was 77; caregivers were a spouse or adult child. Semi-structured interviews with caregivers (n=13) inquiring about overall experience and satisfaction with the service, changes to patient care and symptoms resulting from visits, and the service’s impact on the caregiver were conducted from September 2022-November 2023. Using rapid qualitative analysis, interview transcripts were summarized and compared to identify themes. Caregivers reported working with the geriatrics providers normalized the caregiving experience and provided helpful techniques and resources for managing challenging patient behaviors. Rural caregivers appreciated that visits were done at home alleviating the time and effort required to travel to distant VHA facilities and that providers could spend more time focusing on patient and caregiver needs. The direct access to specialty providers via follow-up appointments or by telephone to ask questions and address emergent problems was particularly valuable. These findings indicate that integrating caregivers into specialty tele-geriatric mental health services may decrease burden and improve well-being for caregivers of rural older Veterans.
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Laub, Natalie, Anish K. Agarwal, Catherine Shi, Arianna Sjamsu, and Krisda Chaiyachati. "Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers." Journal of General Internal Medicine 37, no. 4 (2021): 707–13. http://dx.doi.org/10.1007/s11606-020-06395-9.
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Abstract Background Care delivered using telemedicine has been steadily growing in the USA but represented a small fraction of overall visits before the COVID-19 pandemic as few clinicians had been providing care using telemedicine. Understanding how experienced clinicians have practiced telemedicine can help guide today’s exponential adoption of telemedicine. Objective The objective of this study was to explore barriers and facilitators to providing effective, high-quality urgent care using telemedicine (“tele-urgent care”) from the perspective of clinicians experienced in telemedicine. Approach We conducted semi-structured interviews between July 2018 and March 2019 of clinicians who had been providing tele-urgent care services to patients as a part of their routine clinical practice. Themes were identified using content analysis with a constant comparative coding approach. Key Results Among the 20 clinicians interviewed, the majority were female (90%) and nurse practitioners (65%). We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. Communication and exam techniques from in-person encounters were adapted to tele-urgent care including active listening skills and teaching patients to conduct specific exam maneuvers virtually. The convenience of tele-urgent care should be preserved to support improvements in access to care. Finally, patients and clinicians occasionally had mismatched expectations about what could or would be provided during a tele-urgent care encounter. Managing the added tension that can occur during a telemedicine encounter was important. Conclusion As telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future.
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Areaux, Raymond G., Alejandra G. de Alba Campomanes, Maanasa Indaram, and Ankoor S. Shah. "Your eye doctor will virtually see you now: synchronous patient-to-provider virtual visits in pediatric tele-ophthalmology." Journal of American Association for Pediatric Ophthalmology and Strabismus 24, no. 4 (2020): 197–203. http://dx.doi.org/10.1016/j.jaapos.2020.06.004.
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Chen, Earnest, Michael Mills, Tara Gallagher, Sean Ianchulev, Ranya Habash, and Ronald C. Gentile. "Remote patient monitoring of central retinal function with MACUSTAT®: A multi-modal macular function scan." DIGITAL HEALTH 8 (January 2022): 205520762211321. http://dx.doi.org/10.1177/20552076221132105.
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Introduction There is significant unmet need for patient-centric remote monitoring of visual function for chronic retinal diseases, as demonstrated by the COVID-19 pandemic. The Macustat® central retinal function scan is a novel cloud-based digital health application for remote monitoring. The aim of this study is to assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations. Materials and methods Patients with underlying macular pathology underwent office-based retinal and visual acuity examinations and OCT macula imaging followed by remote tele-monitoring assessment with the Macustat. Central visual function was assessed with the multi-modal Macustat test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation. Results The foveal acuity potential registered with the Macustat test showed high correlation with the office Snellen acuity potential 96% of eyes registered Macustat acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat foveal function scan showed a corresponding abnormality in 89% of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan. Conclusion The Macustat demonstrates high concordance with clinical findings using traditional diagnostic devices. Home monitoring with the Macustat® may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease.
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Gately, Megan, and Lauren Moo. "CAREGIVER PARTICIPATION IN VIDEO VISITS: CHALLENGE OR OPPORTUNITY?" Innovation in Aging 6, Supplement_1 (2022): 6–7. http://dx.doi.org/10.1093/geroni/igac059.019.
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Abstract Rapid expansion of telehealth in response to COVID revealed a digital divide for many patients, particularly older adults. Given the technical complexity of video visits (which may include downloading novel software and enabling a camera and microphone), video visits may be out of reach for older patients with less technological experience or with age and condition-related changes such as sensory loss or cognitive impairment. Involving caregivers in video visits (particularly technical set-up) may not only increase patient access but also enhance clinical care by allowing for collaboration with family. Caregivers may themselves benefit from video visits, given that video offers increased options for caregiver support. Though caregivers are often identified as critical components to older adults’ accessing telehealth and may also benefit from telehealth services, caregivers’ own technical needs are not well-understood. This symposium discusses caregivers’ involvement in telehealth from multiple perspectives. The first presentation includes findings from a national clinician survey about caregivers’ support role in occupational therapy video visits, including barriers and benefits (Gately et al). The second presentation includes findings from a regional survey of interprofessional clinicians about telehealth modalities to provide dementia family caregiver support during COVID-19 (Quach et al). The third presentation includes family caregivers’ technology assistance requirements before and during a virtual, seven-session group skills training program, including benefits of individualized assistance (Moo et al). The fourth presentation includes caregiver perspectives about tele-geriatrics visits, highlighting caregivers’ support role and enhancements of video versus phone (Boudreau et al).
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Lamba, Shiv, Sandra Garcia, Elizabeth Bast, et al. "IMPROVING HOME-CARE SERVICES FOR HIGH-RISK OLDER ADULTS USING PEER-LED VIDEO VISITS TO HOME." Innovation in Aging 6, Supplement_1 (2022): 596. http://dx.doi.org/10.1093/geroni/igac059.2229.
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Abstract Older Veterans at high-risk for institutionalization often require home- and community-based services (HCBS). Yet, current HCBS delivery often fails to meet the needs of high-risk Veterans due to decreased veteran engagement in outpatient programs and limited HCBS capacity. A promising approach to address these gaps is the use of Veteran-Peers to make home-visits. Peer-2-PACT is a peer-led needs-assessment intervention for high-risk older veterans. Two trained peers conducted a checklist-guided virtual and/or in-person home-assessment to identify unmet needs and home-safety concerns. Veterans with access, acceptance and ability for video-capable technology were offered video-visits. We report on the feasibility of video home-visits in this high-risk group, and the experience of the video-visits using the visit-data and interviews with peers.Eight of 27 Peer-2-PACT Veterans successfully completed initial video-visit to home. The video-visit participants (n=8) were age 74±9; Non-Hispanic Black (50%); males (100%), compared to initial in-person home-visit participants (n=19), age 75.3±10.8; Non-Hispanic Black (47%); males (89%). The commonest needs identified during video-home-visits were home-safety devices 5(62.5%), housing assistance 4(50%), and medication refills 2(25%). Peers report that identifying veterans suitable for video-visits was challenging. During video-visits, depth-perception by peers is limited and sometimes needed in-person follow-up. Main advantages of video-visits was ability to identify unmet needs, engage veterans, provide care during COVID, and tele-present to remote clinicians. Preliminary data suggest that peer-conducted video home-visits is a feasible way to identify unmet needs in some high-risk older adults. This is particularly important improve care of Veterans who live at a distance from the facility.
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Caze II, Todd, Gregory P. Knell, John Abt, and Scott O. Burkhart. "Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis." JMIR Pediatrics and Parenting 3, no. 2 (2020): e19924. http://dx.doi.org/10.2196/19924.
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Background Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non–medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. Objective The purposes of this paper are to describe a pediatric concussion specialty clinic’s experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. Methods The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. Results The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. Conclusions Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population.