Adoption Of Telehealth Research Articles

Telehealth Adoption During COVID-19: Lessons Learned from Obstetric Providers in the Rocky Mountain West.

Obstetric providers have used telemedicine to manage gestational diabetes, mental health, and prenatal care. However, the uptake of telemedicine in this field has not been universal. The COVID-19 pandemic catalyzed the adoption of telehealth in obstetric care, which will have lasting effects, especially for rural communities. We sought to understand the experience of adapting to telehealth among obstetric providers in the Rocky Mountain West to identify implications for policy and practice. This study included 20 semi-structured interviews with obstetric providers in Montana, Idaho, and Wyoming. The interviews followed a moderator's guide based on the Aday & Andersen Framework for the Study of Access to Medical Care, exploring domains of health policy, the health system, the utilization of health services, and the population at risk. All the interviews were recorded, transcribed, and analyzed using thematic analysis. Findings indicate that participants view telehealth as a useful tool during prenatal and postpartum care; many participants intend to continue telehealth practices after the pandemic. Participants shared that their patients reported benefits to telehealth beyond COVID-19 safety, including limiting travel time, reducing time off work, and alleviating childcare needs. Participants expressed concern that expanding telehealth will not equally benefit all patients and could widen existing health inequities. Success moving forward will require a telehealth infrastructure, adaptive telehealth models, and provider and patient training. As obstetric telehealth expands, efforts must prioritize equitable access for rural and low-income communities, so all patients can benefit from the technological advancements to support health.

The Effects of a Health Care Chatbot's Complexity and Persona on User Trust, Perceived Usability, and Effectiveness: Mixed Methods Study.

The rising adoption of telehealth provides new opportunities for more effective and equitable health care information mediums. The ability of chatbots to provide a conversational, personal, and comprehendible avenue for learning about health care information make them a promising tool for addressing health care inequity as health care trends continue toward web-based and remote processes. Although chatbots have been studied in the health care domain for their efficacy for smoking cessation, diet recommendation, and other assistive applications, few studies have examined how specific design characteristics influence the effectiveness of chatbots in providing health information. Our objective was to investigate the influence of different design considerations on the effectiveness of an educational health care chatbot. A 2×3 between-subjects study was performed with 2 independent variables: a chatbot's complexity of responses (eg, technical or nontechnical language) and the presented qualifications of the chatbot's persona (eg, doctor, nurse, or nursing student). Regression models were used to evaluate the impact of these variables on 3 outcome measures: effectiveness, usability, and trust. A qualitative transcript review was also done to review how participants engaged with the chatbot. Analysis of 71 participants found that participants who received technical language responses were significantly more likely to be in the high effectiveness group, which had higher improvements in test scores (odds ratio [OR] 2.73, 95% CI 1.05-7.41; P=.04). Participants with higher health literacy (OR 2.04, 95% CI 1.11-4.00, P=.03) were significantly more likely to trust the chatbot. The participants engaged with the chatbot in a variety of ways, with some taking a conversational approach and others treating the chatbot more like a search engine. Given their increasing popularity, it is vital that we consider how chatbots are designed and implemented. This study showed that factors such as chatbots' persona and language complexity are two design considerations that influence the ability of chatbots to successfully provide health care information.

Virtual Clinics for Diabetes Care.

Virtual Clinics for Diabetes Care.

Pre-pandemic geographic access to hospital-based telehealth for cancer care in the United States.

Little is known about US hospitals' capacity to ensure equitable provision of cancer care through telehealth. To conduct a national analysis of hospitals' provision of telehealth and oncologic services prior to the SARS-CoV-2 pandemic, along with geographic and sociodemographic correlates of access. Retrospective cross-sectional analysis with Geographic Information Systems mapping of 1) 2019 American Hospital Association (AHA) Annual Hospital Survey and IT Supplement, 2) 2013 Urban Influence Codes (UIC) from the United States Department of Agriculture, 3) 2018 Area Health Resources Files from the Health Services and Resources Administration (HRSA). Hospitals were categorized by telehealth and oncology services availability. Counties were classified as low-, moderate-, or high-access based on availability of hospital-based oncology and telehealth within their boundaries. Geospatial mapping of access to hospital-based telehealth for cancer care. Generalized logistic mixed effects models identified associations between sociodemographic factors and county- and hospital-level access to telehealth and oncology care. 2,054 out of 4,540 hospitals (45.2%) reported both telehealth and oncology services. 272 hospitals (6.0%) offered oncology without telehealth, 1,369 (30.2%) offered telehealth without oncology, and 845 (18.6%) hospitals offered neither. 1,288 out of 3,152 counties with 26.6 million residents across 41 states had no hospital-based access to either oncology or telehealth. After adjustment, rural hospitals were less likely than urban hospitals to offer telehealth alongside existing oncology care (OR 0.27; 95% CI 0.14-0.55; p < .001). No county-level factors were significantly associated with telehealth availability among hospitals with oncology. Hospital-based cancer care and telehealth are widely available across the US; however, 8.4% of patients are at risk for geographic barriers to cancer care. Advocacy for adoption of telehealth is critical to ensuring equitable access to high-quality cancer care, ultimately reducing place-based outcomes disparities. Detailed, prospective, data collection on telehealth utilization for cancer care is also needed to ensure improvement in geographic access inequities.

Assessment and Diagnosis of HIV-Associated Dementia.

The modern combined antiretroviral treatment (cART) for human immunodeficiency virus (HIV) infection has substantially lowered the incidence of HIV-associated dementia (HAD). The dominant clinical features include deficits in cognitive processing speed, concentration, attention, and memory. As people living with HIV become older, with high rates of comorbidities and concomitant treatments, the prevalence and complexity of cognitive impairment are expected to increase. Currently, the management of HAD and milder forms of HAND is grounded on the best clinical practice, as there is no specific, evidence-based, proven intervention for managing cognitive impairment. The present article acknowledges the multifactorial nature of the cognitive impairments found in HIV patients, outlining the current concepts in the field of HAD. Major areas of interest include neuropsychological testing and neuroimaging to evaluate CNS status, focusing on greater reliability in the exclusion of associated diseases and allowing for earlier diagnosis. Additionally, we considered the evidence for neurological involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the impact of the coronavirus (COVID-19) pandemic, with wider consequences to population health than can be attributed to the virus itself. The indirect effects of COVID-19, including the increased adoption of telehealth, decreased access to community resources, and social isolation, represent a significant health burden, disproportionately affecting older adults with dementia who have limited social networks and increased functional dependence on the community and health system. This synopsis reviews these aspects in greater detail, identifying key gaps and opportunities for researchers and clinicians; we provide an overview of the current concepts in the field of HAD, with suggestions for diagnosing and managing this important neurological complication, which is intended to be applicable across diverse populations, in line with clinical observations, and closely representative of HIV brain pathology.

Telehealth Implementation in Federally Qualified Health Centers During the COVID-19 Pandemic: Changes to Care Provision

Background During the COVID-19 pandemic, federally qualified health centers (FQHCs) experienced rapid telehealth adoption, which drastically shifted how FQHCs delivered care to underserved patients. While studies indicate clinicians and patients would like to continue to use telehealth after the pandemic, questions remain about telehealth care quality, and there are opportunities for improvement in FQHCs. Objective The aim of this paper is to explore changes to care provision that occurred in FQHCs between 2020 and 2021 and identify opportunities to address challenges and maximize benefits as virtual care evolves. Methods A total of 15 semistructured interviews were conducted with clinic personnel (leaders, physicians, and staff) at 2 FQHCs in Northern California, between December 2020 and April 2021, to examine telehealth adoption and use of 2 synchronous modalities (audio-video and audio-only or phone) during the pandemic. Results Physicians and staff reported several positive changes as a result of using telehealth, including increases in patient reach, reductions in no-show rates, and an improved ability to discuss specific medications that patients generally have nearby for reference at home. Other changes occurring during telehealth use had mixed or negative impacts on care provision. For example, the elimination of body language cues, a reduction in the amount of information exchanged, and a reported reduced ability to develop and foster interpersonal connections affected the patient-physician relationship. Respondents also described distractions that were present in some virtual appointments, such as background noise, interruptions, or when patients were multitasking (ie, cooking and cleaning). Modifications to clinic workflow and care processes were reported as well, including the need to triage appointment types (in person vs virtual), and to conduct previsit intake interviews by phone. Clinics developed work-arounds for addressing social and nonmedical needs, such as mailing or emailing resources or pamphlets to patients or providing referrals and support by phone. Respondents also described additional considerations or processes to address newfound privacy needs of telehealth, including confirming whether patients were in a private space during the visit, switching from video to phone visits to increase privacy if necessary, and requesting follow-up from physicians if the patient was unable to share pertinent information due to a lack of privacy during a virtual appointment. Conclusions Telehealth implementation in FQHCs required modifications to care processes and impacted the patient-physician relationship. These findings highlight unique challenges and opportunities for disseminating and sustaining telehealth in settings that deliver care to safety net populations. Guidelines and evidence-based practices are needed to improve telehealth use in FQHCs, including strategies to increase information exchange during virtual appointments and support interpersonal connections between patients and physicians. The following are also needed: best practices for how clinics can most effectively triage virtual appointments; protocols to further mitigate privacy issues and decrease distractions during telehealth appointments; and identifying when telehealth can best supplement in-person care to improve patient outcomes and clinic efficiency. Conflicts of Interest None declared.

Leveraging Web 3.0 Architecture for Healthcare 4.0

The global digital transformation has been exponentially accelerated by the latest pandemic and we have a unique opportunity to redefine, redesign and reconfigure global wellness, global health and global health-care delivery systems. Telehealth and telemedicine play a key role in this new ecosystem and can act as a gateway to achieving Healthcare 4.0. The dual power of increased telehealth adoption, and transitioning towards a decentralized next generation internet (web 3.0) can act as a catalyst to enhance our efforts toward attainment of a more equitable healthcare ecosystem.

Care Continuity, Telehealth Use, and Quality of Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study

Background Community health centers (CHCs) pivoted to remote chronic care services during the COVID-19 pandemic. While care continuity is associated with improved care quality and patients’ experiences, telehealth’s impact on these relationships is unclear. Objective We aimed to examine the association among care continuity, telehealth use, and quality of diabetes or hypertension care in CHCs before and during the COVID-19 pandemic. Methods We collected electronic health record data from a cohort of 20,792 patients with diabetes or hypertension with ≥2 visits per year from March to December 2019 and 2020 among 166 California CHCs in the OCHIN Accelerating Data Value Across a National Community Health Center Network Collaborative. Logistic regression models estimated the association between care continuity (modified, modified continuity index [MMCI]) and telehealth adoption and blood pressure or hemoglobin A1c (HbA1c) testing. Generalized linear regression models for 2019 and 2020 estimated the association between MMCI and blood pressure or HbA1c, exploring telehealth as a mediator. Results Patients experienced reduced care continuity (2019: MMCI=0.71, SD 0.28; 2020: MMCI=0.63, SD 0.36; P&lt;.001) and more blood pressure (99.99% vs 99.75%) and HbA1c (53.38% vs 48.99%) assessments in 2019 vs 2020. Telehealth accounted for 0.33% of 2019’s visits and 9.55% of 2020’s visits. MMCI scores were associated with higher odds of telehealth use in 2020 (odds ratio [OR] 1.96; P&lt;.001). MMCI (2019: OR 1.72, P&lt;.001; 2020: OR 1.66, P&lt;.001) and telehealth use (2019: OR 2.44, P&lt;.001; 2020: OR 6.82, P&lt;.001) were associated with greater HbA1c testing. MMCI was associated with lower HbA1c values in 2020 (–0.40, P=.01) and lower systolic (2019: –1.64, P=.045; 2020: –2.40, P=.001) and diastolic (2019: –1.24, P=.007; 2020: –1.33, P=.001) blood pressure. MMCI and telehealth were not associated with HbA1c values in 2019. In 2020, telehealth mediated the relationship between MMCI and HbA1c testing (percent mediated 59%), but not between MMCI and other study outcomes. Conclusions Care continuity facilitates telehealth use and enables resilient performance on process measures. Elucidating how care continuity influences telehealth adoption may provide insights about implementing patient-centered innovations.

Impacts of health care service changes implemented due to COVID-19 on children and young people with long-term disability: A mapping review.

To identify the research on childhood disability service adaptations and their impact on children and young people with long-term disability during the COVID-19 pandemic. A mapping review was undertaken. We searched the World Health Organization Global COVID-19 database using the search terms 'children', 'chronic/disabling conditions', and 'services/therapies'. Eligible papers reported service changes for children (0-19 years) with long-term disability in any geographical or clinical setting between 1st January 2020 and 26th January 2022. Papers were charted across the effective practice and organization of care taxonomy of health system interventions and were narratively synthesized; an interactive map was produced. Reduction of face-to-face care and usual provision had a huge impact on children and families. Adoption of telehealth provided continuity for the care and management of some conditions. There was limited evidence of changes to mental health services, transitions of care, social care, or child-reported satisfaction or acceptability of service changes. The long-term impacts of service change during the pandemic need full evaluation. However, widespread disruption seems to have had a profound impact on child and carer health and well-being. Service recovery needs to be specific to the individual needs of children with a disability and their families. This should be done through coproduction to ensure that service changes meet needs and are accessible and equitable.

Adoption of Telemedicine during the COVID-19 pandemic in Ibero-America: A Systematic Literature Review

The outbreak of COVID-19 caused a major international public health crisis and led to the imposition of social distancing measures to contain the spread of the virus. In this context, the use of telehealth skyrocketed as the only way to deliver healthcare to patients during a lockdown was remotely. The countries of Latin America and the Iberian Peninsula were severely hit by the pandemic and the prospects and challenges associated with widespread adoption of telehealth are unique. The goal of this systematic literature review is to explore how telehealth has been used during the pandemic to prevent, diagnose, treat and control diseases in Ibero-America. Thus, we sought to identify the main keywords, themes, theoretical frameworks and methodologies used by researchers in this area. We used several tools for bibliographic management like Rayyan, VOSViewer and NVIVO and followed the PRISMA protocol. Our analysis of themes showed the existence of 3 nodes within the literature: students, teachers and education. After searching in 6 databases, 1826 articles were found. After excluding the duplicates (231 articles), we screened and read the titles and abstracts of 1595 articles. Only 119 articles met the inclusion criteria. Finally, after a full-text analysis, a final sample of 106 articles was selected for analysis. Spain and Brazil are the countries who have produced the greatest volume of research in the region. The public sector is the largest funder of research on this topic by far especially at national level.&amp;nbsp; Our findings show that the research output in the region of Ibero-America (Latin America and Iberia) on this topic is still relatively small when compared to regions like North America.

Comparison of the level of eHealth literacy between patients with COPD and registered nurses with interest in pulmonary diseases

BackgroundThis study examines the level of eHealth literacy (eHL) of COPD patients and registered nurses (RN) prior to the implementation of a new national telehealth service. The objective was to provide the nurses with an understanding of eHL and to provide knowledge about the patients’ eHL level, socio-demographic characteristics, and digital behaviour for the nurses to be better able to support the patients’ adoption and usage of telehealth. MethodThe eHealth Literacy Questionnaire (eHLQ) was administered in an outpatient clinic in February and March 2020 (N = 42). The staff-eHLQ was administered by web in November 2019 and at a conference in January 2020 (N = 39). The RNs were asked about workplace and experience with telehealth and the patients about gender, age, and educational level as well as their digital health behaviour.A multiple linear regression analysis tested for relations between the socio-demographic and digital behaviour variables and the eHLQ-scores for the COPD patients. ResultsThe RNs’ eHLQ-scores relating to engagement with information, motivation, and experience with digital services signified an insufficient eHL level which may influence their ability to motivate and promote the usage of telehealth to patients.The patients’ scores were higher than the RNs’ with respect to motivation and experience with digital services but seemed to have an insufficient level in relation to using technology to process information and actively engage with digital services. ConclusionThe patients need support in relation to processing information and interacting with services. The RNs’ eHLQ-scores being lower than the patients are problematic as it may influence how well they are able to support the adoption of the new telehealth service.

Telehealth adoption for substance use and mental health disorders in Minnesota and North Dakota: a quasi-experimental study

Telehealth adoption for substance use and mental health disorders in Minnesota and North Dakota: a quasi-experimental study

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era.

The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children's Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10-17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.

Telehealth adoption in cancer clinical trials: An Australian perspective.

Cancer clinical trials have traditionally occurred in-person. However, the COVID-19 pandemic has forced adaptions of all aspects of cancer care (including clinical trials) so they can be delivered remotely. We aimed to quantify and qualify current use of telehealth and how it can be further improved and routinely integrated into cancer clinical trials in Australia. We used a mixed-method study design, involving surveys of 14 multi-site Collaborative Cancer Clinical Trial Groups members across Australia (n = 98) and qualitative interviews with trial administrators and clinicians (n = 21). The results of our study indicated a strong willingness to use telehealth for certain transactions of clinical trials because it was perceived as a way of increasing efficiency and reach of services. Hybrid models (including telehealth and in-person methods), which considered transaction, cancer type, and patient preferences were most favorable. Additionally, telehealth allowed for greater equity to access and reduced trial burden but interestingly had little effect on increased diversity and recruitment. Factors influencing telehealth service implementation and uptake included communication among trial stakeholders, training, and learning from the experience of others in the clinical trials community. Many but not all aspects of clinical trial care are appropriate to be delivered via telehealth. A hybrid approach provides flexibility to trial delivery and may support greater equity of access to trials in the future. Our findings and actionable recommendations support the need for greater planning, training, and guidelines to enable telehealth to be better integrated into clinical trials. Opportunities exist to expand the use of remote patient monitoring to enable more objective data collection from trial participants in the future.

Sustaining telehealth among cardiac and pulmonary rehabilitation services: a qualitative framework study.

Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June-August 2021. Interview questions were guided by Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: 1. Variable levels of readiness; 2. Greater telehealth uptake in pulmonary versus cardiac rehabilitation; 3. Safety and risk management; 4. Client willingness - targeted support required; 5. Equity and access; and, 6. New models of care. We found sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g., co-design), clinicians (e.g. shared learning), health services (e.g., increasing platform functionality), and the profession (e.g., sharing resources). There are opportunities for telehealth programs servicing large geographic areas, and to increase program participation rates more broadly. Centralised models of care serving large geographic areas could maximise sustainability with current resource limitations; however, realising the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organisations both have roles to play in sustaining telehealth in cardiac and pulmonary services.

Acceptability, Feasibility, and Efficacy of Telehealth Interventions for HIV Testing and Treatment in Adult Populations.

Introduction: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the rapid adoption of telehealth to provide HIV care and treatment. However, limited information exists about the feasibility, acceptability, and efficacy of telehealth interventions at different points of the HIV care continuum. Methods: A systematic search was conducted of Ovid MEDLINE, PsycINFO, and CINAHL databases to synthesize evidence regarding the feasibility, acceptability, and efficacy of videoconferencing and video-based interventions for HIV testing and treatment in adult populations. Seventeen articles published through July 2021 were included in the review. We used descriptive methods to analyze data, and findings were reported using frequencies and percentages. Results: Findings show that videoconferencing and video-based interventions are generally feasible and acceptable. Videoconferencing is effective in improving adherence to HIV treatment and in promoting HIV testing. In addition, video-based interventions were effective in promoting HIV testing, treatment initiation, and adherence to medication. Both modalities enhanced linkage and retention in treatment for HIV-positive patients. Conclusions: Video-based and videoconferencing interventions are beneficial in HIV testing and treatment. However, the scarcity of primary studies employing these telehealth modalities means that there is a need for more research in these areas. Also, reviewed studies suffered from several limitations, including reliance on subjective measures, lack of standardized ways of evaluating acceptability and feasibility, use of small sample sizes, and short follow-up durations. In addition, there was less representation of studies from resource-limited settings disproportionately affected by HIV and AIDS. Thus, future research should focus on addressing these challenges.

Clinical Outcomes of Telehealth in Patients With Coronary Artery Disease and Heart Failure During the COVID-19 Pandemic

The COVID-19 pandemic necessitated a rapid adoption of telehealth (TH); however, its safety in subspecialty clinical practice remains uncertain. To assess the clinical outcomes associated with TH use in patients with coronary artery disease and/or heart failure during the initial phase of the COVID-19 pandemic, eligible adult patients who saw cardiologists from March 1, 2020, to August 31, 2020 (TH period) were identified. Patients were divided into two 3-month subcohorts (TH1, TH2) and compared with corresponding 2019 prepandemic subcohorts. The primary outcome was cardiovascular (CV) events within 3 months after index visits. Secondary analysis was CV events in patients aged ≥75 years within 3-month follow-up associated with TH use. Multivariable logistic regression was used to evaluate the association between TH use and CV outcomes. The study cohort included 6,485 TH and 7,557 prepandemic patients. The mean age was 70 years, with 40% of patients aged ≥75 years and 35% women. TH visits accounted for 0% of visits during the prepandemic period, compared with 68% during the TH period. Telephone visits comprised ≥92% of all TH encounters. Compared with the prepandemic period, patients seen during the TH period had fewer overall CV events (adjusted odds ratio 0.78, 95% confidence interval 0.67 to 0.90). Patients aged ≥75 years had similar findings (adjusted odds ratio 0.70, 95% confidence interval 0.55 to 0.89). Additional analysis of CV outcome events within 6 months after index visits showed similar findings. In conclusion, TH largely by way of telephone encounters can be safely incorporated into the ambulatory cardiology practice regardless of age.

Patient Portal Perceptions in an Urban Community Health Center Setting: Insights for Telehealth

Introduction&#x0D; Patient portals are the “front door” to telehealth - online scheduling, video visit links, and digital after visit summaries are often conveyed via the patient portal. Patient portal tools often require similar patient skills and attitudes as telehealth adoption. Analyzing patients’ perceptions and beliefs around this digital patient engagement tool may lead to insights regarding telehealth, particularly in historically underrepresented patient populations.&#x0D; &#x0D; Methods&#x0D; Participants from a Federally Qualified Health Center (FQHC) in Chicago, IL were surveyed on general technology use, healthcare-specific technology use, and barriers and facilitators to patient portal use.&#x0D; &#x0D; Results&#x0D; The 149 respondents (81% response rate) represented a unique population base with 96% African American, 74% with educational attainment of some college or less, and 48% with at least one chronic medical condition. Technology access and use were high with 78% computer ownership, 98% mobile phone ownership (with 75% smartphone ownership). In terms of patient portal perception, 75% rated Perceived Usefulness (U) as high. Perceived Ease of Use (E) domains similarly had 70% or higher agreement from patients, and potential barriers and facilitators in the Attitudes Toward Use (A) section included a preference to calling their doctor, and minority of patients viewing the portal as unsafe way to communication, too complicated to use, or taking too much time. Additional stratification analysis by demographic variables (age, gender, educational attainment, and number of chronic conditions) revealed differences in portal perception across the Usefulness, Ease of Use, and Attitudes domains.&#x0D; &#x0D; Discussion&#x0D; Insights from barriers, attitudes, and capacity to use patient portal tools deliver important insight into overall adoption of other digital health modalities, including telehealth. In an urban historically underserved patient population, technology access and use is quite high, and mobile phones access was nearly ubiquitous with a large majority using the internet function on their mobile device. Different age groups, genders, levels of educational attainment, or degree of multi-morbidity have different values and needs. Therefore, each subpopulation needs targeted messaging of different portal benefits.&#x0D; &#x0D; Conclusion&#x0D; Our research provides initial insights into patient-level factors influencing patient portal attitudes, with implications toward telehealth adoption. Demographic differences have a significant impact on attitudes toward technology adoption. Equitable uptake of portal and telehealth services will require tailored messaging, training, and multiple modes of communication, including web-based and mobile.

Rapid utilisation of telehealth services for specialist paediatric general surgery outpatient clinics in response to COVID-19

BackgroundThe COVID-19 pandemic is highly infectious and prompted, amongst other changes, strict social distancing requirements for medical practitioners in Western Australia. Despite significant previous research into telehealth, uptake had been limited beyond servicing rural patients, in spite of numerous purported benefits.ResultsRapid adoption of telehealth for a majority of outpatient appointments was instituted in the sole tertiary paediatric general surgery with high overall success rates — a satisfactory outcome being achieved without requiring an in-person appointment (97.1% for telephone consults, 93.8% for videoconferencing) during the initial COVID-19 crisis from April to June 2020. Success of appointments was lowest for new referrals for undescended testicles at 81.3%. Operations booked through telehealth consultations were only altered in 1 case (5%), and this was not significantly different to in-person bookings (p > 0.05). No cases of COVID-19 were incurred by the surgical team or patients during the study period.ConclusionsWe found that with existing technology and minimal training, paediatric surgical consultations were able to be performed via telehealth with high success, high accuracy, and without significant adverse outcomes.

Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic.

The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.