Adoption Of Telehealth Research Articles

Ethical considerations of telehealth: Access, inequity, trust, and overuse

In the U.S. healthcare system, telehealth is increasingly present and demands ethical assessment. On the one hand, telehealth increases access to healthcare services for some at-risk populations (e.g., people suffering from mental illness and addictions) and in specific contexts (e.g., rural). On the other hand, telehealth widens the digital divide and can lead to overuse of services. Furthermore, because it is still unclear how telehealth influences trust between patients and primary care clinicians, connecting relationship science and human communication research can inform critical reasoning. Finally, healthcare policy is advancing toward the wide adoption of telehealth. Hence, it is urgent to address these ethical issues and invest in further research.

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends.

BackgroundThe adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic–related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services.ObjectiveOur aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities.MethodsWe examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination.ResultsThe trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination.ConclusionsThe current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

Telehealth Adoption in an Outpatient Oncology Ward: A Best Practice Implementation Project.

Telehealth is increasingly taking place to support the transition of care and self-management of people living with cancer in outpatient oncology settings. Despite its recognised value, the scientific evidence points to disparities with regard to implementation of telehealth that might compromise the equity of access. Following the Joanna Briggs Institute (JBI) implementation approach, this project aims to promote the implementation of best practice recommendations for telehealth adoption in an outpatient oncology setting. Assisted by the Practical Application of Clinical Evidence System (PACES), the implementation process comprises three phases of (i) a baseline audit, (ii) feedback to the healthcare team and establishment of implementation strategies with the Getting Research into Practice (GRiP) tool, and (iii) a follow-up audit. The project is expected to allow the identification of barriers and facilitators for the implementation of telehealth in outpatient oncology and develop a strategy plan for its adoption, with the involvement of end-users and stakeholders. The successful adoption of telehealth according to the best available evidence will likely enhance equity of access to healthcare and quality of care at a distance.

Identifying Feasible and Impactful Approaches to Implementing Telehealth in Rural Washington Communities: Group Concept Mapping Study

Background The expansion of telehealth use during the COVID-19 pandemic increased access to health care services for many US residents. This is particularly true for provider-to-patient telehealth communication. In rural communities, telehealth can increase access to health care services that would otherwise be limited due to geographic and distance barriers. The adoption of telehealth in rural communities, however, has been hindered by technology barriers, lack of community awareness, and lack of provider buy-in. The purpose of this study was to explore community-identified approaches to improving telehealth access in rural North Central Washington. Objective The aim of this study was to identify, group, and rate approaches to expanding and integrating telehealth in rural communities in North Central Washington. Methods We used group concept mapping, a participant-engaged, mixed method approach, to explore participant perspectives and preferences. Purposively sampled participants were community leaders and stakeholders in rural North Central Washington. Participants brainstormed strategies for implementing and expanding community telehealth access in their community and sorted them into conceptually similar groups. Strategies were then rated by participants in terms of potential impact, feasibility, and the cost of implementation. Quantitative analyses included multidimensional scaling and hierarchical cluster analysis to produce a cluster map and pattern match graph for interpreting the community members’ ideas and preferences. Results Participant brainstorming yielded 70 strategies for implementing telehealth in rural North Central Washington. Strategies were individually sorted into groups (point map stress value 0.21), producing a 6-cluster solution. The clusters were “Community infrastructure,” “Ensuring access to telehealth technology,” “Technology infrastructure for telehealth,” “Training/awareness of telehealth,” “State- and policy-level considerations,” and “Health care systems engagement and delivery.” Participants rated “Training/awareness of telehealth” and “Health care systems engagement and delivery” to be highly impactful and feasible approaches. The “Training/awareness of telehealth” cluster included strategies such as educating community members that telehealth is an easy, reliable, convenient, and private way to access health care and providing community training on how to access health care remotely. The latter cluster, “Health care systems engagement and delivery,” included approaches that were ranked as highly feasible and impactful, such as engaging with clinics and providers on overcoming barriers to implementing telehealth services or ensuring that local health clinic staff is on board with telehealth as an alternative platform to provide services. Conclusions Strategies identified and rated by participants incorporate the importance of community engagement in telehealth implementation, including educating community members about telehealth and engaging with community health clinics to facilitate use by providers. Community partners in North Central Washington will use these findings, along with additional community survey data, broadband speed test data, and provider input, to increase access to telehealth in their rural and remote communities. Conflicts of Interest None declared.

Understanding and Addressing the Digital Health Literacy Needs of Low-Income Limited English Proficient Asian American Patients.

Introduction:During the pandemic, Asian Health Services (AHS), a federally qualified health center serving patients in 14 Asian languages, transformed rapidly to provide telehealth visits, developed an intensive remote patient monitoring program, and conducted a digital health literacy survey.Method:This article describes how AHS collected and utilized descriptive data on our patient population to inform our rapid adoption of telehealth and assess our patients' response to these changes.Results:Our experiences show that audio visits are invaluable for our patients. In addition, our remote monitoring program resulted in 96% of patients improving their blood pressure control.Conclusion:Many barriers to widespread adoption of telehealth exist, including low digital literacy and the need for in-language digital training. Disaggregated data by ethnicity and language are needed to inform future work.

User attitudes towards virtual home assessment technologies

Telehealth has long been highlighted as a way to solve issues of efficiency and effectiveness in healthcare and to improve patients’ care and has become fundamental to address patients’ needs during the COVID-19 pandemic; however previous studies have shown mixed results in the user acceptance of such technologies. Whilst many previous studies have focussed on clinical application of telehealth, we focus on the adoption of telehealth for virtual assessments visits aimed to evaluate the suitability of a property where a patient is discharged, and eventual adaptations needed. We present a study of stakeholders’ attitudes towards such virtual assessment visits. The study has been carried out with healthcare professionals and patients and allowed us to identify user attitudes, barriers and facilitators for the success of virtual assessment visits from the point of view of healthcare professionals and patients. Finally, we discuss implications for designers of telehealth services and guidelines that can be derived from our study.

Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study.

BackgroundTelehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted.ObjectiveOur primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth.MethodsWe used the 2016 National Emergency Department Inventory–USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both.ResultsOf the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was “improving level of clinical care.” Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003).ConclusionsIn 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.

New Clinical Research Methods and Technologies

What types of innovative clinical studies are we expecting for the coming years? Four main trends are becoming clear.&#x0D; Firstly, we will see technological solutions, apps and platforms, becoming widely available to support trial designs. Electronic informed consent (eConsent) and web-based questionnaires are two new trial elements to influence methodologies. Especially relevant is that eConsent, the digital consent process for patient enrolment to confirm participant comprehension is significantly streamlining clinical research overall.&#x0D; A second key trend, is the adoption of decentralised and hybrid clinical research design. Decentralised designs are expected to reduce research costs and te adoption of telehealth will significantly reduce study administration costs, and improve recruitment and participant retention&#x0D; A third key trend is the adoption of electronic patient-reported outcome (ePRO), another technology that will gain significance in parallel to the growth of real-world evidence (RWE) and real-world data (RWD) which are more widely accepted as methodologies. One procedure that will become common being ePRO allowing patients to complete and submit information about symptoms, side effects, drug timing and more, using electronic devices related to clinical research.&#x0D; A fourth key trend, will be adoption of artificial intelligence (AI), Big Data, application programming interfaces (APIs) and digital platforms expected to improve patient selection, enhance data collection, integration and analysis, while at the same time reduce time, this level of digital transformation would improve both pre-clinical and clinical research.&#x0D; Clinical trial data is diverse and multi-modal. It can come from patients, clinicians, devices such as wearables and other sources. This being a key change in clinical research occurring at fast pace, will change clinical research publishing too.

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.

BackgroundThe COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.ObjectiveThe aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.MethodsIn March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.ResultsChange in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range –6.6 to –14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each.ConclusionsRTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating “batched” redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

Simplified Community Based Telecare During the COVID-19 Pandemic.

Telehealth has evolved as a very comprehensive tool for treating patients with mild to moderate symptoms across the globe during the global pandemic. Adoption of Telehealth in India posed special challenges because of its diversity in languages. Lack of proper healthcare infastructure and especially poor network connectivity have affected pre-hospitalisation care. We have developed an easy to use replicable tool and shown the path to succesful telecare for affected communities. Methods MedicAidTM - an EMR software has been used along with Zoom® to quickly provide online consultations for COVID patients, individually and in groups. Results A total of 60 COVID patients were given online consultation and provided support with recovery in all. Conclusion Group based community care is safe for mass treatment of COVID.

Impact COVID-19 pandemic on lung cancer care from screening to postoperative follow-up.

e18509 Background: The COVID-19 pandemic has presented various challenges for the healthcare system. This study aims to estimate the impact of the COVID-19 pandemic on Lung Cancer Screening (LCS), Lung Resections (LR), and Outpatient Visits (OPV). Methods: This is a longitudinal quasi-experimental time-series analysis using data from the institutional electronic medical records (EMR) from January 2018 to December 2021, considering the first and second waves of COVID-19 cases in Massachusetts; March, and November 2020, respectively. The main outcomes were (A) Monthly LCS exams, (B) Monthly LR surgeries, (C) Monthly Overall-cancer-OPV. Results: 9,057 LSC exams, 333 LR surgeries, and 5,918 outpatient visits were analyzed. The average patient age that underwent LCS was 64; 48.9% were female and 91.4% White. LR was performed in patients 67 years old on average, 67.7% female and 93.6% White. The Overall-cancer-OPV was 58.1% for female patients, 89.4% for White patients, and the overall average patient age was 68 years. The monthly number of LCS (A) presented a statistically significant reduction in the first wave (p = 0.001) with a significant recovery in the following months with a monthly increase rate of 26 exams per month (p = 0.002). The second wave did not represent a sharp reduction in the LCS. Nevertheless, a significant monthly reduction of 44 exams was found. There was no statistical decline for the monthly LR surgeries (B). However, an increase in time from the first visit to the surgery was observed. The COVID-19 surges did not significantly impact the (C) Monthly Overall-cancer-OPV, and it was due to the implementation of telehealth services. The use of telehealth prevented a decline in OPV of 59% (p = 0.001) overall and 40% (p = 0.0190) for cancer. Telehealth visits accounted for 27.7% of cancer-related visits. Female patients were more likely to have a telehealth appointment. White, Black, and Asian patients presented with a similar percentage of telehealth use (26.3%, 25.0%, and 26.8%), while Latinos were less likely to have a telehealth appointment when compared with non-Latinos (18%, p &lt; 0.02). Age was not significantly different between telehealth and non-telehealth appointments. However, for those who preferred a phone appointment, the average age was 67 years old, while for those who used video appointments, the age was 63 (p-value &lt; 0.05). Conclusions: The COVID-19 pandemic affected significantly LCS while lung resections were stable over time; nonetheless, the time from the first visit to surgery increased. The use of telehealth technology allowed patients with cancer to safely receive care throughout the COVID-19 Pandemic. The adoption of telehealth can expand access to care in the pandemic context in low-resource areas. Still, future studies should assess the impact of the COVID-19 pandemic on staging at diagnosis, time to treatment initiation, and survival, especially for the underserved population.

Telehealth for Preoperative Evaluation of Patients With Breast Cancer During the COVID-19 Pandemic.

Introduction The COVID-19 pandemic drove rapid, widespread adoption of telehealth (TH). We evaluated surgical telehealth utilization and outcomes for newly diagnosed breast cancer patients during the initial pandemic period. Methods We identified patients with breast cancer diagnosed March 17, 2020 through May 17, 2020 who underwent surgery as the initial treatment. Clinicodemographic characteristics were collected. Initial consultation types (office, telephone, or video) were categorized. Outcomes included time to consultation, surgeon touchpoints, time to surgery, surgery types, and reexcision rates. Continuous variables were compared using Mann-Whitney tests or t-tests, and categorical variables were compared using χ2 or Fisher's exact tests. Results Of 158 patients, 56% had initial telehealth consultations (21% telephone, 35% video) and 42% did not have a preoperative physical examination. Age, race/ethnicity, and stage distributions were similar between initial visit types. Median time to consultation was lower in the initial telehealth group than the office group (6 days vs 9 days, p = 0.01). Other outcomes (surgeon touchpoints, time to surgery, surgery type, reconstruction) were similar between visit types. We observed higher reexcision rates in patients with initial telehealth visits (20% telehealth vs 4% office, p = 0.01), but evaluation was limited by small numbers. The reexcision rate was 13% for patients with telehealth visits and no preoperative physical exam. Discussion During the initial pandemic period, the majority of new breast cancer patients had an initial telehealth surgical consultation. Office and telehealth consultation visits had comparable numbers of postconsultation surgeon touchpoints and most outcomes. Our findings suggest that telehealth consultations may be feasible for preoperative breast cancer consultations.

Association between telehealth and adherence with patient-reported outcomes (PRO)-based remote symptom monitoring among adolescent/young adults (AYA), middle age, and older adults with cancer.

1513 Background: PRO-based remote symptom monitoring favorably impacts quality of life, healthcare utilization, and overall survival in patients (pts) with cancer. However remote PRO completion rates outside of a clinical trial remained widely varied. With the wide adoption of telehealth in cancer care during the pandemic, telehealth’s impact on health behaviors such adherence w remote PROs is not fully characterized. To that end, we investigated PRO completion patterns in routine cancer care, pre- and during the pandemic. Methods: We queried a prospectively maintained institutional database of all PROs remotely delivered to pts at our institution from 1/1/18 to 12/31/21. Pts were divided into 2 time cohorts (“pre-pandemic” 1/1/18 to 3/31/20, “during pandemic” 4/1/20 to 12/31/21) and 3 age cohorts (AYA 15-39y, midage 40-64y, older adults 65y+). We calculated descriptive statistics and compared (t-test, ANOVA) between time and age cohorts and independent variables. Results: Overall 93,875 unique patients over 4 years received 1+ remote PROs as a part of their routine cancer care. PRO response rate increased from 35% prepandemic (12011 of 34742 pts responding) to 67% during pandemic (p &lt;0.00001). To understand patient-level response patterns, we selected one representative global health PRO tool used widely across clinics in our institution and analyzed completion in a representative month over 4 years, 2 before (Oct ’18, ‘19) and 2 mid-pandemic (Oct ’20, ‘21). Overall 2738 pts (median age 60y, range 17-94y; 290 AYA 15-39y, 1444 midage 40-64y, 1004 older adults 65y+) were sent 3249 PROs during these 4m, 1378 PROs to 1075 pts in 2 pre-pandemic months &amp; 1871 to 1663 pts in 2 mid-pandemic months. Overall, PRO response rate increased from 52% pre-pandemic to 81% during, non-responders dropping from 48% to 19%, and response rate without any reminder from the team increasing from 13% pre-pandemic to 79% during. Across all 3 age cohorts, overall PRO response rates increased (AYA up 21%, midage up 27%, seniors up 35%, p 0.012), PRO non-response rate decreased (AYA by 21%, midage by 27%, seniors by 35%, p 0.01), and PRO response rate without reminders from clinic team increased significantly (AYA, by 71%, midage by 78%, senior by 61%, p &lt;0.00001). When further analyzing by visit type during pandemic, the improvements in overall PRO response rates are driven almost exclusively by telehealth where in-person PRO completion decreased by 19% (pre-pandemic 52%, during 33%) while pts who had an upcoming virtual visit had 94% PRO response rate (p &lt; 0.00001). Conclusions: Substantially higher adherence with PRO-based remote symptom monitoring was seen during the pandemic with virtual visits accounting substantially for this broad adherence and the highest increases seen in older adults, highlighting the implications of telehealth on cancer care.

Mitigating the Impact of the COVID-19 Pandemic on Adult Cancer Patients through Telehealth Adoption: A Systematic Review.

During the first wave of the COVID-19 pandemic, the delivery of life-saving and life-prolonging health services for oncology care and supporting services was delayed and, in some cases, completely halted, as national health services globally shifted their attention and resources towards the pandemic response. Prior to March 2020, telehealth was starting to change access to health services. However, the onset of the global pandemic may mark a tipping point for telehealth adoption in healthcare delivery. We conducted a systematic review of literature published between January 2020 and March 2021 examining the impact of the COVID-19 pandemic on adult cancer patients. The review’s inclusion criteria focused on the economic, social, health, and psychological implications of COVID-19 on cancer patients and the availability of telehealth services emerged as a key theme. The studies reviewed revealed that the introduction of new telehealth services or the expansion of existing telehealth occurred to support and enable the continuity of oncology and related services during this extraordinary period. Our analysis points to several strengths and weaknesses associated with telehealth adoption and use amongst this cohort. Evidence indicates that while telehealth is not a panacea, it can offer a “bolstering” solution during a time of disruption to patients’ access to essential cancer diagnostic, treatment, and aftercare services. The innovative use of telehealth has created opportunities to reimagine the delivery of healthcare services beyond COVID-19.

Experiences with Telehealth for Outpatient Palliative Care: Findings from a Mixed-Methods Study of Patients and Providers across the United States.

Background: The COVID-19 pandemic introduced a rapid adoption and scale-up of telehealth for palliative care services in the United Sates. Objectives: To examine and compare in-person versus telehealth experience among outpatient palliative care programs and patients. Design: Mixed-methods study (1) comparing patient experience survey data received between September 2020 and February 2021 from patients who received only in-person care versus those who received only telehealth and (2) qualitative interviews with outpatient palliative care providers. Data for this study were collected as part of a larger effort to develop quality measures for outpatient palliative care in the United States. Setting/Subjects: Outpatient palliative care patients and programs. Measurements: We measured patients' experiences of "feeling heard and understood" by their palliative care provider and team and their overall rating of their provider and team. We also conducted in-depth semistructured interviews with 47 palliative care providers across 25 outpatient palliative care programs. Results: Of 1753 patient experience surveys, 26% reflected telehealth only versus 74% in-person only. Patients in both groups reported highly positive experiences; there were no differences in "feeling heard and understood" or the overall ratings of the provider and team between the telehealth-only and in-person-only groups. Palliative care program leaders described the benefits and challenges of telehealth, including increased efficiency, the ability to incorporate family members, and challenges conducting a physical examination. Conclusion: Data from this study provide preliminary evidence of overall positive experiences of telehealth for outpatient palliative care among patients and providers; future research is needed to examine the sustainability of telehealth for palliative care.

Abstract #1167052: Grappling with Compliance in the Telemedicine Age

Telehealth adoption is transforming healthcare and is believed to transmit medical information adequately. However, there is a loss of interpersonal interaction.The WHO reports 50% general medical compliance in developed countries. One study reported 30% thyroid treatment compliance where forgetfulness, symptom resolution, and access were reasons for non-adherence. Below is a case of non-compliance due to a lack of a face-to-face encounter.

Association of Telehealth with Short-Interval Follow-Up.

The COVID-19 pandemic led to wide adoption of telehealth in primary care. The impact of telehealth on subsequent follow-up visit volume is mixed. This study examines the association of newly expanded telehealth with short-interval follow-up visits during the COVID-19 pandemic in an academic primary care practice. Scheduling data were used to compare rates of 0 to 60-day follow-up visits after telehealth and in-person visits before and after onset of the COVID-19 pandemic. Compared with in-person visits, telehealth visits were associated with significantly higher rates of total short-interval follow-ups and higher rates of first short-interval follow-ups occurring in 0 to 15 days. Higher rates of short-interval follow-up may be due to inefficiencies created by rapid expansion of telehealth including suboptimal scheduling algorithms, pandemic-related safety considerations, and discomfort with the visit modality. Short-interval follow-ups have potential negative impacts on practice access, patient-centered outcomes, and sustainability of telehealth in primary care. Newly expanded telehealth visits conducted in the year after the onset of the COVID-19 pandemic resulted in higher rates and sooner first occurrence of short-interval follow-up visits. Future research should identify optimal scheduling processes for telehealth visits to minimize short-interval follow-ups.

Pandemics and pediatric otolaryngology

The objective is to describe how the COVID pandemic changed the epidemiology and management of pediatric otolaryngologic diseases, which may influence clinical decision-making in the future. Many changes were made to the structure of healthcare delivery to minimize transmission of coronavirus. As a result, there was a widespread adoption of telehealth. Additionally, guidelines were published with new protocols for evaluation and management of common pediatric otolaryngologic conditions, which in many circumstances, delayed or replaced surgical intervention. Now, as we evaluate the impact of these clinical changes, we have gained new understanding about the pathophysiology of certain pediatric conditions, namely otitis media, for which upper respiratory infection exposure may play a larger role than previously thought. As we have altered practice patterns for common pediatric otolaryngologic conditions, we recognize that ongoing research may help us determine if surgical interventions have been overutilized in the past and help guide clinical practice guidelines moving forward.

Bugs in the Virtual Clinic: Confronting Telemedicine's Challenges Through Empathy and Support.

Although telemedicine has been an important conduit for clinical care during the COVID-19 pandemic, not all patients have been able to meaningfully participate in this mode of health care provision. Challenges with accessing telemedicine using consumer technology can interfere with the ability of patients and clinicians to meaningfully connect and lead to significant investments in time by clinicians and their staff. In this narrative case, we identify issues related to patients’ use of technology, make comparisons between telehealth adoption and the deployment of electronic health records, and propose that building intuitive and supported digital care experiences for patients is required to make virtual care sustainable.

Telehealth survey of providers and caregivers of children on peritoneal dialysis during the COVID-19 pandemic.

BackgroundThere has been growing support for the adoption of telehealth (TH) services in pediatric populations. Children on chronic peritoneal dialysis (PD) represent a vulnerable population that could benefit from increased use of TH. The COVID-19 pandemic prompted rapid adoption of TH services in the population among pediatric centers participating in The Children’s Hospital Association’s Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative.MethodsWe developed a survey to explore the experience of both pediatric PD providers and caregivers of patients receiving PD care at home and using TH services during the COVID-19 pandemic.ResultsWe obtained responses from 27 out of 53 (50.9%) SCOPE centers that included 175 completed surveys from providers and caregivers. Major challenges identified by providers included inadequate/lack of physical exam, inability to visit with the patient/family in-person, and inadequate/lack of PD catheter exit site exam. Only 51% of caregivers desired future TH visits; however, major benefits of TH for caregivers included no travel, visit takes less time, easier to care for other children, more comfortable for patient, and no time off from work. Providers and caregivers agreed that PD TH visits are family centered (p = 0.296), with the lack of a physical exam (p < 0.001) and the inability to meet in-person (p = 0.002) deemed particularly important to caregivers and providers, respectively.ConclusionsTH is a productive and viable visit option for children on PD; however, making this a successful, permanent part of routine care will require an individualized approach with standardization of core elements.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information.Supplementary InformationThe online version contains supplementary material including a graphical abstract available at 10.1007/s00467-022-05543-z.