Expansion Of Telehealth Research Articles

Consequences of Rapid Telehealth Expansion in Nursing Homes: Promise and Pitfalls.

Expectations regarding use and potential benefits of telehealth (TH) in nursing homes (NHs) are high; however, unplanned and unexpected consequences can occur as a result of major policy and technological changes. The goal of this study was to elicit stakeholder perspectives of consequences of rapid TH expansion in NHs. Using a qualitative descriptive design, we drew a sample based on findings from a national study examining trends in NH information and technology (IT) maturity, including TH use. We used maximum variation sampling to purposively select participants who (1) participated in our IT maturity survey for two consecutive years, (2) completed year 1 of the IT maturity survey prior to TH expansion (before March 6, 2020) and year 2 after TH expansion (after March 6, 2020), (3) represented a broad range of facility characteristics, and (4) were identified as an end user of TH or responsible for TH implementation. Using six questions from the IT maturity survey, we created a total TH score for each facility and selected participants representing a range of scores. Interviews were conducted with (n = 21) NH administrators and clinicians from 16 facilities. We found similarities and differences in perceptions of TH expansion according to facility TH score, NH location, and participant role. Desirable consequences included four subthemes as follows: (1) benefits of avoiding travel for the NH resident, (2) TH saving organizational resources, (3) improved access to care, and (4) enhanced communication. Undesirable consequences include the following five subthemes: (1) preference for in-person encounters, (2) worsening social isolation, (3) difficulty for residents with cognitive impairment, (4) workflow and tech usability challenges, and (5) increased burden on NH staff/infrastructure. Participants from rural NHs perceived lack of training, poor video/sound quality, and internet/connectivity issues to be potential pitfalls. Clinicians and NH administrators should consider leveraging the desirable consequences of rapid TH expansion and implement mitigation strategies to address the undesirable/unanticipated consequences.

Disparities in telephone and video telehealth engagement during the COVID-19 pandemic.

ObjectiveThe COVID-19 pandemic and subsequent expansion of telehealth may be exacerbating inequities in ambulatory care access due to institutional and structural barriers. We conduct a repeat cross-sectional analysis of ambulatory patients to evaluate for demographic disparities in the utilization of telehealth modalities.Materials and MethodsThe ambulatory patient population at Oregon Health & Science University (Portland, OR, USA) is examined from June 1 through September 30, in 2019 (reference period) and in 2020 (study period). We first assess for changes in demographic representation and then evaluate for disparities in the utilization of telephone and video care modalities using logistic regression.ResultsBetween the 2019 and 2020 periods, patient video utilization increased from 0.2% to 31%, and telephone use increased from 2.5% to 25%. There was also a small but significant decline in the representation males, Asians, Medicaid, Medicare, and non-English speaking patients. Amongst telehealth users, adjusted odds of video participation were significantly lower for those who were Black, American Indian, male, prefer a non-English language, have Medicaid or Medicare, or older.DiscussionA large portion of ambulatory patients shifted to telehealth modalities during the pandemic. Seniors, non-English speakers, and Black patients were more reliant on telephone than video for care. The differences in telehealth adoption by vulnerable populations demonstrate the tendency toward disparities that can occur in the expansion of telehealth and suggest structural biases.ConclusionOrganizations should actively monitor the utilization of telehealth modalities and develop best-practice guidelines in order to mitigate the exacerbation of inequities.

COVID-19 Telehealth Impact Study

Importance: This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S.
 Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders. 
 Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021).
 Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care. 84% of patients agreed that quality of their telehealth visit was good.
 Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery. 74% of patients indicated they will use telehealth services in the future.
 Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

Evaluating consumer and clinical sleep technologies: an American Academy of Sleep Medicine update

Evaluating consumer and clinical sleep technologies: an American Academy of Sleep Medicine update

Medical Oncology Patient Perceptions of Telehealth Video Visits.

Telehealth in medical oncology has expanded secondary to the COVID-19 pandemic. However, quantitative research on medical oncology telehealth use shows conflicting results on patient satisfaction, whereas qualitative data are sparse. Our qualitative study aimed to identify the factors influencing patient acceptability of video visits for medical oncology care before and at the onset of the expansion of telehealth because of the COVID-19 pandemic. Semi-structured interviews were conducted between November 2019 and April 2020 with 20 patients who participated in a telehealth visit with a medical oncology provider at Thomas Jefferson University. Of the 20 participants, 13 (65%) were female and 15 (75%) were White, with a mean (standard deviation) age of 60.5 years (11.8). Patients identified convenience, anxiety, COVID-19, and provider preference as positively influencing the acceptability of video visits; however, some patients noted limitations in provider connection, physical examinations, and visit length as disadvantages. Regarding receipt of serious or bad news, some preferred video visits for privacy, immediacy of results, news processing, and family comfort. Others preferred in-person encounters for provider support and the ability to receive written information and in-person referrals. Patient-perceived factors influencing general acceptability, appropriateness of serious and bad news delivery, and future uses of telehealth were unique to each individual, but shared common themes. Understanding each patient's perspective of telehealth acceptability and tailoring use to their preferences is critical for continued utilization. Further research is needed to understand and address reasons for lack of telehealth uptake among certain patients.

COVID-19 Crisis: What is the Role of Telehealth?

Background: The adverse outcomes of COVID-19 on the healthcare system has prompted the enactment of social distancing and self-isolation or quarantine to minimize the spread of the contagious virus. The need for social distancing and isolation has made telehealth a game-changer in the war against COVID-19.
 Objectives: The objectives of this study were: (1) To evaluate the current trends of using telehealth during COVID-19 pandemic, (2) To discuss regulatory and policy changes related to telehealth at the service provider level, (3) To analyze recommendations by professional organizations, and (4) To evaluate challenges and recommendations for best practices.
 Methods: This is a narrative review. Most current information (focused on the measures that the healthcare system has adopted to integrate telehealth in the coronavirus response measures) was obtained from peer-reviewed journals and the website of payers, pharmacies, and professional organizations.
 Results: Response and management of COVID-19 has seen a surge in the use of telehealth and mobile applications. Health insurance providers have reformed their payer policies to integrate telehealth in COVID-19 response. Waiving premiums, co-pays, and cost-sharing are the most common changes across the industry. For example, Cleveland Clinic has reported a 1,665% increase in the number of telemedicine visits, recording 60,000 visits in March compared to 3,400 before coronavirus. The expansion of telehealth in the era of COVID-19 has presented practical challenges stymying progress.
 Conclsion: Telehealth is indisputable in promoting social distance, which is a proven public health promotion intervention for curbing the spread of coronavirus.

Telerehabilitation: Has Its Time Come?

Telerehabilitation: Has Its Time Come?

Reimbursement for clinical services provided by ambulatory care pharmacists via telehealth

AbstractIntroductionData specific to pharmacists' value in patient‐provided clinical services in New York are limited due to their scope of practice restrictions. However, due to the coronavirus disease 2019 (COVID‐19) pandemic, there has been an expansion of telehealth and allowance for billable services for pharmacists.ObjectivesThe objective of this study was to complete a retrospective review to assess reimbursement of clinical services provided by pharmacists via telehealth during the pandemic in a primary care setting.MethodsA report was generated which identified patients 18 years and older, who were provided services by pharmacists within a primary care group via telehealth during March to July 2020 in New York. It identified patients with an appointment type code of “PharmD Telemed 30” or “PharmD TM Follow UP 15,” including Medicare Annual Wellness Visits or AWVs (G0438‐G0439) with procedural codes, and incident‐to CPT codes (99211‐99214). Information received included medical record number, name, date of birth, carrier plan name, billed procedure code and description, carrier payment amount, and patient responsible amount.ResultsA total of 485 patients were provided services during the timeframe. There were 223 encounters billed for the 99 211 CPT code, 156 of which received payment from insurers with an average of $20.14. For initial and subsequent AWVs there were a total of 48 and 150 encounters, respectively, billed by the pharmacists. Forty‐one of the encounters billed as a G0438 received payment from insurers with an average of $175.75. One hundred thirty‐three of the encounters billed as a G0439 received payment from insurers with an average payment of $114.09.ConclusionThe results of this study provided insight into whether specific services or insurances should be targeted for payment of services. Expansion of these services could show improvement in patient care and can assist in gathering outcomes to better support pharmacists gaining provider status on the state and national level.

Virtual care revolution: Impact on clinical pharmacy practices in the Department of Veterans Affairs

AbstractFor nearly two decades, the Department of Veterans Affairs (VA) has invested in the development and implementation of telehealth services which comprises video, store and forward services, and remote patient monitoring. Virtual care includes telehealth services along with telephone care and e‐consults. These efforts proved critical in 2020 due to the coronavirus disease 2019 (COVID‐19) pandemic. Expanding implementation of telehealth to the home became an access and safety imperative. This article highlights VA efforts and infrastructure for expansion of telehealth into the home and clinical pharmacy practice integration of virtual care. The acceptance of technology coupled with advancements in legislation, policy, and technologies has resulted in expanded applications within the health care system. While continued expansion of virtual care seems inevitable, there remain challenges to ensuring both access to virtual care and the safety and effectiveness of the care delivered. Looking to the future, there will be a continued need for future research on outcomes associated with virtual care, exploration of the benefits of video capability over telephone care, and cost‐effectiveness.

How Telehealth Expansion Can Support Comprehensive Virtual Care

Summary Telehealth utilization grew rapidly in response to the Covid-19 pandemic, enabled by significant changes to regulations, benefits, and payments by the U.S. Centers for Medicare & Medicaid Services and commercial payers. These flexibilities are now extremely popular among providers, and telehealth will continue to play an enhanced role in the delivery of needed care. However, policy makers will face multiple challenges in sustaining and building on effective telehealth reforms after the public health emergency expires. Payers and providers alike will be concerned about appropriate reimbursement and utilization. Moreover, most of the effective uses of telehealth are not stand-alone substitutes for traditional in-person visits, but part of technology-driven virtual care models that also include remote monitoring, data analytics, care teams, and other innovations that are poorly compensated under fee-for-service payments. Current proposals for telehealth expansion are most likely to extend some flexibilities for a designated time frame, making them unlikely to help organizations invest in creating more comprehensive virtual care models. The authors describe why a more impactful expansion would advance telehealth in conjunction with complementary steps to expand and sustain these care models supported by value-based payment reforms.

Disrupted Access to Therapies and Impact on Well-Being During the COVID-19 Pandemic for Children With Motor Impairment and Their Caregivers.

The aim of this study was to determine the impact of the COVID-19 pandemic on access to rehabilitation therapies and the impact of changes in therapy access on the physical and mental well-being of children with motor impairment and their caregivers. Caregivers of children younger than 18 yrs with childhood-onset motor impairment (primarily cerebral palsy) completed an anonymous survey through the online platform REDCap between May 5 and July 13, 2020. The survey was completed by 102 participants. Before the pandemic, 92 of 102 children (90%) were receiving one or more therapies; at the time surveyed, 55 children (54%) were receiving any therapies (P < 0.001). More than 40% of the sample reported increased child stress, decreased physical activity, and/or decline in mobility/movement. Participants who reported a decrease in number of therapies at the time surveyed more frequently reported lower satisfaction with treatment delivery (P < 0.001), a decline in child's mobility (P = 0.001), and increased caregiver stress (P = 0.004). Five qualitative themes were identified from open-ended question responses related to therapies and well-being. Access to pediatric rehabilitation therapies was disrupted during COVID-19. Disrupted access may be related to impact on physical and mental health. With the expansion of telehealth, caregiver and child feedback should be incorporated to optimize benefit.

Expansion of telehealth in primary care during the COVID-19 pandemic: benefits and barriers.

The novel coronavirus disease 2019 (COVID-19) pandemic remarkably accelerated the adoption of telemedicine in outpatient settings. Out of necessity, virtual care became a preferred and default modality of extending primary care services to health care consumers. Although telemedicine is not a new concept and had been used in many organizations and health systems, the COVID-19 pandemic scaled up its use in a variety of health care settings. Telehealth's use in primary care was particularly important because of the need to maintain continuity of care for successful coordination of chronic disease management. This article examines the benefits of telehealth, including continuity of care, convenience of access to care, screening and triaging, and social distancing and disease prevention. The utilization of telehealth and financial implications are discussed, including reimbursement and cost-effectiveness. Barriers and challenges are addressed, including methods for successful implementation of nurse practitioner (NP) in primary care practices as a response to the COVID-19 pandemic. The leadership role of the NP in telehealth is discussed and implementation guidance is provided.

Telemedicine during the COVID-19 pandemic : adult reconstructive surgery perspective.

The COVID-19 pandemic led to a swift adoption of telehealth in orthopaedic surgery. This study aimed to analyze the satisfaction of patients and surgeons with the rapid expansion of telehealth at this time within the division of adult reconstructive surgery at a major urban academic tertiary hospital. A total of 334 patients underging arthroplasty of the hip or knee who completed a telemedicine visit between 30 March and 30 April 2020 were sent a 14-question survey, scored on a five-point Likert scale. Eight adult reconstructive surgeons who used telemedicine during this time were sent a separate 14-question survey at the end of the study period. Factors influencing patient satisfaction were determined using univariate and multivariate ordinal logistic regression modelling. A total of 68 patients (20.4%) and 100% of the surgeons completed the surveys. Patients were "Satisfied" with their telemedicine visits (4.10/5.00 (SD 0.98)) and 19 (27.9%) would prefer telemedicine to in-person visits in the absence of COVID-19. Multivariate ordinal logistic regression modelling revealed that patients were more likely to be satisfied if their surgeon effectively responded to their questions or concerns (odds ratio (OR) 3.977; 95% confidence interval (CI) 1.260 to 13.190; p = 0.019) and if their visit had a high audiovisual quality (OR 2.46; 95% CI 1.052 to 6.219; p = 0.042). Surgeons were "Satisfied" with their telemedicine experience (3.63/5.00 (SD 0.92)) and were "Fairly Confident" (4.00/5.00 (SD 0.53)) in their diagnostic accuracy despite finding the physical examinations to be only "Slightly Effective" (1.88/5.00 (SD 0.99)). Most adult reconstructive surgeons, seven of eight (87.5%) would continue to use telemedicine in the future. Telemedicine emerged as a valuable tool during the COVID-19 pandemic. Patients undergoing arthroplasty and their surgeons were satisfied with telemedicine and see a role for its use after the pandemic. The audiovisual quality and the responsiveness of physicians to the concerns of patients determine their satisfaction. Future investigations should focus on improving the physical examination of patients through telemedicine and strategies for its widespread implementation. Cite this article: Bone Joint J2021;103-B(6 Supple A):196-204.

Dramatic Increases in Telehealth-Related Tweets during the Early COVID-19 Pandemic: A Sentiment Analysis.

The COVID-19 pandemic resulted in a large expansion of telehealth, but little is known about user sentiment. Tweets containing the terms “telehealth” and “telemedicine” were extracted (n = 192,430) from the official Twitter API between November 2019 and April 2020. A random subset of 2000 tweets was annotated by trained readers to classify tweets according to their content, including telehealth, sentiment, user type, and relation to COVID-19. A state-of-the-art NLP model (Bidirectional Encoder Representations from Transformers, BERT) was used to categorize the remaining tweets. Following a low and fairly stable level of activity, telehealth tweets rose dramatically beginning the first week of March 2020. The sentiment was overwhelmingly positive or neutral, with only a small percentage of negative tweets. Users included patients, clinicians, vendors (entities that promote the use of telehealth technology or services), and others, which represented the largest category. No significant differences were seen in sentiment across user groups. The COVID-19 pandemic produced a large increase in user tweets related to telehealth and COVID-19, and user sentiment suggests that most people feel positive or neutral about telehealth

The intertwined expansion of telehealth and buprenorphine access from a prescriber hub

In this manuscript, we describe how efforts to increase access to buprenorphine for Opioid Use Disorder (OUD) through a telemedicine hub before and since the COVID-19 pandemic have played out in the Veterans Healthcare Administration (VHA) in New England. We look at how the COVID-19 pandemic and subsequent spike in opioid overdoses tilted the risk: benefit calculation for tele-prescribing a controlled substance such as buprenorphine toward expanding access to tele-buprenorphine. We conclude that there is a need for tele-buprenorphine hubs that can fill gaps in geographically dispersed healthcare systems.

Managing the COVID-19 Pandemic Using Quality Improvement Principles: A New York City Pediatric Primary Care Experience.

Introduction:In the setting of COVID-19, pediatric primary care in New York City faced multiple challenges, requiring large-scale practice reorganization. We used quality improvement principles to implement changes to care delivery rapidly.Methods:Plan-do-study-act cycles were used, based on primary drivers of consolidation, reorganization of in-person and urgent care, telehealth expansion, patient outreach, mental health linkages, team communication, and safety.Results:The average visit volume in pediatrics decreased from 662 per week to 370. Telehealth visits increased from 2 to 140 per week, whereas urgent in-person visits decreased from 350 to 8 per week. Adolescent visits decreased from 57 to 46 per week. Newborn Clinic visits increased from 37 per week to 54. Show rates increased significantly for pediatrics and adolescent (P = 0.003 and P = 0.038, respectively).Conclusions:Quality improvement methodology allowed for the consolidation of pediatric primary care practices during the first wave of the COVID-19 pandemic, ensuring care for patients while prioritizing safety, evidence-based practices, and available resources.

The experience of Australian general practice patients at high risk of poor health outcomes with telehealth during the COVID-19 pandemic: a qualitative study

BackgroundThe emergence of the COVID-19 pandemic has raised concerns about the potential decrease in access and utilisation of general practice services and its impact on patient care. In March 2020, the Australian Government introduced telehealth services to ensure that people more vulnerable to COVID-19 do not delay routine care from their general practitioners. Evidence about patients’ experience of telehealth and its impact on patient care is scarce. This study aimed to investigate the experience with telehealth by Australian general practice patients at high risk of poor health outcomes during the COVID-19 pandemic.MethodsSemi-structured telephone interviews were conducted with 30 patients from nine general practices in metropolitan Adelaide (May–June 2020). Participants were identified by their regular doctor as being at high risk of poor health outcomes. Interviews sought participants’ perspectives and experiences about telehealth services in the general practice setting during COVID-19, and the value of offering continued telehealth services post pandemic. Interviews were recorded and transcribed verbatim. Data were analysed using a coding structure developed based on deductive codes derived from the research questions and any additional concepts that emerged inductively from interviews.ResultsParticipants expressed satisfaction with telehealth including convenient and timely access to general practice services. Yet, participants identified challenges including difficulties in expressing themselves and accessing physical exams. Prescription renewal, discussing test results and simple follow-ups were the most common reasons that telehealth was used. Telehealth was mainly via phone that better suited those with low digital literacy. Participants indicated that an existing doctor-patient relationship was important for telehealth services to be effective. Subjects believed that telehealth services should be continued but needed to be combined with opportunities for face-to-face consultations after the COVID-19 pandemic was over.ConclusionsThe expansion of telehealth supported access to general practice including chronic disease management during the COVID-19 pandemic. In the future, telehealth in Australia is likely to have a stronger place in primary healthcare policy and practice and an increased acceptance amongst patients.

Telehealth: from the abstract to necessity to competency

The COVID‐19 pandemic caused significant disruption in medical education. With disruption comes the opportunity for innovation. Telehealth had been growing rapidly in many fields of medicine prior to the pandemic; however, the necessities of social distancing, scarcity of personal protective equipment, and mandates to prevent unnecessary exposures for healthcare workers and patients alike, brought opportunities for the exponential expansion of telehealth. With the expansion of telehealth services came the need to expand the curriculum in telehealth to prepare medical students to return to vastly transformed clinical settings as well as prepare them for a future clinical landscape likely to incorporate telehealth to a much greater degree. The University of Colorado School of Medicine (CUSOM) rapidly developed a course in telehealth to prepare students for this changing clinical environment. Simultaneously, a faculty development curriculum was created to support clinical faculty new to telehealth in basic skills and teaching in a virtual environment. Lastly, adaptations were made to the summative Clinical Practice Exam administered to students at the completion of clerkships to incorporate telehealth. Recognizing the importance of achieving competence in telehealth, the CUSOM has taken steps to invest in the development of comprehensive and integrated telehealth curricula. Many creative and innovative solutions have been adopted in the wake of this pandemic to allow medical education to continue despite many hurdles and barriers; many of these will not persist past the pandemic. However, we expect telehealth clinical skills and the curricula developed to support them to remain relevant long past the time when the COVID‐19 pandemic has faded into history.

Employing telehealth within HIV care: advantages, challenges, and recommendations.

Employing telehealth within HIV care: advantages, challenges, and recommendations.

Telehealth in Multiple Sclerosis Clinical Care and Research.

Purpose of ReviewThe COVID-19 pandemic has provided us with a unique opportunity to experiment with telehealth and evaluate its benefits and limitations. This review discusses the impact of telehealth on multiple sclerosis (MS) care and research in adults and children.Recent FindingsTelehealth visits for MS patients have been shown to reduce missed workdays and costs for patients. Brief telephone-based counseling may be associated with better adherence to disease-modifying therapy, although results of multiple home-based tele-rehabilitation for people with MS have been equivocal. Overall, patients and providers have reported high levels of satisfactions with telehealth. Several remote disability measures and numerous other technological tools have emerged for use in remote MS research and care. Major challenges of telehealth include limitations to performing a complete neurologic exam and disparities in access to telehealth amongst vulnerable populations with limited access to virtual platforms.SummaryFollowing the rapid expansion of telehealth during the pandemic, it is highly likely that we will continue to embrace the benefits of this valuable tool. Future directions for improving telehealth should include more evidence-based research on the diagnostic accuracy in neuroimmunology and reducing disparities in the access to telehealth.