Future Health Care Delivery Research Articles

COVID-19: Implications for Nursing and Health Care in theUnited States.

COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary. Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus. Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce. The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all. The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims.

Impact of Digital Technologies on Clinical Care for Adults with Cystic Fibrosis.

The coronavirus disease 2019 pandemic accelerated the implementation of digital technologies, which have now become embedded as essential tools for the management of chronic disease, including cystic fibrosis (CF). Despite subsequent easing of restrictions and because of improved clinical stability resulting from the introduction of highly effective modulator therapy, digital technologies including video and telephone consultations and remote monitoring are likely to remain integral to the future delivery of CF health care. In this article, we explore some of the key developments in digital technologies, barriers to their adoption, and how the CF community is likely to embrace lessons learned from the recent pandemic to help modernize and reshape the future of CF care.

Exploring telerobotic cardiac catheter ablation in a rural community hospital: A pilot study

Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the United States and worldwide. Advancements in telecommunications, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings. The purpose of this study was to pilot test a system and methods to explore telerobotic cardiac catheter ablation in a rural community hospital setting. We assembled a portable preclinical telerobotic catheter ablation system from commercial-grade components using third-party vendors. We then carried out 4 telerobotic surgery simulations with an urban surgeon and a rural community hospital operating room (OR) team spanning a distance of more than 2000 miles. Two challenge scenarios were incorporated into the simulations, including loss of network connection and cardiac perforation with subsequent life-threatening tamponade physiology. An ethnographic analysis was then performed. Interviews and observations suggested that rural OR teams readily adapt to the telesurgery context. However, participant perceptions of team trust, communication, and emergency management were significantly altered by the remote location of the surgeon. In addition, most participants believed the OR team would have been better equipped for the challenges had they received formal training or had prior experience with the procedure being simulated. We demonstrate the utility and feasibility of a system and methods for studying specialty telerobotic surgery in a rural hospital OR setting.

The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review.

BackgroundDigital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group.ObjectiveIn this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology.MethodsA narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as “digital health design,” “mHealth design,” “e-Health design,” “agile health,” and “agile healthcare.” The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review.ResultsA review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios.ConclusionsDigital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.

Self-care of hypertension of older adults during COVID-19 lockdown period: a randomized controlled trial

BackgroundCOVID-19 pandemic has aggravated chronic diseases and health disparities especially hypertension because it is more common among vulnerable populations such as older adults.ObjectiveThis study aimed to examine the effects of a public health nursing intervention plus m-Health applications for hypertension management on enhancing the self-care, systolic and diastolic of blood pressure, and quality of life in older adults during the lockdown period in Jordan.MethodsA randomized, controlled trial design was performed in Jordan. A total of 120 participants were randomly allocated to three groups (n = 40); interventional group (public health nursing interventions plus m.Health applications) and two control groups (m.Health applications alone group and standard care group).ResultsAfter 3 months, the interventional group show significantly decreased in systolic blood pressure − 14 (F = 16.74, P = 0.001), greater improvement in self-care maintenance, monitoring, and confidence (+ 30, + 17.75, + 40.27; P < 0.01, respectively) compared to the two control groups. Greater improvement in role limitations due to physical health and due to emotional problems, pain, energy/fatigue, emotional well-being, and social functioning of quality of life (P < 0.05) compared to the standard care group. No statistical significant difference was found in diastolic blood pressure (F = 3.91, P = 0.141), physical functioning (P = 0.613), and general quality of life (P = 0.060).ConclusionsThis study supports the adoption of technology with nursing intervention as a method of supporting continuity of self-management of chronic illness during the pandemic, and its potential implications for future delivery of health care, not just in Jordan, but across the world.Trial registrationClinical Trial.gov (ID NCT04992000). Registered August 12, 2021.

PO-631-01 TELEROBOTIC CARDIAC CATHETER ABLATION IN A RURAL HOSPITAL: A PROOF-OF-CONCEPT SIMULATION STUDY

Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the US and worldwide. Advancements in telecommunication, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings. The purpose of this study was to pilot test a system and methods to explore remote surgery in a rural community hospital setting using a novel telerobotic catheter ablation platform. Telerobotic System: We assembled a portable pre-clinical telerobotic catheter ablation system from commercial-grade components using 3rd party vendors. A Plexiglas case housed a 3-dimensionally printed cardiac model and simulated vasculature to represent the patient. Finally, we used a proprietary telerobotic cloud service and an off-the-shelf VR headset to allow a remote operator to perform the simulated telerobotic operations. Simulations: We carried out eight simulations with an experienced operator in Chicago, IL, and the Operating room (OR) team at Ocean Beach Hospital, a rural community hospital in Ilwaco, WA. OR team members were assigned to one of two simulation scenarios: loss of network connection or cardiac perforation with subsequent life-threatening tamponade physiology. Ethnographic Study: Two ethnographers observed and recorded each simulation via two stationary cameras in the rural hospital OR. The ethnographers also conducted semi-structured and focus group interviews. Interviews and observations suggested that rural OR teams could readily adapt to the telesurgery context. However, team perceptions of communication and emergency management were significantly impacted during simulated network failure with loss of contact with the remote operator. Most participants believed the team would have been more responsive to the challenges had they received formal training or had prior experience with the procedure. We demonstrate feasibility of a system and methods for the study of specialty telerobotic surgery in a rural hospital OR setting.

Exploring the Effect of COVID-19 on Graduate Nursing Education.

Graduate nursing students are both nurses and adult learners. During the COVID-19 pandemic, many found themselves working on the frontlines while maintaining their studies and confronting challenges in their professional, educational, and personal lives. Changes in work environments, including redeployments, increased hours, and furloughs, challenged their work–study balance. The rapid pivot to virtual instruction allowed graduate nursing students to continue their coursework, but asynchronous delivery of course content increased their isolation and stress. Academic institutions supported graduate nursing students through innovations such as regular town hall meetings and flexible attendance policies, while the widespread closure of clinical learning sites became one of their biggest challenges. A minimum of 500 hours of supervised direct patient care is required to prepare a student to practice as a nurse practitioner, but there is no formal, financed clinical placement system for nurse practitioner students—leaving this clinical learning requirement particularly vulnerable to disruption during the pandemic. Some of the clinical learning alternatives employed included occupational health work, tele-precepting, and simulation. Since telehealth will be a part of the future of health care delivery, tele-precepting practices should be further developed, but simulation was underused and not an acceptable replacement for supervised direct patient care. A postpandemic future needs to limit gaps in the development of safe, competent health care providers by viewing graduate nursing students as essential workers and ensuring their access to the robust didactic and clinical learning opportunities that will best position them as leaders in health care.

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Future challenges in rheumatology - is telemedicine the solution?

The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional ‘face-to-face’ visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.

Attitudes of Undergraduate Public Health and Health Science Students towards Interprofessional Education (IPE) at a California University

Introduction: The study revealed that many healthcare professional students begin their academic studies with positive and high expectations towards interprofessional collaborative studies. Unfortunately, students lose interest if their initial expectations are not met with consistent opportunities to enhance their communication skills and better understand the different healthcare professions. The study aimed to explore health science and public health students’ attitudes toward IPE. The participants’ backgrounds and demographics were used as the variations for the study. Methods: A pre-post semi-quantitative anonymous survey was designed to assess health science and public health undergraduate students’ attitudes toward IPE. The reason for this design was to capture the participants’ attitudes toward IPE at the start of a semester when they had no academic exposure to IPE. Qualtrics was used to collect the research data. A valid and reliable scale was used to measure attitudes toward IPE. A post-survey was included to measure the participants’ change in attitude toward IPE during the semester. The goal was to measure the IPE curriculum effectiveness. There were 21 survey questions. The questions were divided into four validated subscales. The first seven questions (Questions 1 - 7) pertained to the participants’ demographics s, such as gender, age, race, ethnicity, major field of study, and prior education. Questions 8, 9, 16, & 20 were designed to determine how the participants perceived their roles and responsibilities in their future healthcare careers. Each IPE attitude question’s central tendency and demographic variations were measured. The correlation between demographics and IPE attitudes was measured. Results: The pre-survey had 192 participants, and the post-survey had 97 participants. The pre-survey had 87% of participants in the age group 17 - 25 years, while the post-survey had 82.5% in the same age group. Only 5.7% of the participants were 36 years or older in the pre-survey and 9.3% in the post-survey. The participants were 80.70% female in the pre-survey and 85.6% in the post-survey. The largest healthcare career field concentration was nursing, with 42.7% and 45.4% in the pre- and post-surveys. The other three larger career fields were healthcare administration, community health education, and physician assistant. The participants’ attitudes toward learning with different healthcare career students and becoming more effective members of a healthcare team increased from 4.36 (SD = 0.13) to 4.40 (SD = 0.17). Two negative IPE attitude questions showed an increased value: 1) The function of nursing therapists is mainly to provide support for doctors (3.51, SD = 0.19 to 3.12, SD = 0.24, p-value ≤ 0.004) and 2) Clinical and healthcare problem-solving skills could only be learned with students from the same career field (3.73, SD = 0.13 to 3.31, SD = 0.24, p-value ≤ 0.001). Conclusion: Interprofessional Education in an academic setting is essential to help healthcare students prepare and succeed in their future healthcare careers. The study results show that health science and public health students understand IPE and value academic exposure to the IPE process during their studies. Academic healthcare programs should continue integrating the IPE learning model and content throughout the student’s academic journey. The variations in IPE attitude do not significantly vary based on demographics and healthcare career fields. This study only represents a sample size of the many healthcare careers. Interprofessional communication and collaboration are essential to the future healthcare delivery challenges we face. For this reason, IPE should be integrated into healthcare education for all health science and public health students. It is recommended that more research should be done on creative curriculum design to get students more engaged in various healthcare IPE learning activities.

Effect of an educational intervention on manual toothbrush bristle wear: A light microscopic study.

The usage of a toothbrush with the most appropriate bristle type and a correct brushing technique are the most important factors in determining the thoroughness of plaque control. The dental undergraduate course conventionally does not impart tooth brushing techniques in the preclinical years. This study aimed to assess the effect of an educational intervention of correct tooth brushing technique on the wear of toothbrush bristles by light microscopic examination amongst the budding dental professionals. Toothbrush bristle wear was measured by light microscopy before and after an educational intervention amongst 30 first-year dental professional students. Wear index (WI), wear rate (WR), and acceptable percentage of bristle end morphology were calculated. Mann-Whitney U-statistics test and unpaired t-test were used to compare measurements of acceptable percentage and gender wise, respectively. The difference was said to be significant if P < 0.05. The mean WI before intervention was 0.29 ± 0.122 and after the intervention was 0.23 ± 0.07, while the mean WR before intervention was 1.6 ± 0.167 and after the intervention was 1.17 ± 0.46% of bristle end morphology before intervention was 52.5 ± 10.064 and after intervention was 64.5 ± 5.625 with the difference being statistically significant with P < 0.05. The present study highlights the importance of imparting a correct tooth brushing technique in reducing the toothbrush bristle wear and improving the efficiency of the toothbrush in maintaining optimum oral hygiene. Early intervention of correct oral hygiene measures is especially prudent for the budding dental professional for future healthcare delivery to the general population.

The Perioperative Patient Experience During COVID-19.

BackgroundAccess to elective surgical procedures has been impacted by the COVID-19 pandemic.MethodsWe sought to understand the patient experience by developing and distributing an anonymous online survey to those who underwent non-emergency surgery at a large academic tertiary medical center between March and October 2020.ResultsThe survey was completed by 184 patients; the majority were white (84%), female (74.6%), and ranged from 18 to 88 years old. Patients were likely unaware of case delay as only 23.6% reported a delay, 82% of which agreed with that decision. Conversely, 44% felt that the delay negatively impacted their quality of life. Overall, 82.7% of patients indicated high satisfaction with their care. African American patients more often indicated a “neutral” vs “satisfactory” hospital experience (P < .05) and considered postponing their surgery (P < .01). Interestingly, younger patients (<60) were more likely than older (≥60) patients to note anxiety associated with having surgery during the pandemic (P < .01), feeling unprepared for discharge (P < .02), not being allowed visitors (P < .02), and learning about the spread of COVID-19 from health care providers (P < .02).DiscussionThese results suggest that patients are resilient and accepting of changes to health care delivery during the current pandemic; however, certain patient populations may have higher levels of anxiety which could be addressed by their care provider. These findings can help inform and guide ongoing and future health care delivery adaptations in response to care disruptions.

Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care

Telehealth use greatly increased in 2020 during the first year of the COVID-19 pandemic. Patient preferences for telehealth or in-person care are an important factor in defining the role of telehealth in the postpandemic world. To ascertain patient preferences for video visits after the ongoing COVID-19 public health emergency and to identify patient perceptions of the value of video visits and the role of out-of-pocket cost in changing patient preference for each visit modality. This survey study was conducted using a nationally representative sample of adult members of the RAND American Life Panel. The data were obtained from the American Life Panel Omnibus Survey, which was fielded between March 8 and 19, 2021. Preferences for video visits vs in-person care were analyzed in the survey. The first question was about participants' baseline preference for an in-person or a video visit for a nonemergency health issue. The second question entailed choosing between the preferred visit modality with a cost of $30 and another modality with a cost of $10. Questions also involved demographic characteristics, experience with video visits, willingness to use video visits, and preferences for the amount of telehealth use after the COVID-19 pandemic. A total of 2080 of 3391 sampled panel members completed the survey (participation rate, 61.3%). Participants in the weighted sample had a mean (SE) age of 51.1 (0.67) years and were primarily women (1079 [51.9%]). Most participants (66.5%) preferred at least some video visits in the future, but when faced with a choice between an in-person or a video visit for a health care encounter that could be conducted either way, more than half of respondents (53.0%) preferred an in-person visit. Among those who initially preferred an in-person visit when out-of-pocket costs were not a factor, 49.8% still preferred in-person care and 23.5% switched to a video visit when confronted with higher relative costs for in-person care. In contrast, among those who initially preferred a video visit, only 18.9% still preferred a video visit and 61.7% switched to in-person visit when confronted with higher relative costs for video visits. This survey study found that participants were generally willing to use video visits but preferred in-person care, and those who preferred video visits were more sensitive to paying out-of-pocket cost. These results suggest that understanding patient preferences will help identify telehealth's role in future health care delivery.

The Impact of COVID-19 and Lockdown on Spinal Services at a National Level: Lessons Learned and Areas of Service Improvement for Future Health Care Delivery.

The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on the provision of health care worldwide. The delivery of national spinal service for emergent surgery, elective surgery, and outpatient assessment has been incredibly challenging. A variety of innovative measures were undertaken to facilitate the safe provision of acute service and are outlined in this review, along with a number of key learning points which will improve the quality of health care delivered over the coming years. The challenges facing the spinal surgery community with regard the reintroduction of elective surgery is discussed, and a potential roadmap for the safe resumption of services is presented.

Pharmacy in the future: A consumer perspective

Pharmacy in the future: A consumer perspective

Emergency physician perspectives on using telehealth with older adults during COVID-19: A qualitative study.

ObjectivesEmergency medicine physicians have played a pivotal role throughout the coronavirus disease 19 (COVID‐19) pandemic through in‐person and remote management and treatment. Our primary objectives were to understand emergency medicine physicians’ experiences using telehealth throughout the pandemic, any facilitators/barriers to successful usage, lessons learned during implementation, and successful/abandoned strategies used to engage with older adults.MethodsUsing a semi‐structured interview guide, we conducted 30‐min interviews. We used purposeful sampling to recruit emergency medicine physicians from all United States regions, rural–urban settings, and academic and community practices, who reported caring for patients 65 years or older in‐person or virtually during the pandemic. Interviews were audio‐recorded, transcribed, double‐coded, and analyzed for emergent themes using framework analysis.ResultsA total of 15 in‐depth interviews were completed from September to November 2020. Physicians had a median age of 37 years, 7 were women, and 9 had experience with telehealth before the pandemic. We identified several themes: (1) there were various motivations for telehealth use; (2) telehealth was used primarily to supplement, not replace in‐person care; (3) most platforms were easy to use; (4) patients and caregivers had high acceptability of telemedicine; and (5) older adults with sensory and cognitive impairments often relied on caregivers. Emergency medicine physicians played a critical role during primary care office closures during the first wave—dispelling misinformation about COVID‐19, triaging patients to testing and treatment, and providing care that would otherwise have been deferred.ConclusionsOur data show that telemedicine gained acceptability among emergency medicine physicians and provided options to patients who may have otherwise deferred care. These findings can inform future healthcare delivery for acute care needs or pandemic responses.

Impact of a Student-teach-student Model for IPE Between Pharmacists and Dermatologists on Student Knowledge and Attitude

Introduction: The effective delivery of patient care is a complex venture, often requiring efficient collaboration among varied healthcare professions. Not surprisingly, research continues to indicate collaboration between these diverse professionals can be challenging. Early exposure of health professions students to interprofessional education (IPE) offers a promising way to improve this collaboration and, in turn, improve patient care and service delivery. Objectives: This study examines the impact of an innovative IPE cocurricular event on knowledge, understanding, and attitudes, regarding future healthcare delivery between medical and pharmacy students. Method: Students developed and conducted an IPE cocurricular event involving medical students of a dermatology-interest club, and pharmacy students of a compounding-interest club. Medical students introduced a patient case, delivered in a standardized-patient format. This was followed by a pharmacy student presentation representing compounding the prescriptions needed for the patient case and writing accurate prescriptions. Following both presentations, students from each program were paired. Each interprofessional pair then communicated and compounded two medications for the case, working collaboratively. Pre- and post-questionnaires were designed with rating scales and open-ended questions for data collection. Results: Both parametric and nonparametric tests revealed significant differences between the pretests and posttests. There was no significant difference in responding between the groups. Inspection of the open-ended questions revealed changes in attitudes regarding collaboration and learning. Conclusions: This study found students of both professions reported significant improvements in their level of knowledge, understanding, and interest in interprofessional collaboration. The open-ended questions revealed both groups of students began the event with different expectations regarding cooperation and interprofessional activities but left the session with very similar perspectives. By including similar IPE activities in early healthcare education, medical students will gain an understanding of the knowledge, skills, and services that a compounding pharmacist can offer in personalized patient care, and pharmacy students will acquire clinical reasoning based on patient presentations. Both factors promote collaboration between professions and ultimately show promise in improving outcomes in patient care.

The Use and Promise of Conversational Agents in Digital Health.

SummaryObjectives: To describe the use and promise of conversational agents in digital health—including health promotion andprevention—and how they can be combined with other new technologies to provide healthcare at home. Method: A narrative review of recent advances in technologies underpinning conversational agents and their use and potential for healthcare and improving health outcomes. Results: By responding to written and spoken language, conversational agents present a versatile, natural user interface and have the potential to make their services and applications more widely accessible. Historically, conversational interfaces for health applications have focused mainly on mental health, but with an increase in affordable devices and the modernization of health services, conversational agents are becoming more widely deployed across the health system. We present our work on context-aware voice assistants capable of proactively engaging users and delivering health information and services. The proactive voice agents we deploy, allow us to conduct experience sampling in people's homes and to collect information about the contexts in which users are interacting with them. Conclusion: In this article, we describe the state-of-the-art of these and other enabling technologies for speech and conversation and discuss ongoing research efforts to develop conversational agents that “live” with patients and customize their service offerings around their needs. These agents can function as ‘digital companions’ who will send reminders about medications and appointments, proactively check in to gather self-assessments, and follow up with patients on their treatment plans. Together with an unobtrusive and continuous collection of other health data, conversational agents can provide novel and deeply personalized access to digital health care, and they will continue to become an increasingly important part of the ecosystem for future healthcare delivery.

Patient satisfaction and acceptability with telehealth at specialist medical outpatient clinics during the COVID‐19 pandemic in Australia

BackgroundOutpatient clinics were shifted rapidly to telehealth in Australia during the Coronavirus disease 19 (COVID‐19) pandemic, drastically altering patient care and experience.AimsTo investigate patient satisfaction and acceptability of telehealth consultations during the COVID‐19 pandemic.MethodsProspective observation study conducted in two hospital rheumatology outpatient departments (OPD) undertaking telehealth consultations during COVID‐19. A modified version of a validated telehealth evaluation survey was posted to all patients attending the telehealth OPD rheumatology clinics, including balanced 5‐point Likert scales and free‐text responses. Cluster analysis was applied to the Likert‐scale questions, alongside thematic analysis of free‐text responses.ResultsThere were 128 respondents (29% response rate), of which 69.5% were women and the majority (87.5%) was aged 50 years or older. All telehealth consultations were conducted by telephone. Nearly one‐fifth of patients indicated consistent dissatisfaction with telehealth across the range of questions. These patients were older, reported lower educational qualifications and lower health literacy scores and lacked access to the Internet. While many patients found this mode of consultation to be convenient, patients expressed concerns regarding absence of physical examination. A recurrent theme was a desire for a mixed‐model clinic in the future, with flexibility of having both telehealth and face‐to‐face consultations.ConclusionsThis study offers unique insights into patients' experiences with telehealth, which until the current global pandemic, has been an uncommon mode of consultation delivery in urban areas. This study suggests when defining the place of telehealth in future healthcare delivery, patient perspective and careful patient selection will be key. Disease progression, language and cognitive ability, health literacy, technology access and patient and clinician preference are important considerations when deciding how effectively to embed and integrate telehealth into consultations.

Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care

Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care