Implementation Of Telehealth Services Research Articles

Clinician and System-Level Facilitators for Successful School-Based Telehealth Implementation during COVID-19: Guiding Factors to Help Embrace Changes in Service Delivery

Abstract School-based mental health clinics are the ideal venue to provide mental health services for youth due to their accessibility and lack of stigma compared with other community treatment centers. There were challenges associated with the abrupt shift to remote education and clinic services caused by COVID-19, but some school-based mental health clinics excelled in their implementation of telehealth services. This study of New York schools found four main facilitators to implementing telehealth services among school-based mental health clinics: (1) strong collaborative relationships between the clinic and school setting, (2) active and responsive leadership, (3) provider experience in conducting telehealth, and (4) provider flexibility to accommodate the needs of children and families. Factors were identified at every level of the school-based mental health clinic and system that helped to facilitate exemplary telehealth service delivery and implementation.

Managing innovation: a qualitative study on the implementation of telehealth services in rural emergency departments

BackgroundTelehealth studies have highlighted the positive benefits of having the service in rural areas. However, there is evidence of limited adoption and utilization. Our objective was to evaluate this gap by exploring U.S. healthcare systems’ experience in implementing telehealth services in rural hospital emergency departments (TeleED) and by analyzing factors influencing its implementation and sustainability.MethodsWe conducted semi-structured interviews with 18 key informants from six U.S. healthcare systems (hub sites) that provided TeleED services to 65 rural emergency departments (spoke sites). All used synchronous high-definition video to provide the service. We applied an inductive qualitative analysis approach to identify relevant quotes and themes related to TeleED service uptake facilitators and barriers.ResultsWe identified three stages of implementation: 1) the start-up stage; 2) the utilization stage; and 3) the sustainment stage. At each stage, we identified emerging factors that can facilitate or impede the process. We categorized these factors into eight domains: 1) strategies; 2) capability; 3) relationships; 4) financials; 5) protocols; 6) environment; 7) service characteristics; and 8) accountability.ConclusionsThe implementation of healthcare innovation can be influenced by multiple factors. Our study contributes to the field by highlighting key factors and domains that play roles in specific stages of telehealth operation in rural hospitals. By appreciating and responding to these domains, healthcare systems may achieve more predictable and favorable implementation outcomes. Moreover, we recommend strategies to motivate the diffusion of promising innovations such as telehealth.

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 < 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 < 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.

Implementing Telehealth Services with the B.E.L.T. Tool

Nowadays, as technology takes on a more important role in our everyday lives, telehealth is emerging. Evidence proves that it can ease and improve access to quality care.(1) This commentary offers a synopsis of the narrative on the use of B.E.L.T. mnemonic to be used by a nurse champion to structure the implementation of telehealth services. This opinion and later research indicate that further testing is needed to adapt and validate the tool. The COVID-19 worldwide pandemic could not be a better opportunity to further test the tool through the implementation of telehealth in different settings across the world.

Developments in paediatric cancer care throughout the COVID-19 pandemic: Lessons from China

Developments in paediatric cancer care throughout the COVID-19 pandemic: Lessons from China

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment.

In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. We conducted semi-structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School-Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. School-based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school-based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers.

Telehealth in surgery: an umbrella review.

Telehealth use has increased worldwide during the COVID-19 pandemic. However, hands-on requirements of surgical care may have resulted in slower implementation. This umbrella review (review of systematic reviews) evaluated the perceptions, safety and implementation of telehealth services in surgery, and telehealth usage in Australia between 2020 and 2021. PubMed was searched from 2015 to 2021 for systematic reviews evaluating real-time telehealth modalities in surgery. Outcomes of interest were patient and provider satisfaction, safety, and barriers and facilitators associated with its use. Study quality was appraised using the AMSTAR 2 tool. A working group of surgeons provided insights into the clinical relevance to telehealth in surgical practice of the evidence collated. From 2025 identified studies, 17 were included, which were of low to moderate risk of bias. Patient and provider satisfaction with telehealth was high. Time savings, decreased healthcare resource use and lower costs were reported as key advantages of the service. Inability to perform comprehensive examinations was noted as the primary barrier. In Australia, peak telehealth usage coincided with the introduction of temporary telehealth services and increased lockdown measures. Patients and providers are broadly satisfied with telehealth and its benefits. Barriers may be overcome via multidisciplinary collaboration. Telehealth may benefit surgical care long-term if implemented correctly both during and after the COVID-19 pandemic.

Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study.

BackgroundAt the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020.ObjectiveWe compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020).MethodsWe used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes.ResultsPrior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted.ConclusionsTechnological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.

Adoption of telepharmacy within a community health center: A focus on clinical pharmacy services

AbstractIntroductionDue to the current coronavirus disease 2019 (COVID‐19) pandemic, telehealth has shifted from an underutilized service to a medical necessity almost overnight. While guidelines are available regarding implementation of telepharmacy services, there is limited practice‐level evidence demonstrating successful adoption of telepharmacy for the delivery of clinical pharmacy services.ObjectivesThe purpose of this article is to provide a description of how telehealth has been utilized to deliver pharmacy services within a Community Health Center (CHC), to discuss the impact of telehealth services, and to provide a framework by which other entities may create successful telehealth programs within the ambulatory care setting.MethodsOverall CHC productivity, clinical pharmacist productivity, and patient demographics were compared between the 7 months preceding and the 7 months after implementation of telehealth services. Patient satisfaction with telehealth was measured via anonymous surveys administered via Feedtrail XM and provider satisfaction was measured via a survey created by the New Jersey Primary Care Association.ResultsTelepharmacy has caused a shift in the demographics of patients receiving pharmacy services, increasing the proportion of patients with private insurance, who were 65 years or older, and who were non‐English speakers. While overall productivity at the CHC remained stable, the number of clinical pharmacy encounters increased. Patients were satisfied with telepharmacy visits indicating that they were of the same or greater quality than in‐person visits and expressed a preference to continue telepharmacy visits in the future.CONCLUSIONSOur results suggest that telepharmacy is an effective way to deliver care particularly around chronic conditions. To be sustainable, telehealth requires ongoing support from local, State, and Federal agencies in terms of maintaining regulations around expanded scopes of practice and in terms of reimbursement.

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.

Teletherapy in Training: A Trying and Transformative Experience

Recent changes in federal and state laws, largely brought on because of the novel coronavirus, have underscored the need for revolutionizing the clinical training experience for Marriage and Family Therapy (MFT) programs and their implementation of telehealth services. This article addresses the current telehealth training in MFT programs, featuring the process of teletherapy training at Nova Southeastern University's (NSU) Department of Family, including adaptation to current policies and procedures. This study utilized semistructured interviews with eight graduate- and post-graduate–level MFT students at NSU who received telehealth training prior to participating in a teletherapy-based clinical practicum at NSU's Brief Therapy Institute. The emergent themes from the analysis included crisis management, flexibility, and self-care. Lastly, we discuss the implications and limitations of our study and suggest areas of future research. The information provides knowledge on necessary training topics and expands the literature on teletherapy.

Continuity of Care in the Epicenter of a Global Pandemic: How One New York City Rehabilitation Psychology Outpatient Service Met the Challenge of COVID-19

To provide useful insights for future crises by describing the large-scale rapid deployment of telehealth services which provided continuity of psychological care for rehabilitation outpatients living in New York City (NYC), the epicenter of the global COIVD-19 pandemic. Case Study. Interdisciplinary general rehabilitation facility located in the heart of NYC. A large-scale rehabilitation psychology service providing individual and group psychotherapy and cognitive remediation to adult outpatients with acquired brain injury, stroke, multiple sclerosis, and other disabling health conditions. Implementation of telehealth services on an urgent basis after NYC’s “lockdown” went into effect on March 22, 2020. At this time, NYC began enforcing Matilda’s Law, which restricted travel outside the home for vulnerable individuals including those over 70 and those with chronic health conditions. Number of patient visits completed. Patient and staff satisfaction with telehealth services. After declining by over 50% as the pandemic shut down much of NYC, the number of clinical encounters rebounded to 100% of pre-COVID levels with the introduction of telehealth services. Approximately 75% of staff psychologists reported satisfaction with delivering psychological services via telehealth, including the provision of essential continued care, while addressing social isolation and other emergent mental health concerns for vulnerable rehabilitation outpatients self-quarantining in their homes. Similarly, a majority of patients reported satisfaction with the ability to continue their psychological treatment during the lockdown, while avoiding risk of exposure to the coronavirus. This case study provides useful insights for future crises that require rapid responding and change to clinical program structure in order to meet the needs of vulnerable outpatients with disabilities.

Clinician Satisfaction with Rapid Adoption and Implementation of Telehealth Services During the COVID-19 Pandemic.

Background: To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Materials and Methods: Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Results: A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Discussion: Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Conclusions: This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.

Implementation of Vision Therapy Using Telehealth Services in an Academic Practice

Background: In telehealth, care is delivered through a virtual platform with the provider and the patient using a real-time audio and video telecommunication system. Interest in telemedicine services has grown considerably since the clinic closures enforced by the COVID-19 pandemic. In this paper, we outline the implementation of telehealth services for delivering vision therapy at our academic clinical practice. Methods: A secure, Health Insurance Portability and Accountability Act (HIPAA) compliant service with synchronous audio-video capability was chosen as the platform for delivery of care. The office staff and the providers underwent training on how to use the platform for patient enrollment and conducting visits respectively. To ensure continuity of care, patients who were previously receiving vision therapy were offered and enrolled in telehealth if interested. Components of a virtual visit and documentation of the visit are discussed. Conclusions: Since its implementation, our telehealth-based vision therapy service has been welcomed both by the providers and patients. Given the current state of the pandemic, interest in implementing telehealth services is likely to grow. The relaxed policies and regulations for telehealth in response to COVID-19 are temporary. Sustainable and successful implementation depends on feasibility, user satisfaction, improvement in clinical outcomes and cost effectiveness. Evaluation of these telehealth attributes for vision therapy is warranted for informed-decision making.

COVID-19 and abortion: The importance of guaranteeing a fundamental right

Because of the COVID-19 Pandemic many problems have emerged in the organization of the National Health Systems. In Italy, a very serious problem is emerging which needs a rapid solution. Italian women are finding increasingly difficult to access abortion. These difficulties are related to the organizational changes that have occurred in many hospitals due to the emergency COVID-19. A possible solution would be to resort to the procedure of pharmacological abortion which, however, in Italy, is characterized by many limitations imposed by law. To protect the right to health of all women will need a reorganization of abortion procedures in Italy with implementation of telehealth services.

Spotlight on the May 26 issue

#### Notable in Neurology this week This issue features an article that shows patients with cluster headaches have substantially more sickness absence and disability pension days compared to matched references; another investigates the association of aerobic exercise with improvements in cognition and cerebrovascular regulation. A featured Special Editorial discusses the effect of the global COVID-19 pandemic on the dissemination and implementation of telehealth services. ### Liver transplantation as a rescue therapy for severe neurologic forms of Wilson disease Liver transplantation (LT) for the management of patients with Wilson disease (WD) with severe neurologic worsening, but without liver failure, is controversial. Eighteen patients who underwent LT for pure neurologic indication were retrospectively studied. …

The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis.

ObjectiveAs the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake.MethodSystematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool.Findings705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking—(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of ‘work’ practices (causes burden or empowerment).ConclusionFindings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at an earlier stage of telehealth/service development.