Providing Telehealth Services Research Articles

Health Care Facility Characteristics Associated With Providing Telehealth HIV Care Services During the COVID-19 Pandemic.

Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility's own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. (Am J Public Health. Published online ahead of print January 16, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307908).

Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID-19 pandemic.

To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic. A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural-urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type. Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%-31%) than RHCs (8%-14%) in 2020-2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers.Overall, 19%-34% of originating site providers were psychiatrists and 10%-31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020-2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%-15.8% in rural) followed by rural ID_RHCs (10.2%-11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic. Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020-2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.

Roles of Pharmacy, Medicine, Nursing, Laboratory, Anesthesia, Urology, Public Health, and Occupational Health, Infection Control, and Hospital Management, in the Integration of Telehealth in Saudi Arabia: A Comprehensive Review

Different sectors have contributed to successfully integrating telehealth services into the Saudi healthcare system during the emergent need for high-quality health services. Hence, this review attempts to assess different sectors and their professionals for their contribution toward the implementation and sustainability of telehealth services, including pharmacy, medicine, nursing, laboratory services, anesthesia, urology, public health, occupational health, infection control, and hospital management. Each sector offers a unique contribution to the emergence and continuity of telehealth services, and physicians have implemented telehealth for diagnosis while maintaining chronic patients at home with distant control. Pharmacists have started providing medication support through telehealth, and physicians have extended their use by treating chronic patients through teleconsulting. Hospital nurses have improved their professional access by providing virtual education and consulting to treat chronic patients. Laboratory services enable fast and accurate diagnosis, and anesthesiologists have begun to use it for preoperative and postoperative assessments. Urologists have integrated telehealth into the management of chronic patients. Public health professionals provide telehealth services for health promotion, disease prevention, and management. Occupational health practitioners provided remote ergonomic consultation. Infection prevention and control teams delivered training sessions and telehealth surveillance of hygiene-related practices. In addition, initiatives to plan and create a system for telehealth implementation are a significant contribution to hospital management. The incorporation of telehealth across professional silos has increased the quality-of-care delivery, enhanced patient empowerment, and built system resilience in Saudi Arabia. This multidisciplinary collaboration thus underscores how furthering telehealth services can only be realized through cooperation to ensure equitable access and advance healthcare modernization under any national initiative.

Crossroads of Care: A Black Social Worker’s Insights into the Lives of Black Men from Adolescence to Adulthood

ABSTRACT This autoethnographic study, “Crossroads of Care: A Black Social Worker’s Insights into the Lives of Black Men from Adolescence to Adulthood,” explores the intersections of race, education, and mental health throughout the life course of Black men. Drawing on varied professional and personal experiences – from providing telehealth services for college students to being a resource within a predominantly Black high school – the research illuminates systemic barriers and profound effects of marginalization and isolation. Emphasizing evidence-based social work interventions and culturally relevant care, the study underscores the importance of narrative therapy and self-disclosure in addressing Black men’s multifaceted needs. The findings contribute to discussions on racial equity in mental health and education, offering actionable recommendations for practitioners, policymakers, and educators to strengthen support systems. Advocating for a comprehensive care model, this research endeavors to empower Black men across various life milestones, enhancing well-being by addressing the complexities of race, education, and mental health.

Secure Cloud Services for the Healthcare Industry: Addressing Unique Challenges and Ensuring Compliance

Abstract: The healthcare industry is increasingly adopting cloud computing to manage patient data, provide telehealth services, and support remote work. However, this adoption presents unique challenges due to stringent regulations governing the handling of personal health information (PHI), such as HIPAA in the United States and GDPR in the European Union. Noncompliance with these regulations can result in significant financial penalties, reputational damage, and loss of patient trust. This article explores the specific data security needs of the healthcare industry, the challenges in adopting cloud services, and the essential features of secure cloud services tailored for healthcare. It also discusses the integration of artificial intelligence (AI) and automation in cloud services to enhance data security and operational efficiency, as well as future trends in cloud computing for healthcare, such as the increasing adoption of AI and machine learning for predictive analytics and automated threat detection. By providing a comprehensive overview of the data security needs, challenges, and solutions in adopting cloud services for healthcare, this article aims to assist healthcare organizations in making informed decisions when considering the adoption of cloud services and to highlight the importance of prioritizing data security and compliance in the digital transformation of the healthcare industry.

Alignment of Canada's COVID-19 policy response with barriers and facilitators for coping reported by caregivers of youth with developmental delays, disorders, and disabilities.

The UNICEF-WHO Global Report on Developmental Delays, Disorders, and Disabilities is an ongoing initiative aimed at increasing awareness, compiling data, providing guidance on strengthening health systems, and engaging country-level partners. Data from its caregiver survey assessing impacts of the COVID-19 pandemic showed that half of youths with developmental delays and disabilities (DDDs) and their caregivers struggled to cope, with a significant portion reporting a lack of supports and difficulty managing the worsening of the child's symptoms in isolation. Governments created service strategies supporting vulnerable groups. Little is known about the alignment between COVID-19 policies for persons with disabilities and their lived experiences. Contextualizing caregivers' experiences can promote the development of tailored public supports for these families following a public health crisis. Online survey data were collected from June-July 2020, leading to a convenience sample of caregivers of youth with DDDs across Canada. Respondents answered two open-ended questions regarding challenges and coping strategies during the pandemic. We conducted a thematic analysis of responses using inductive coding on NVivo software. Overarching codes derived from the dataset were contextualized using an analysis of provincial policies published during the pandemic. Parallels with these policies supported the exploration of families' and youths' experiences during the same period. Five hundred and seventy-six (N = 576) participants answered open-ended questions. Barriers to coping included family mental health issues, concerns about the youths' regression, challenges in online schooling, limited play spaces, and managing physical health during quarantine. Environmental barriers encompassed deteriorating family finances, loss of public services, and a lack of accessible information and supports. In contrast, caregivers reported coping facilitators, such as family time, outdoor activities, and their child's resilience. Environmental facilitators included community resources, public financial supports, and access to telehealth services. Few COVID-19 policies effectively addressed caregiver-identified barriers, while some restrictions hindered access to facilitators. Prioritizing needs of families of youths with DDDs during public health emergencies can significantly impact their experiences and mental health. Enhancing financial benefits, providing telehealth services, and creating inclusive public play spaces are priority areas as we navigate the post-pandemic landscape.

A service provider’s experience providing telehealth services during the COVID-19 pandemic in a community-based opioid substitution clinic in Bangladesh

Abstract Introduction The COVID-19 pandemic incurred numerous impediments on day-to-day emergency medical services including Opioid Substitution Therapy (OST) for People Who Inject Drugs (PWID). To prevent treatment cessation and lost to follow-up, we tried to implement an alternate mitigating intervention like telehealth. Methodology This research was conducted on a cohort of OST clients during the COVID-19 pandemic ( from 1st April 2020 to 31st March 2021) in Narayanganj, a port city adjacent to the capital Dhaka and one of the most COVID-affected districts, with a high PWID and HIV burden. The participants were male, female and transgender women who were all ex-PWID and were under OST services. A telehealth intervention model was designed and implemented in the OST clinic at Narayangonj. Quantitative data were collected during pre and post-intervention of telehealth services. Results A total of 297 OST clients of Narayangonj were provided with telehealth services from April 2020 to March 2021. The participants were predominantly male (98.7%), 37.7% were between 30–39 years of age. 39.4% of the telephone calls were related to COVID-19-related symptoms followed by 21.7% for opioid withdrawal, 12.5% for COVID-19 & vaccine-related information, 11.3% for chronic diseases like diabetes, hypertension and asthma, 9.3% for Skin and Soft Tissue Infection (SSTI), and 5.8% for methadone-related effects. There was an improvement in treatment retention (14.4% to 87%), loss to follow-up (20% to 8%), and overdose-related death (1.3% to 0%) from pre to post intervention of telehealth services. Conclusion From our experience, we found that the telehealth intervention is beneficial for the OST clients and thus ensures treatment continuity and retention, both of which serve as crucial success indicators of the OST programme. Using simply the mobile phone, this intervention can reduce structural and logistical needs like clinic spaces and fewer human resources, ensuring cost-effectiveness and value for money.

Co-development and evaluation of the Musculoskeletal Telehealth Toolkit for physiotherapists.

In-person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time-intensive responsibilities. The COVID-19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co-developed and evaluated a web-based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions. A mixed-methods exploratory sequential design applied modified experience-based co-design methods (physiotherapists [n=13], clinic administrators [n=2], and people with musculoskeletal conditions [n=7]) to develop an evidence-informed toolkit. Semi-structured workshops were conducted, recorded, transcribed, and thematically analysed, refining the toolkit prototype. Subsequently, the toolkit was promoted via webinars and social media. The usability of the toolkit was examined with pre-post surveys examining changes in confidence, knowledge, and perceived telehealth competence (19 statements modelled from the theoretical domains framework) between toolkit users (>30min) and non-users (0min) using chi-squared tests for independence. Website analytics were summarised. Twenty-two participants engaged in co-design workshops. Feedback led to the inclusion of more patient-facing resources, increased assessment-related visual content, streamlined toolkit organisation, and simplified, downloadable infographics. Three hundred and twenty-nine physiotherapists from 21 countries completed the baseline survey, with 172 (52%) completing the 3-month survey. Toolkit users had greater improvement in knowledge, confidence, and competence than non-users in 42% of statements. Seventy-two percentage of toolkit users said it changed their practice, and 95% would recommend the toolkit to colleagues. During the evaluation period, the toolkit received 5486 total views. The co-designed web-based Musculoskeletal Telehealth Toolkit is a professional development resource that may increase physiotherapist's confidence, knowledge, and competence in telehealth.

Experiences of nurse practitioners with telehealth during the COVID-19 pandemic.

The COVID-19 pandemic brought many changes to the way nurse practitioners (NPs) provided care for patients, including the explosive and instantaneous use of telehealth in lieu of face-to-face services to maintain safe health care access and provision for patients and providers. Although the literature abounds with patient perspectives and benefits of telehealth, little is found about the perceptions and experiences of NPs providing telehealth services during this time when telehealth was the primary care mode of providing nonacute care. This mixed-methods, descriptive, exploratory study describes demographic and quantitative data about telehealth experiences collected from NPs across the nation early in the pandemic during fall 2020, and similar quantitative data collected later in spring 2021 from NPs in one state. Significant findings between the 2020 national and 2021 state NP data include years of NP experience and the NP perceived barriers in the provision of telehealth services. Major patient-centric telehealth barriers were patient comfort with and accessibility to telehealth software. Major NP perceived telehealth barriers were regulatory laws, difficulty including telehealth visits into workflow when seeing patients in person, and comfort using telehealth software. Specific strategies can help to overcome identified telehealth barriers.

Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022

Although telehealth services expanded rapidly during the COVID-19 pandemic, the association between state policies and telehealth availability has been insufficiently characterized. To investigate the associations between 4 state policies and telehealth availability at outpatient mental health treatment facilities throughout the US. This cohort study measured whether mental health treatment facilities offered telehealth services each quarter from April 2019 through September 2022. The sample comprised facilities with outpatient services that were not part of the US Department of Veterans Affairs system. Four state policies were identified from 4 different sources. Data were analyzed in January 2023. For each quarter, implementation of the following policies was indexed by state: (1) payment parity for telehealth services among private insurers; (2) authorization of audio-only telehealth services for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries; (3) participation in the Interstate Medical Licensure Compact (IMLC), permitting psychiatrists to provide telehealth services across state lines; and (4) participation in the Psychology Interjurisdictional Compact (PSYPACT), permitting clinical psychologists to provide telehealth services across state lines. The primary outcome was the probability of a mental health treatment facility offering telehealth services in each quarter for each study year (2019-2022). Information on the facilities was obtained from the Mental Health and Addiction Treatment Tracking Repository based on the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Service Locator. Separate multivariable fixed-effects regression models were used to estimate the difference in the probability of offering telehealth services after vs before policy implementation, adjusting for characteristics of the facility and county in which the facility was located. A total of 12 828 mental health treatment facilities were included. Overall, 88.1% of facilities offered telehealth services in September 2022 compared with 39.4% of facilities in April 2019. All 4 policies were associated with increased odds of telehealth availability: payment parity for telehealth services (adjusted odds ratio [AOR], 1.11; 95% CI, 1.03-1.19), reimbursement for audio-only telehealth services (AOR, 1.73; 95% CI, 1.64-1.81), IMLC participation (AOR, 1.40, 95% CI, 1.24-1.59), and PSYPACT participation (AOR, 1.21, 95% CI, 1.12-1.31). Facilities that accepted Medicaid as a form of payment had lower odds of offering telehealth services (AOR, 0.75; 95% CI, 0.65-0.86) over the study period, as did facilities in counties with a higher proportion (>20%) of Black residents (AOR, 0.58; 95% CI, 0.50-0.68). Facilities in rural counties had higher odds of offering telehealth services (AOR, 1.67; 95% CI, 1.48-1.88). Results of this study suggest that 4 state policies that were introduced during the COVID-19 pandemic were associated with marked expansion of telehealth availability for mental health care at mental health treatment facilities throughout the US. Despite these policies, telehealth services were less likely to be offered in counties with a greater proportion of Black residents and in facilities that accepted Medicaid and CHIP.

HIPAA Compliance for Telehealth to Be Required Again on August 9

Back to table of contents Next article Government & LegalFull AccessHIPAA Compliance for Telehealth to Be Required Again on August 9Mark MoranMark MoranSearch for more papers by this authorPublished Online:31 May 2023AbstractHIPAA compliance is about more than just technology—it also means having physical or environmental and process security measures in place. A business associate agreement with a vendor may be necessary to ensure compliance with HIPAA.The federal Office of Civil Rights (OCR) in April extended the deadline for requiring telehealth compliance with the Health Insurance Portability and Accountability Act (HIPAA) by 90 days to August 9.At that time, health care professionals practicing telehealth must comply with HIPAA’s Security Rule and will no longer be able to use standard video technologies such as Zoom, Skype, or Facebook to meet with patients, as they had been allowed to do during the Public Health Emergency (PHE), which ended on May 11. Even before the new deadline, psychiatrists and other health care professionals need to pay attention to state rules about HIPAA compliance as well as the requirements of their institution, organization, or practice.“Best practices to ensure environmental privacy include clinicians connecting from a private space and letting patients know if there are others in the room with them,” said Shabana Khan, M.D. “This demonstrates to patients that their telehealth clinician values protecting their health information.”“OCR is providing this transition period to allow health care practitioners and practices to make necessary changes to ensure that their telehealth technologies are private and secure in a way that is adherent with HIPAA rules,” said Shabana Khan, M.D., chair of the APA Committee on Telepsychiatry. “Though OCR has provided this 90-day transition period through August 9, telehealth clinicians must also consider state rules and practice or organization requirements when deciding which technologies to use for telehealth services. We have this flexibility at the federal level, but an organization may require that their clinicians use approved HIPAA-adherent technologies.”HIPAA, which was signed in 1996 by President Bill Clinton, sets national standards for health information protections. The U.S. Department of Health and Human Services (HHS) established these standards to ensure protected health information (PHI) processed and utilized by “covered entities” is private and secure. OCR is responsible for implementing and enforcing this rule. HIPAA requirements cover a broad range of patient data and information, including making an appointment, conducting the appointment, and billing the patient’s insurance.HIPAA encompasses two major rules: the Privacy Rule and the Security Rule. The Privacy Rule protects all identifiable data of an individual patient; the Security Rule, a subset of the Privacy Rule, protects information that a covered entity creates, receives, maintains, or transmits in electronic form.So what does it mean to be HIPAA compliant when providing telehealth services? Importantly, it’s not just about technology. It also means having physical or environmental and process security measures in place to ensure that only those who are supposed to have access to patients’ information are able to get it.“Environmental privacy best practices include clinicians connecting from a private space and letting patients know if there are others in the room with them—for instance, a nurse or medical student who may be off screen,” Khan said. “Clinicians should also provide guidance to their patients on the importance of connecting to telehealth visits from a private space and avoiding public or semi-public settings. Clinicians can also ask patients if there is anyone in the room with them at the start of the visit. This demonstrates to patients that their telehealth clinician values protecting their health information.”Technology features that can help a HIPAA-covered entity meet compliance requirements include the following:Fully encrypted data transmission.Additional authentication and security through required passwords.Secure point-to-point connection.Private high-speed network.Administrative, physical, and technical safeguards for electronic protected health information.Audit controls.Breach notification.John Torous, M.D., chair of the APA Committee on Mental Health IT, said psychiatrists must use vendors of telehealth technology who can assure HIPAA compliance and have a signed business associate agreement (BAA).“Often you can use the same product (such as Zoom) without a BAA, but to make it HIPAA complaint, a psychiatrist needs to use the version of Zoom that requires the signature of a BAA,” he wrote in an email. “Regardless of the technology, being HIPAA complaint means the psychiatrist still has to offer reasonable physical safeguards (such as keeping computer passwords secure) and have process safeguards in place too (restricting access to patient files, creating plans for appropriate use of data).” ■ResourcesHHS Office for Civil Rights AnnouncementHIPAA & HIT: A PrimerSummary of the HIPAA Privacy RuleThe Security Rule ISSUES NewArchived

533 Medical Photo Application–Delivering Expert Burn Care in the Intermountain West

Abstract Introduction As the only verified Burn Center in the Intermountain West, we are faced with the challenge of providing care and support to a referral area spanning five states. In an effort to make consulting with our Burn Center more efficient and direct, we provide TeleHealth services. We typically provide real-time facility-to-facility consultation, facility-to-patient consultation, phone consultation, and photo consultation. Prior to development of our medical photo application (MedPic app), photo consults were completed via encrypted email. The consult process was inefficient resulting in multiple phone calls for one consult. As a result, we received requests to improve the process, making it more user friendly and HIPPA compliant. Initially, our Burn Center created a photo consultation website that enabled referring providers to go to a webpage and upload photos. The consult began with a phone call from the referring provider. The Burn Center staff would inform the referring provider of the photo website and the referring provider would upload the photos. This improved the photo consult process, however it was still inefficient. Based on these requests from our referring providers, staff, and patients, we developed the MedPic app. With the new MedPic app, we provide an easy to access and efficient process to consult with our Burn center; thus improving efficiency, reducing unnecessary hospital admissions, and associated medical transport costs. Methods The photo app was created and made available in March of 2020. The app streamlined the consult process by creating a direct link from referring providers to Burn providers. Burn providers receive images as soon as they are uploaded through the app. The MedPic app is a photo consultation tool and requires three steps: 1. Take photos of the wounds; 2. Enter patient information; and 3. Enter a return call back number. A plan of care is communicated back to the referring provider within 30 minutes. Photos taken within the app are not saved to any device. The images are encrypted to protect patient information making the app HIPPA compliant. We collected encounter data generated by photo consultation to our burn center prior to and after the MedPic app development (January 2016- September 2022). Results Since the MedPic app was released in March of 2020 we have noted 2,071 app downloads and have seen a steady increase in photo consultations. Figure 1 shows the total number of photo consultations to our Burn Center from January 2016 through September 2022. Conclusions Our Burn Center created the MedPic app resulting in over 2,000 downloads. The app is integrated into our Burn Center Telehealth consultation workflow. By providing a direct approach to acute burn injury consultations, we are able to efficiently assess patient wounds and ensure the patient receives the level of care they need in a timely manner. Applicability of Research to Practice This directly impacts triage and management of outpatient acute burn injuries.

Delivery of Exposure and Response Prevention Among Veterans with Obsessive-Compulsive Disorder.

Veterans with obsessive-compulsive disorder (OCD) often face barriers to receiving evidence-based treatments such as exposure and response prevention (ERP). Through retrospective review of electronic medical records, this study examined the rates of ERP delivery in a national sample of 554 veterans newly diagnosed with OCD in the Veterans Health Administration between 2016 and 2017. Results indicated that only 4% of veterans (n = 22) received any ERP treatment; and, of those, 16 veterans received "true ERP." Veterans who received any ERP were younger than those who did not. ERP was primarily delivered by psychologists in urban facilities along the East and West coasts of the USA. The findings from this study emphasize the need to train more providers to effectively deliver ERP in addition to providing telehealth services to increase access to care for veterans in rural areas.

Utilizing Telehealth to Meet the Needs of Rural Veterans: Introduction the VA's Clinical Resource Hubs Geriatric Mental Health Programs

The Department of Veterans Affairs Clinical Resource Hubs (CRHs) offer a variety of telehealth initiatives designed to expand access to care. Each VA Integrated Service Network (VISN) or region has its own CRH to provide telehealth services to veterans residing in that region. Many older veterans receiving services through the telemental health programs reside in rural areas, with limited access to specialty care. Several CRHs offer geriatric mental health consults to expand older veterans’ access to specialty mental health treatment. By utilizing telehealth consultations, older veterans are able to receive high quality mental health care in their homes or at small local clinics.At this time, the CRHs serving VISN 9 (Tennessee and Kentucky), VISN 23 (North Dakota, South Dakota, Nebraska, Iowa, and Minnesota), VISN 1 (New England), VISN 20 (Washington, Oregon, Idaho and Alaska), and VISN 4 (Pennsylvania) offer specialized geriatric mental health services. All of these CRHs offer consultative care with exception of VISN 20, which offers fully virtual continuity clinics to highly underserviced areas within that region. VISN 23 was the first region to offer such a program and has been in operation through the CRH since 2018 (although its geriatric psychiatrist was providing consultative telehealth services prior to that). VISN 9, VISN 20, and VISN 1 began program development and services in 2021. The programs receive additional support from the VA Office of Rural Health, which has also funded a program evaluation team.Each region's geriatric mental health program has a geriatric psychiatrist as well as additional team members with geriatric specialty experience in various fields such as psychology, pharmacy, neuropsychology, internal medicine, and nursing. Care is provided through a range of modalities, including electronic consultations (e-consults), direct to home video visits, video visits at local clinics and inpatient/residential settings, and telephone evaluations. A range of diagnosis and concerns are addressed including, but not limited to, dementia diagnosis and management, caregiver support, treatment of complex psychiatric conditions in late life, and capacity. Veterans residing in outpatient, inpatient, and VHA residential/long term care settings are all eligible for care through CRH programs. Although these programs share a common goal to expand access to geriatric mental health treatment, each program operates uniquely, with different models of care based on the needs of their region's specific population. Our session will start by highlighting the care offered by CRHs and the VA Office of Rural Health's program evaluation research. The geriatric psychiatrist from VISN 9, VISN 23, and VISN 1 will present the specifics of their program, focusing on program development, types of care provided, and population served.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Usability of telehealth among healthcare providers during COVID-19 pandemic in Nineveh Governorate, Iraq

ObjectivesTo identify the usability of telehealth services and barriers during the coronavirus disease (COVID-19) pandemic among healthcare providers in Nineveh Governorate-Iraq. Study designThis was a multicenter cross-sectional survey. MethodsWe collected the required data from April to July 2022 using self-administered open-ended questionnaires. The healthcare providers were physicians, pharmacists, and nurses with at least six months of services at hospitals. A modified form of the Telehealth Usability Questionnaire (TUQ) was used to assess the usability of telehealth services. ResultsThere were 460 healthcare providers, of which 269/460 (58.5%) were users of telehealth services. These were mostly physicians (n = 167/269, 62.1%), nurses (52/269, 19.3%), and pharmacists (n = 50/269, 18.6%), with a p-value of 0.001. During the COVID-19 pandemic, physicians (n = 100/167, 60.0%) and pharmacists (n = 28/50, 56.0%) increased their provision of telehealth services. Approximately 60% of physicians and nurses preferred to provide telehealth services in a synchronized manner. The participants mostly used smartphones to provide telehealth services through Messenger/Facebook and WhatsApp applications, specifically utilizing voice and/or video messages. There was some agreement among the participants (n = 269) regarding the usability of telehealth services. The overall mean score (±SD) was 4.8 (±0.88). The most reported barriers to telehealth services were poor Internet services, the presence of specific diseases, lack of technical comprehension, and insufficient time allocated to the service. ConclusionHealthcare providers demonstrated a tendency towards the usability of telehealth services. Despite the available barriers, triage collaborations among patients, healthcare providers, and healthcare institutions are needed to achieve more successful adoption of these services.

An investigation into the digitalisation of New Zealand general practice services during COVID-19.

This study investigates the digital transition initiated by the onset of the COVID-19 pandemic and the factors that enabled the digitalisation of general practices (GPs) in New Zealand. Using a multiple case study design, we conducted 86 in-depth interviews with staff from 16 GP centres in New Zealand. The critical enablers of digital transition in response to the pandemic were support from the community, agility and adaptability of GP medical centres and the ability to pragmatically create external operational processes to ensure business continuity and to meet patient expectations. Major barriers to digitalisation at the early stage of the COVID-19 pandemic (28 February to 30 August 2020) included lack of organisational leadership, financial support availability, systems management collaboration, and patient and staff knowledge and preferences. Digitalisation was characterised by the GP centre's ability to provide telehealth services using existing systems and technology, embracing e-prescription, e-referrals, e-lab and video-only consults. The decision to adopt digitalisation had a significant impact on GP centres, disrupting the norm but also allowing continued access to health services to patients who were the most vulnerable during the pandemic. The pandemic forced GP medical centres to change to digitalisation and led to significant changes in GP medical centres' business models. However, it remains to be seen how the rapid change effected at this time correlates with patient satisfaction and how the digitalisation capabilities that have been built impact on future primary care services. This study suggests that changes brought about by COVID-19 may pave the way to an expansion of GP telehealth services, which has the potential to permanently change the primary care landscape.

A mixed-methods examination of clinicians' perceived barriers to telehealth delivered applied behavior analysis.

Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.

How Has the Code of Ethics Weathered COVID-19?

Countries, communities, institutions, families, and individuals all live by a code of ethical standards. Social work takes pride in conducting itself according to a set of written ethical principles and standards that are derived from the core values of the profession. Depending on the state, the Code of Ethics, or parts thereof, may have the force of law. To ensure that the Code remains relevant it must have an inherent character that is neither too rigid nor too flexible, and it must be interpreted in such a way as to reflect the constantly changing dynamics and pressures of the social work profession and society. The COVID-19 pandemic has surely tested the mettle of the Code, as practitioners began to provide telehealth services, with or without weighing important practice provisions, core values, ethical principles and standards, and critical areas of knowledge. The article seeks to examine existing interpretations of the Code and the influence they have on social work practice during the pandemic. Most importantly, the article aims to broaden practitioners’ awareness and judgement regarding ethical and legal duties in social work practice. Keywords: Code of Ethics, COVID-19, social work practice, ethical decision-making processes

The Future of Nursing 2020–2030: Charting a path to achieve health equity

The Future of Nursing 2020–2030: Charting a path to achieve health equity