Remote Video Visits Research Articles

Supported remote video visits for children with incarcerated parents in the United States

ABSTRACT The Enhanced Visits Model (EVM) provides support to families in the United States, including technology to connect remotely with incarcerated parents, funding for video visits, and visit coaching for adults to support relationship building with children. Such support is intended to decrease barriers to traditional visits but not replace in-person visiting. The EVM is important for parents who are in local jails, rather than prisons, since jails typically incarcerate people for less time than prisons and lack programs that often exist in prisons. This paper focuses on development of the EVM and initial results of a feasibility and acceptability study. Although some challenges exist regarding engagement of children’s caregivers and the quality of sound and visual images, families and professionals provided positive feedback about the intervention. During video visits, children interacted with their incarcerated parents in creative ways, including showing toys, playing games, singing, reading, and doing homework. Moreover, incarcerated parents were virtually present at key times, including children’s mealtimes, bedtimes, holidays, and daily routines. This paper provides evidence that remote video visits are enjoyed by families and incarcerated parents and supports the recommendation to supplement (but not replace) in-person contact with remote video visits for children and incarcerated parents.

Safety of COVID-19 mRNA vaccination in patients with history of acquired hemophilia A: a case series

Coronavirus disease 2019 (COVID-19) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection called for a specific and massive vaccination campaign. Acquired hemophilia A (AHA) is a potential life-threatening coagulopathy. Hematological- targeted autoimmune conditions including immune thrombocytopenia, vaccine-induced thrombotic thrombocytopenia and AHA emerged during large-scale vaccination against SARS-CoV-2 and contributed to vaccination hesitation. The aim of the present study was to evaluate the putative recurrence of AHA after vaccination against SARS-CoV-2 with mRNA vaccines (BNT162b2 and mRNA- 1273) in patients with relatively recent history of AHA. Thirteen patients (8 women and 5 men, mean age = 63.1±16.6 years) with AHA in the previous two-to-five years were enrolled in the study. Platelet count, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen and Factor VIII levels were evaluated 48 hours prior to each vaccine dose and 10 days post-vaccination. Clinical self-assessment and remote video visits were performed in the presence of even minor hemorrhagic signs. No major bleeding events were detected at any time-point, including evaluation at 30 days after the 3rd vaccine dose. No significant hemorrhagic changes were observed, in particular no thrombocytopenia and/or significant alterations in PTT and Factor VIII emerged across subjects. Patients with a previous history of AHA of various etiology do not seem to have an increased recurrence risk after a COVID-19 vaccination course of 3 doses with either mRNA vaccine. This finding supports this specific safety aspect in the face of the possible continuation of the vaccination campaign based on the trend of the COVID-19 pandemic.

Recruitment for Remote Decentralized Studies in Parkinson's Disease.

Background:Traditional in-person Parkinson’s disease (PD) research studies are often slow to recruit and place unnecessary burden on participants. The ongoing COVID-19 pandemic has added new impetus to the development of new research models.Objective:To compare recruitment processes and outcomes of three remote decentralized observational PD studies with video visits.Methods:We examined the number of participants recruited, speed of recruitment, geographic distribution of participants, and strategies used to enhance recruitment in FIVE, a cross-sectional study of Fox Insight participants with and without PD (n = 203); VALOR-PD, a longitudinal study of 23andMe, Inc. research participants carrying the LRRK2 G2019S variant with and without PD (n = 277); and AT-HOME PD, a longitudinal study of former phase III clinical trial participants with PD (n = 226).Results:Across the three studies, 706 participants from 45 U.S. states and Canada enrolled at a mean per study rate of 4.9 participants per week over an average of 51 weeks. The cohorts were demographically homogenous with regard to race (over 95%white) and level of education (over 90%with more than a high school education). The number of participants living in primary care Health Professional Shortage Areas in each study ranged from 30.3–42.9%. Participants reported interest in future observational (98.5–99.6%) and interventional (76.1–87.6%) research studies with remote video visits.Conclusion:Recruitment of large, geographically dispersed remote cohorts from a single location is feasible. Interest in participation in future remote decentralized PD studies is high. More work is needed to identify best practices for recruitment, particularly of diverse participants.

Convenience is Key for Patient Engagement with Remote Video Visits in a Musculoskeletal Practice.

Remote video visits (aka telemedicine, virtual care) have the potential to increase access to orthopaedic specialty evaluation while decreasing the overall cost of care. Clinical implementation of remote video visits may benefit from an understanding of potential barriers to participation. We enrolled one hundred and thirty participants from a university-based musculoskeletal clinic with a large uninsured population. We asked participants to complete a survey, including demographics and scaled perception questions about remote video visits. Data from these surveys were analyzed with multivariable logistic regression to determine factors associated with willingness to participate in video visits, as well as the situations in which patients would consider a video visit. Willingness to participate in video visits was associated with the perception of video visits being more convenient (OR 3.0) and a decreased perceived importance of physical exam (OR 0.36) but not age, technology comfort, or travel distance to the clinic. Additionally, those with prior video visit experience were more comfortable with technology, perceived video visits to be more convenient, and were more willing to have another video visit. Fifteen percent were willing to have a video visit for their first visit, while 78% would participate for a routine non-surgical follow-up. Musculoskeletal telemedicine programs can become established by focusing on people that prioritize convenience, place less importance on a hands-on exam, and are established patients.

Patient and Clinician Perceptions about Remote Video Visits for Musculoskeletal Problems: A Qualitative Study.

An understanding of patient and clinician opinions about remote video musculoskeletal consultations might help determine how to increase appeal and utilization. The purpose of this study was to evaluate perceptions of remote video musculoskeletal consultations. Our research questions was what are patient and clinician facilitators and barriers for the use of remote video consultations? Prior to the COVID-19 pandemic 27 English speaking adult patients seeking ambulatory care for a musculoskeletal problem, and 10 English-speaking musculoskeletal clinicians were interviewed using a guide. Interviews were audio-recorded, transcribed, and coded using applied thematic analysis. Patient and clinician incentives for remote video consultations included increased convenience, lower costs, less waiting time, and a better experience. Patient and clinician barriers to remote video consultations included concerns about familiarity with technology, lack of personal interaction and physical examination, inability to perform procedures, difficulties with reimbursement (clinicians), as well as technical, logistical, and privacy issues. This qualitative study performed prior to the pandemic found that adoption of remote video consultation for musculoskeletal problems may improve with seamless, efficient, and effective care, at an affordable price, particularly if the human connection is similar to what occurs in person.

Patient satisfaction assessment in telemedicine

Rationale: A new specialist telecare system, eViSuS, has been in use, in the Clinical Nutrition Service of S. Lazzaro Hospital (Alba, Italy), for the assessment and management of malnourished patients in Nursing Home through remote video-visits (VV). The target of the study is to assess patients’ satisfaction.

Telemedicine After Upper Extremity Surgery: A Prospective Study of Program Implementation

PurposeOur purpose was to evaluate the implementation of a postoperative hand and upper extremity telemedicine program. We aimed to compare travel burden, visit time, and patient satisfaction between an initial postoperative telemedicine visit and a second conventional in-clinic visit.MethodsTelemedicine guidelines established by our hospital system were used as inclusion criteria for this prospective study, which included patients indicated for surgery in the outpatient clinic during a 3-month period. Patients were excluded if they had wounds closed with nonabsorbable suture, remained admitted to the hospital, or required a custom orthosis at their first postoperative visit. Baseline demographics and patient-reported outcome measures were collected prior to surgery. Information pertaining to technology usage was collected for the telemedicine visit and travel information was obtained for the in-clinic visit. Patient satisfaction was recorded for both visits.ResultsFifty-seven of 87 patients (66%) who met the inclusion criteria elected to participate in the study. A cell phone was utilized by 89% of patients and 88% of visits were performed from the patient’s home. There were 4 technological complications during the study period (7%). Mean round-trip travel distance for the in-clinic visit was 60 miles with an average drive time of 85 minutes. Visit times were significantly shorter with telemedicine (7 minutes vs 38 minutes). Telemedicine was preferred by 90% of patients for subsequent encounters. All 4 clinical complications were recognized during the telemedicine visit.ConclusionsA telemedicine program for postoperative care after hand and upper extremity surgery decreases travel burdens associated with conventional in-clinic appointments. Telemedicine significantly decreases visit times without decreasing patient satisfaction for patients who elect to participate in remote video visits. The ability to recognize early postsurgical complications was not compromised by utilizing this technology, even during our early experience.Clinical relevanceTelemedicine after hand and upper extremity surgery results in high levels of patient satisfaction and decreases visit times and the travel burdens associated with conventional in-clinic appointments.

Tele-Urology During COVID-19: Rapid Implementation of Remote Video Visits.

COVID-19 has brought unprecedented challenges to the delivery of urological care. Following rapid implementation of remote video visits at our tertiary academic medical center serving a large rural population we describe and assess our experience with planned video visits and ongoing scheduling efforts. Patients scheduled for video visits between April 14 and April 27, 2020 were included. Prospective and retrospective data were collected on patient and clinical characteristics as well as telemedicine outcomes. Multivariable logistic regression was performed to evaluate factors influencing video visit success. Concurrently scheduling data were collected from a separate cohort regarding patient access to technology and willingness to participate in video visits. A total of 209 patients were included with an overall video visit success rate of 67%. Of video visits that failed (69) reasons included no-show (35%), inability to connect to the telemedicine platform (23%) and lack of Internet access (10%). Nearly half of failed video visits (46.4%) were completed as phone visits. After adjustment for patient demographics commercial insurance was significantly associated with video visit success. In assessment of scheduling outcomes 179 patients were contacted to offer video visits. Of these patients 6.7% reported not having Internet access. Of those with Internet access 87% agreed to proceed with a video visit in lieu of visiting in person. Our experience indicates that rapid implementation of video telemedicine is feasible and highly accepted by patients. Efforts focused on standardized pre-visit patient education may further optimize successful telemedicine visits.

Telemedicine and eConsults for Hospitalized Patients During COVID-19

Telemedicine and eConsults for Hospitalized Patients During COVID-19

MP39-01 GEOGRAPHIC DISPARITIES IN UROLOGIC CANCER MORTALITY: WHERE SHOULD WE TEST TELEMEDICINE INTERVENTIONS?

INTRODUCTION AND OBJECTIVES:Poor access to local urology care is associated with high urologic cancer mortality rates (MR). The use of remote video visits (a form of telemedicine) has been proposed...

Visitation Modality Preferences for Adults Visiting Jails

The development of technology has introduced new options for prison and jail visits, including video visits from jail lobbies and remote video from virtually anywhere. Researchers surveyed visitors to three jails who were participating in either on-site visits through Plexiglas, lobby video visits, or remote video visits. On-site Plexiglas visitors rated their visits as more stressful and time-consuming, while remote video visitors were most likely to indicate that it was difficult to locate finances for the visit. Visitors expressed a preference for contact visits but noted that remote video visits were likely to be the most convenient.

Efficiency, Satisfaction, and Costs for Remote Video Visits Following Radical Prostatectomy: A Randomized Controlled Trial

BackgroundTelemedicine in an ambulatory surgical population remains incompletely evaluated. ObjectiveTo investigate patient encounters in the outpatient setting using video visit (VV) technology compared to traditional office visits (OVs). Design, setting, and participantsFrom June 2013 to March 2014, 55 prescreened men with a history of prostate cancer were prospectively randomized. VVs, with the patient at home or at work, were included in the outpatient clinic calendar of urologists. InterventionRemote VV versus traditional OV. Outcome measurements and statistical analysisAn equivalence analysis was used to assess the primary outcome, visit efficiency as measured by time studies. Secondary outcomes were patient/provider satisfaction and costs. Results and limitationsThere were 28 VVs and 27 OVs. VVs were equivalent in efficiency to relative to OVs, as measured by patient–provider face time (mean 14.5 vs 14.3min; p=0.96), patient wait time (18.4 vs 13.0min; p=0.20), and total time devoted to care (17.9 vs 17.8min; p=0.97). There were no significant differences in patient perception of visit confidentiality, efficiency, education quality, or overall satisfaction. VVs incurred lower costs, including distance traveled (median 0 vs 95 miles), travel time (0 vs 95min), missed work (0 vs 1 d), and money spent on travel ($0 vs $48; all p<0.0001). There was a high level of urologist satisfaction for both VVs (88%) and OVs (90%). The major limitation was sample size. ConclusionsVV in the ambulatory postprostatectomy setting may have a future role in health care delivery models. We found equivalent efficiency, similar satisfaction, but significantly reduced patient costs for VV compared to OV. Further prospective analyses are warranted. Patient summaryAmong men with surgically treated prostate cancer, we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist. Video visits were associated with equivalent efficiency, similar satisfaction, and significantly lower patient costs when compared to office visits. We conclude that video visits may have a future role in health care delivery models.

Reply

We live in an era immersed in cyber technology in which video-enabled smart mobile devices have become ubiquitous. Indeed, studies have reported that more than half of all patients own a smart mobile device and up to 80% access online health information. 1 Thackeray R. Crookston B.T. West J.H. Correlates of health-related social media use among adults. J Med Internet Res. 2013; 15: e21 Crossref PubMed Scopus (190) Google Scholar In fact, in 2011, the US Secretary of Health and Human Services referred to mobile telehealth services as “the biggest technology breakthrough of our time” and maintained that its use would “address our greatest national challenge,” that is, health care access. 2 Steinhubl S.R. Muse E.D. Topol E.J. Can mobile health technologies transform health care?. J Am Med Assoc. 2013; 310: 2395-2396 Crossref PubMed Scopus (311) Google Scholar It therefore seems intuitive that such technology could provide a safe, efficient, and effective avenue for health care delivery through remote video visits (VVs). Editorial CommentUrologyVol. 85Issue 6PreviewThere is a paradigm shift taking place in medicine, and in particular, in the field of urology. We have seen urologic cases that were once open procedures and are now performed with minimally invasive surgery using laparoscopy and robotic surgery. We have seen more surgeries conducted in ambulatory surgical centers and as office procedures, such as a microwave of the prostate gland. We have gone from seeing patients one at a time to shared medical appointments,1 in which the doctor can provide care for 8-10 patients at the same time. Full-Text PDF

Are Patients Willing to Engage in Telemedicine for Their Care: A Survey of Preuse Perceptions and Acceptance of Remote Video Visits in a Urological Patient Population

To examine patient preuse acceptance and perceptions of video visit (VV) technology within an ambulatory urology setting. Patients treated by a single urology department from January to June 2013 were identified. A Web-based survey was conducted evaluating patient demographics, preuse perceptions, and acceptance of VV. In total, 1378 patients (25%) completed the survey; of which 868 (63%) were willing to participate in VV for their urologic care. Compared with patients "unlikely," those "likely" to participate in VV were younger (62 vs 65 years), had a college education (77% vs 65%), had previous exposure to videoconference technology (57% vs 38%), were more comfortable discussing new symptoms (56% vs 30%) and sensitive information (48% vs 27%), and played an active role in their healthcare (65% vs 54%). Moreover, patients willing to participate in VV traveled larger distances (>90 minutes; 69% vs 58%), missed more work (>1 day; 39% vs 29%), and incurred greater expenses for their care (>$250; 52% vs 25%) relative to those who were unlikely. After controlling for associated patient characteristics, a high level of agreement among urology-specific questions remained independently associated with greater likelihood of VV acceptance among both male and female patients. A large proportion of patients are willing to participate in VV for their urologic care. This may have significant implications by reducing costs and increasing access to, and quality of, health care services. These findings may assist urologists in strategically directing future efforts to reach diverse patient populations via VV technology.

Sustaining and realizing the promise of telemedicine.

Sustaining and realizing the promise of telemedicine.