Shift In Health Care Delivery Research Articles

Analyzing the Public Health Impact of Adopting Telehealth after a Pandemic: A Business Model

Abstract: In response to the global shift in healthcare delivery due to the COVID-19 pandemic, this study investigates the adoption of telehealth technologies and assesses their long-term sustainability within new public health paradigms. Telehealth, accelerated by the pandemic's demands, offers a unique perspective on evolving healthcare delivery methods that emphasize accessibility and efficiency. By employing a mixed-methods approach, which synthesizes quantitative data with qualitative insights from various stakeholders, this research evaluates how telehealth has enhanced the delivery of medical services, especially in remote and underserved communities. Despite challenges related to technological infrastructure and regulatory constraints, our analysis of revenue models and cost-benefit evaluations suggests that telehealth is economically feasible and possesses significant market potential. The findings advocate for robust policy support and technological investment to enhance global telehealth accessibility and implementation. Additionally, the study highlights the necessity of expanding educational training for healthcare professionals to effectively adapt to telehealth systems. These strategic measures are pivotal for promoting the widespread application and sustainable development of telehealth, positioning it as a cornerstone in the future landscape of global healthcare. Continued research is recommended to further refine telehealth models and develop comprehensive frameworks that address emerging healthcare challenges and disparities.

Shifting Compensation: The Transition From Traditional to Nontraditional Healthcare

Transformative shifts in healthcare delivery and provider compensation are reshaping the landscape of modern healthcare. This change is driven by the emergence of nontraditional healthcare models such as telehealth and retail clinics. These disruptors have gained significant traction, especially in recent years, as patients increasingly seek convenient and accessible avenues for receiving medical care.

Conceptualization and establishment of value-based healthcare in Saudi Arabia: A scoping review

ObjectivesValue-based healthcare (VBHC) represents a paradigm shift in healthcare delivery through optimizing patient outcomes relative to the costs of achieving those outcomes. This scoping review is aimed at revealing critical insights into the conceptualization and establishment of VBHC in the context of Saudi Arabia, a nation in a critical stage of healthcare transformation. MethodsA scoping review was conducted by using online databases and official websites with a timeframe of 2017–2023. This review included 14 pieces of literature, comprising six research articles, six government documents, and two reports. ResultsThe findings highlight increasing alignment with the definition of global VBHC principles, notably the emphasis on patient outcomes as a primary metric of healthcare value. Furthermore, financial reform has signaled a real move toward VBHC in the Kingdom, through a gradual shift from volume-based payments to value-based payments. However, the diverse interpretations and applications of VBHC across the examined literature indicate a promising stage of implementation characterized by evolving definitions and practices tailored to local needs and constraints. ConclusionThis scoping review describes the current landscape of VBHC conceptualization and establishment, highlighting the substantial progress achieved and the future challenges.

Advancements in Interventional Pulmonology: Harnessing Ultrasound Techniques for Precision Diagnosis and Treatment.

Medical ultrasound has emerged as an indispensable tool within interventional pulmonology, revolutionizing diagnostic and procedural practices through its non-invasive nature and real-time visualization capabilities. By harnessing the principles of sound waves and employing a variety of transducer types, ultrasound facilitates enhanced accuracy and safety in procedures such as transthoracic needle aspiration and pleural effusion drainage, consequently leading to improved patient outcomes. Understanding the fundamentals of ultrasound physics is paramount for clinicians, as it forms the basis for interpreting imaging results and optimizing interventions. Thoracic ultrasound plays a pivotal role in diagnosing conditions like pleural effusions and pneumothorax, while also optimizing procedures such as thoracentesis and biopsy by providing precise guidance. Advanced ultrasound techniques, including endobronchial ultrasound, has transformed the evaluation and biopsy of lymph nodes, bolstered by innovative features like elastography, which contribute to increased procedural efficacy and patient safety. Peripheral ultrasound techniques, notably radial endobronchial ultrasound (rEBUS), have become essential for assessing pulmonary nodules and evaluating airway structures, offering clinicians valuable insights into disease localization and severity. Neck ultrasound serves as a crucial tool in guiding supraclavicular lymph node biopsy and percutaneous dilatational tracheostomy procedures, ensuring safe placement and minimizing associated complications. Ultrasound technology is suited for further advancement through the integration of artificial intelligence, miniaturization, and the development of portable devices. These advancements hold the promise of not only improving diagnostic accuracy but also enhancing the accessibility of ultrasound imaging in diverse healthcare settings, ultimately expanding its utility and impact on patient care. Additionally, the integration of enhanced techniques such as contrast-enhanced ultrasound and 3D imaging is anticipated to revolutionize personalized medicine by providing clinicians with a more comprehensive understanding of anatomical structures and pathological processes. The transformative potential of medical ultrasound in interventional pulmonology extends beyond mere technological advancements; it represents a paradigm shift in healthcare delivery, empowering clinicians with unprecedented capabilities to diagnose and treat pulmonary conditions with precision and efficacy. By leveraging the latest innovations in ultrasound technology, clinicians can navigate complex anatomical structures with confidence, leading to more informed decision-making and ultimately improving patient outcomes. Moreover, the portability and versatility of modern ultrasound devices enable their deployment in various clinical settings, from traditional hospital environments to remote or resource-limited areas, thereby bridging gaps in healthcare access and equity.

Implementation of Telemedicine in Medical Practice: Opportunities and Barriers

The integration of telemedicine into medical practice represents a transformative shift in healthcare delivery, offering both unprecedented opportunities and encountering significant barriers. This journal article explores the implementation of telemedicine, examining the multifaceted landscape of benefits and challenges associated with its adoption in medical settings. The opportunities presented by telemedicine include enhanced accessibility to healthcare services, especially in remote or underserved areas, improved patient outcomes through timely interventions, and increased efficiency in healthcare delivery. Telemedicine also facilitates remote patient monitoring, teleconsultations, and the exchange of medical information, contributing to a more patient-centric and adaptable healthcare system. However, the implementation of telemedicine faces several barriers, including regulatory complexities, concerns about data security and privacy, technological infrastructure limitations, and the need for healthcare professionals to adapt to new modes of communication. Cultural and organizational resistance further complicates the seamless integration of telemedicine into established medical practices. The article critically analyzes case studies and global implementations of telemedicine, highlighting successful models and lessons learned. It emphasizes the importance of policy frameworks, standardization, and ongoing training for healthcare providers to optimize the benefits of telemedicine while mitigating potential risks.

The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis.

Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor's clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor's credentials and accomplishments patients prioritize during their selection process. Our primary aim is to delve deeper into the correlation between physicians' static characteristics-such as their qualifications, experiences, and profiles on the internet-and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction. We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors' internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice. The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (ρ=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001). Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction.

Exploratory Factor Analysis on Acceptance of Artificial Intelligence as Online Healthcare Product Sales Advisor Among Consumers of Guardian Pharmaceutical Outlets in Malaysia

Switching from human to artificial intelligence (AI) as online health sales advisors significantly impact sales. AI has been shown to influence customer purchases and adapt quickly to changes in online retail. While AI enhances efficiency and personalisation in sales, it also introduces ethical dilemmas, such as job loss and bias, alongside consumer scepticism about its accuracy and trustworthiness. Integrating AI into pharmacy practices demands a deep understanding of its effects on pharmacists’ roles, signaling a significant shift in healthcare delivery. This study aims to explore and confirm the seven Unified Theory of Acceptance and Use of Technology 1 (UTAUT1) construct as a robust framework that can be utilized in the consumer acceptance of AI technologies in healthcare retail settings. The participants in the study were patrons of the Guardian Pharmacy in the Klang Valley region. The research team modified 46 questions from an earlier study, employing a dual translation method that involved translating the questionnaire from English to Malay and then back to English to better align with the demographics of the study group. The experts assessed and authenticated these revised statements to ensure their relevance and accuracy, focusing on content and appearance authenticity. The study analyzed and confirmed 103 responses using the exploratory factor analysis (EFA) technique. The EFA results indicated that each construct’s items were grouped into one component with factor loading higher than 0.6, with the total variance explained ranging from 69% to 90% and overall internal reliability of 0.944. This study enriches existing knowledge by validating the UTAUT1 framework as a robust framework in assessing consumer acceptance towards AI integration in healthcare sales, marking a significant shift in healthcare delivery and underscoring the need for a nuanced understanding of AI’s implications on pharmacists’ roles amidst ethical and consumer.

Translating Ideas into Commercial Biomaterial Devices: A Path to Improving Healthcare.

The medical device industry is undergoing substantial transformations, looking to face the increasing pressures on healthcare systems and fundamental shifts in healthcare delivery. There is an ever-growing emphasis on identifying underserved clinical requirements and enhancing industry-academia partnerships to accelerate innovative solutions. In this context, an analysis of the requirements for translation, highlighting support and funding for innovation to transform an idea for a biomaterial device into a commercially available product, is discussed.

Primary Care Providers' Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic.

The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic. Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis. The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education. This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.

The Integration and Application of Extended Reality (XR) Technologies within the General Practice Primary Medical Care Setting: A Systematic Review

The COVID-19 pandemic instigated a paradigm shift in healthcare delivery with a rapid adoption of technology-enabled models of care, particularly within the general practice primary care setting. The emergence of the Metaverse and its associated technology mediums, specifically extended reality (XR) technology, presents a promising opportunity for further industry transformation. Therefore, the objective of this study was to explore the current application and utilisation of XR technologies within the general practice primary care setting to establish a baseline for tracking its evolution and integration. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted and registered with the international database of prospectively registered systematic reviews as PROSPERO-CRD42022339905. Eleven articles met the inclusion criteria and were quality appraised and included for review. All databases searched, inclusive of search terms, are supplied to enhance the transparency and reproducibility of the findings. All study interventions used virtual reality technology exclusively. The application of virtual reality within the primary care setting was grouped under three domains: (1) childhood vaccinations, (2) mental health, and (3) health promotion. There is immense potential for the future application of XR technologies within the general practice primary care setting. As technology evolves, healthcare practitioners, XR technology specialists, and researchers should collaborate to harness the full potential of implementing XR mediums.

Integration of Person-Centered Narratives Into the Electronic Health Record.

Care delivery that is not person-centered has been called discordant care . There has been a shift to incorporate more of a person's narrative into their individual healthcare treatment plan to reduce discordant care. Aligning with this shift in healthcare delivery, we developed a person-centered narrative intervention (PCNI) to address existing gaps in delivery of person-centered care. This study aimed to evaluate the feasibility of conducting a randomized study and describe the outcomes of PCNI to usual care on the following person (patient)-reported outcomes: perceptions of the quality of communication with their nurses and their psychosocial and existential well-being. This study's design was an Obesity-Related Behavioral Intervention Trials model Phase II proof-of-concept randomized study. The participants were people admitted to an acute care hospital diagnosed with heart failure and/or end-stage renal disease. Despite COVID-19 challenges, the PCNI was feasible in an acute care setting; it showed a moderate positive difference between conditions in the person's perception of their quality of communication and a small positive difference in their perception of feeling heard and understood. For our secondary outcomes of anxiety, depression, and psychosocial illness effect, there were small or no effects in the acute care setting. Using a person-centered narrative, such as the PCNI, can help inform delivery of care that incorporates a person's (patient's) beliefs, values, and preferences into their healthcare. This study used a pragmatic approach to evaluate the PCNI in real time in an acute care setting to assess patient-reported outcomes. These positive results in a small sample indicate the need for continued testing of the PCNI. These promising effects require further testing in a Phase III efficacy study within a larger randomized controlled clinical trial.

The Evolving Role of Nurses in Patient-Centered Care

As the healthcare landscape continues to evolve, so too does the role of nurses in providing patient-centered care. Gone are the days when nurses were solely seen as assistants to physicians. Today, nurses play a vital and dynamic role in shaping healthcare outcomes, making significant contributions to the overall patient experience. With their holistic approach, empathetic nature, and clinical expertise, nurses have become key drivers in delivering personalized care that puts patients at the center. The evolving role of nurses in patient-centered care is characterized by their increased autonomy and decision-making authority. Nurses are no longer confined to following strict protocols but are actively involved in care planning, assessment, and coordination. This expanded scope of practice empowers nurses to develop personalized care plans that address the unique needs and preferences of individual patients, fostering a stronger therapeutic alliance.&#x0D; Furthermore, nurses have become integral members of interdisciplinary healthcare teams. Their ability to collaborate and communicate effectively with other healthcare professionals ensures seamless coordination of care and promotes continuity across different settings. Nurses act as advocates for patients, facilitating dialogue and ensuring that their voices are heard in the decision-making process. This collaborative approach fosters a culture of patient-centeredness and enhances the overall quality of care delivered. Another significant aspect of the evolving role of nurses is the integration of technology in patient-centered care. Nurses are now proficient in using various digital tools, electronic health records, and telehealth platforms. These technological advancements enable nurses to collect and analyze patient data more efficiently, monitor vital signs remotely, and provide timely interventions. By leveraging technology, nurses can deliver care that is both personalized and evidence-based, optimizing patient outcomes.&#x0D; The evolving role of nurses in patient-centered care marks a paradigm shift in healthcare delivery. With their expanded scope of practice, interdisciplinary collaboration, and integration of technology, nurses have emerged as leaders in shaping the patient experience. By placing patients at the center of care and tailoring interventions to their unique needs, nurses ensure that healthcare remains truly patient-centered. As the healthcare landscape continues to evolve, it is imperative that we recognize and support the pivotal role nurses play in championing patient-centered care for better health outcomes.

Leveraging COVID-era innovation for cervical cancer screening: Clinician awareness and attitudes toward self-sampling and rapid testing for HPV detection.

Cervical cancer screening rates are declining in the US, with persistent disparities among vulnerable populations. Strategies to better reach under-screened communities are needed. The COVID pandemic sparked major shifts in healthcare delivery, including the accelerated development and adoption of rapid diagnostic testing, broadened access to remote care, and growing consumer demand for self-testing, which could be leveraged for cervical cancer. Rapid tests for the detection of Human Papillomavirus (HPV) have the potential to improve cervical cancer screening coverage, and if coupled with patient-collected cervicovaginal samples, create an opportunity for self-testing. The objectives of this study were: 1) to examine whether COVID influenced clinician perspectives of rapid testing as a screening modality; and 2) to assess clinician awareness, perceived benefits and limitations, and willingness to adopt point-of-care HPV testing, patient self-sampling, and rapid HPV self-testing with self-collected samples. The methodology adopted consisted of an online cross-sectional survey (n = 224) and in-depth interviews (n = 20) were conducted with clinicians who perform cervical cancer screening in Indiana, ranked in the top ten states for cervical cancer mortality and with marked disparities across socio-demographic groups. The main findings show that about half the clinicians reported that the COVID pandemic had influenced their views on rapid testing as a screening modality both positively (greater public acceptability of rapid testing and impact on patient care) and negatively (concerns regarding accuracy of rapid tests). The majority of clinicians (82%) were willing to adopt rapid HPV testing at the point-of-care, while only 48% were willing to adopt rapid HPV self-testing with self-collected samples. In-depth interviews revealed provider concerns around patients' ability to collect their own sample, report results correctly, and return to the clinic for follow-up and other preventive care. Addressing clinician concerns about self-sampling and rapid HPV testing, such as ensuring that rapid tests include sample adequacy controls, is necessary to mitigate barriers to adoption for cervical cancer screening.

Artificial Intelligence, Complementary and Integrative Medicine: A Paradigm Shift in Health Care Delivery and Research?

Artificial Intelligence, Complementary and Integrative Medicine: A Paradigm Shift in Health Care Delivery and Research?

A quality assurance review of penile cancer diagnostic delays and stage at presentation during the COVID-19 pandemic.

Penile carcinomas represent a rare malignancy associated with significant psychosocial impacts that deter afflicted individuals from seeking medical attention, thus, worsening prognosis. Following the dramatic shift in healthcare delivery to virtual platforms, it is suspected that prevalent psychosocial impacts have been further compounded by the COVID-19 pandemic, resulting in several late-stage presentations and engendering poorer outcomes. A retrospective chart review of surgically managed cases of penile cancer was conducted from January 2019 to June 2022 to identify patients that may have been unduly impacted by the COVID-19 pandemic. Included cases were analyzed in quantifying diagnostic and treatment delays, along with patient outcomes. Relevant epidemiological and pathological markers were also examined. Ten patients met the inclusion criteria. Average time delay from first complaint of a penile lesion to surgical management was 75 days, with 60% of patients experiencing a time delay of two months or more. The average delay from first complaint to diagnosis was 62 days in 2020 and 18 days in 2021. Advanced-stage disease was present in n=6 (60%) of individuals at presentation, while n=4 (40%) of patients perished during the study period. In cases of concern for penile malignancy, virtual care cannot replace the necessity of physical exams in preventing diagnostic and treatment delays. The present study further highlights the necessity of initial physical examination of penile abnormalities in preventing fatal outcomes for those afflicted. Such consideration warrants urgent examination of referred males with genital abnormalities to prevent further exacerbation of delays.

Biosimilari za liječenje psorijaze odobreni u Evropi

In recent decades, biologics have emerged as pivotal components in the therapeutic armamentarium, revolutionizing the management of various diseases, including chronic inflammatory skin disorder, the psoriasis. Biosimilars, biological formulations designed to closely mimic but not replicate existing reference biologic drugs, have heralded a seismic shift in healthcare delivery, promising equitable access to innovative therapies while fostering competition in the pharmaceutical market. The advent of biosimilars has democratized access to effective treatments, alleviating the financial burden on healthcare systems and patients alike, particularly pertinent for conditions like psoriasis, notorious for their exorbitant treatment costs. However, despite their widespread adoption and significant promise, significant challenges remain, requiring ongoing research to comprehensively examine their clinical efficacy, safety profiles, and long-term outcomes. This review aims to present all the biosimilars approved so far in Europe. Biosimilars represent a transformative force in modern healthcare, but their optimal integration requires careful monitoring, robust pharmacovigilance mechanisms, and ongoing research initiatives to ensure patient safety, build trust among healthcare providers, and maximize treatment efficacy for individuals struggling with psoriasis and other chronic diseases.

Impact of the COVID-19 Pandemic and Lockdown on Non-COVID Neurosurgical Patients: Lessons Learned

Abstract Objective The COVID-19 pandemic has challenged the basic functioning of the health care system. There has been an adverse impact on non-COVID-19 patients due to a shift in healthcare delivery, which is underreported. This study aims to explore the impact of the pandemic on various aspects of non-COVID neurosurgical patients. Methods This descriptive cross-sectional study was conducted with a structured questionnaire to assess the physical, economic, and psychological impacts of the COVID-19 pandemic and lockdown measures on neurosurgical patients presenting to our hospital after a nationwide lockdown. Results Among 203 patients, non-neurotrauma and neurotrauma cases were 175 (86%) and 28 (16%), respectively. Among non-neurotrauma patients, 130 (64%) patients had cranial pathology. All 56 (27.6%) preoperative patients experienced rescheduling of surgery. Among 52 postsurgical patients, 47 (90%) had their adjuvant therapy delayed. Forty patients experienced deterioration in their neurological symptoms. Seventy-six (37%) patients sought medical attention from private hospitals. A severe contraction of income (≥ 25% of the income before lockdown) was experienced by families of 29 (14.3%) patients. Severe and very severe stress have been experienced by 24 (11.8%) and 14 (6.9%) patients, respectively. Severe and very severe anxiety was experienced by 32 (15.8%) and 9 (4.4%) patients. Conclusion The COVID-19 pandemic and nationwide lockdown had a tremendous impact on the physical, social, and psychological well-being of patients with non-COVID illnesses. We are yet to face the long-term implications of the delay due to this pandemic in scheduled surgical and adjuvant treatments of non-COVID neurosurgical patients.

Inequities in Telehealth Use Associated with Payer Type During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has prompted a shift in health care delivery and compelled a heavier reliance on telehealth. The objective of this study was to determine if differences in coverage policies by payer type resulted in differential telehealth use during the first 3 months of the COVID-19 pandemic. In this population-based cohort study of low-income Arkansans, Medicaid beneficiaries enrolled in the traditional Primary Care Case Management (PCCM) program were compared with Medicaid beneficiaries covered through premium assistance in private Qualified Health Plans (QHPs). Methods: A retrospective review was conducted of insurance claims records from June 1, 2019, to June 30, 2020, for synchronous telehealth and mobile health (m-health) visits, as well as other forms of telehealth. To establish the baseline equivalence of enrollees in the two groups, propensity score matching design was used on demographic and geographic characteristics, Charlson Comorbidity Index, broadband availability, and prior service utilization. Results: Compared with enrollees in the PCCM program, Medicaid expansion enrollees in QHPs had higher odds of having had at least one telehealth visit (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI]: 1.29-1.42) during the early phase of the COVID-19 pandemic. Categorizing utilizations by domain, QHP enrollees were more likely to use synchronous telehealth (aOR = 1.31; 95% CI: 1.25-1.37) and m-health (aOR = 5.91; 95% CI: 4.25-8.21). A higher proportion of QHP enrollees also had at least one mental or behavioral health telehealth session (aOR = 1.13; 95% CI: 1.07-1.19). Conclusions: Our study demonstrated that within low-income populations, payer type was associated with inequitable access to telehealth during the early phase of the COVID-19 pandemic.

PO-697-03 CATHETER ABLATION OF ATRIAL FIBRILLATION IN THE AMBULATORY SURGICAL CENTER DURING THE SARS-COV-2 PANDEMIC

The scheduling of elective ablation procedures in hospitals has been significantly disrupted by the SARS-CoV-2 pandemic. Between March 2020 and December 2021, we performed approximately 500 AF ablations in our specialized heart rhythm ambulatory surgical center. Describe the clinical effectiveness and safety of symptomatic patients with Atrial Fibrillation (AF) or Atypical Atrial Flutter (AAFL) undergoing ablation in the non-hospital setting with same day discharge. All patients received general anesthesia and intubation. Intravenous Heparin was administered to maintain an ACT of > 350 sec. throughout the procedure. A TEE or intracardiac echo was performed to guide trans-septal access. Carto 3 Version 7 (Biosense Webster, CA) was used in all patients; LA mapping consisted of a PENTARAY catheter, and ablation was performed with an Irrigated STSF 8F catheter. The end-point of the procedure was pulmonary vein isolation (PVI) and absence of inducible AF or AAFL and conduction block across ablation lines. Reversal of Heparin was achieved with intravenous Protamine. The study group consists of 652 consecutive patients (83 men, mean age 72 +/- 8 years), including the first patient enrolled in 04/2020. There were 90 patients with paroxysmal AF, 535 patients with persistent AF and/or AAFL. 345 patients (53%) were undergoing their first ablation procedure. PVI was achieved in all patients. LA lines with conduction block (Roof, Mitral Isthmus and/or Septal) were performed in 550 patients (86%). Procedure duration varied between 61-247 minutes (mean 114.9). The total time in the ASC varied between 5.2-14.5 hours (mean 6.4). All except 3 patient were discharged home the same day as the procedure. Complications: 1 acute pericardial eff req. paracentesis, 2 large hematoma req. hospitalization without intervention, 1 protamine anaphylactic rxn treated prior to discharge. The overall major complication rate was <1%. Throughout the pandemic, the ASC has provided an effective outpatient setting to safely perform ablation of AF and AAFL. These findings have important implications for interventional electrophysiology, and support a shift of health care delivery of performing complex ablations in a lower cost and non-hospital setting.

P091 Who do we risk leaving behind? A survey of digital access and e-health literacy in people with inflammatory conditions

Abstract Background/Aims The COVID-19 pandemic led to an overnight shift in healthcare delivery and rapid uptake of digital technology. Such approaches risk digital exclusion for people without access to or not confident in their use of technology. We sought to examine digital access and e-health literacy in people with inflammatory conditions. Methods People (n = 2,024) were identified from their electronic health record and invited to participate in a survey, using SMS and postal approaches. Data were collected on age, gender, self-reported arthritis diagnosis (RA, PsA, AS, SLE and other), access to an internet-enabled device and frequency of internet access, health literacy (single-item literacy screener) and self-perceived e-health literacy (eHEALs). Ethical approval was obtained (Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed it online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. 98.3% were white. Approximately 20% of people did not have access to an internet enabled device (Table). 93 (15.3%) of patients reported never accessing the internet, this proportion was higher in people with RA. Approximately 19% had low health literacy. In those reporting internet use, eHealth literacy was moderate. The most popular options for accessing arthritis advice were telephone helplines or appointments. Conclusion Low health literacy, lack of digital access and low reported internet use was common, especially in people with RA, leading to high use of telephone advice and rheumatology appointments. Digital roll-out needs to take account of people requiring extra support to enable them to access care or risks excluding many patients with inflammatory conditions. Disclosure S. Hider: None. S. Muller: None. L. Gray: None. F. Manning: None. M. Brooks: None. D. Heining: None. A. Menon: None. J. Packham: None. S. Raghuvanshi: None. E. Roddy: None. S. Ryan: None. I. Scott: None. Z. Paskins: None.