Telehealth Access Research Articles

Community-Level Internet Connectivity and Utilization of Maternal Telehealth.

Background: The COVID-19 pandemic brought about a drastic increase in the utilization of telehealth services in place of or as a complement to in-person health services. Telehealth is a tool to help reduce disparities in the receipt of maternal health care. However, a stable internet connection is required for patients to connect to providers via telehealth; lack of internet connectivity is a barrier to maternal telehealth access. Methods: The objectives of this research were to determine whether community-level internet penetration is associated with community-level utilization of maternal telehealth services and assess the heterogeneity of this association across the maternal telehealth utilization spectrum. A cross-sectional study of community-level maternal telehealth is utilized in the United States in 2019. The underlying population is comprised of commercially insured maternal health patients receiving any antenatal, delivery-related, or postpartum care in the United States. The individual-level utilization data are aggregated to the geo-zip level (n = 404), which is a regional subdivision comprised of all zip codes that share the first three digits. Results: Findings show that the estimated relationship between the proportion of households with home-based internet connectivity was statistically significant at the 10th and 25th quantiles of maternal telehealth utilization. For these quantiles, an increase in community-level internet connectivity was associated with an increase in the utilization of maternal telehealth services. Conclusion: There is a positive association between community-level internet connectivity and maternal telehealth utilization, and the association varies in magnitude across the maternal telehealth utilization distribution. Policymakers should consider digital access when addressing telehealth policy for maternal care services.

Examining healthcare access with physical vs. telehealth options: Promise and peril for socially vulnerable older adults

IntroductionThis paper seeks to understand barriers to healthcare access faced by socially vulnerable older adults in Chicago using qualitative analysis. As the U.S. population ages, ease of healthcare access by older adults grows in importance. Yet, current literature lacks an examination of pain points and coping strategies in accessing healthcare, specifically by socially vulnerable older adults. This is especially relevant as virtual telehealth access and transportation options that shape healthcare access evolve rapidly. MethodsIn this work, we conduct three listening sessions with 40 total participants to understand the lived experiences of Black and Latino older adults living in low-income areas of Chicago. Transcript data was analyzed using qualitative concept and emotion coding to identify vulnerabilities that older patients face in accessing care. ResultsThis work highlights five key takeaways from the qualitative analysis: 1) technology struggles and prospects in accessing healthcare, 2) social resources for coping give rise to tension between dependence and autonomy, 3) system disconnects (medical-pharmacy-transportation) represent key pain points, 4) different means of accessing healthcare (traditional transportation vs. telehealth) are value and emotion ladened, 5) different means of observing lead to new methodological insights. ConclusionOvercoming healthcare access barriers for older adults ultimately requires analysis of specific interfaces between infrastructure, healthcare, and communications systems. Solutions should prioritize the autonomy of older adults by offering physical accessibility and customized technology. The three intervention policies recommended in this paper include: health kiosks implementation, digital access classes, and specialized training for transit drivers and medical staff.

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.

Obstetrician-Gynecologists' Telehealth Provision at the Beginning, During, and Latter Stages of the COVID-19 Pandemic.

Objective: This study aims to determine how obstetrician-gynecologists provided telehealth from January 2020 to December 2022 in the United States, using de-identified commercial insurance data from FAIR Health. It also explores the trends in telehealth provision by physicians' age, gender, and by state policies on telehealth payment parity. Methods: Aggregated, de-identified data derived from medical claims containing 450,588 physician-quarter observations during 2020 to 2022 were analyzed using descriptive methods to examine the total number of telehealth services to pregnant individuals provided, the number of obstetrician-gynecologists that provided telehealth, and the mean number of telehealth services provided per quarter. Results: Obstetrician-gynecologists' telehealth provision increased rapidly after the onset of the COVID-19 pandemic, reaching its peak during the winter 2020 wave (fourth quarter) during which 4,663 obstetrician-gynecologists provided 13,846 telehealth visits. This was followed by a drop in subsequent quarters and during the fourth quarter of 2022, about 9,500 visits were provided by 2,800 obstetrician-gynecologists. Mean number of telehealth visits per physician was higher among older obstetrician-gynecologists and among those that practiced in states that adapted telehealth payment parity policies. Conclusions: Physician sex, age, and the state of practice location impacted their telehealth provision during the COVID-19 pandemic. Future policies aimed at ensuring telehealth access for pregnant people should consider these factors.

Telehealth use and acceptability amongst a diverse oncology patient population.

104 Background: Existing research describes numerous barriers to care for patients with cancer, including time constraints, cost, and additional health conditions. We sought to assess telehealth access and experience amongst a diverse patient population at an academic medical center. Methods: We administered a 60-question, cross-sectional, in-person survey to adult patients with a diagnosis of solid tumor or hematological malignancy on active treatment at Columbia University Irving Medical Center (CUIMC) in New York, NY between January 2023 and February 2024. The survey assessed access to and attitudes, beliefs and experience with telehealth as part of routine care and clinical trials. Demographics including age, gender, race/ethnicity, marital status, income, insurance type and education were self-reported. Results: The survey was administered to 100 patients with cancer (breast cancer, n=25; gastrointestinal cancer, n=25; genitourinary cancer n=25; and hematologic malignancy, n=25); 37% were actively enrolled or previously enrolled on a clinical trial. The mean age was 61 years; 51% were female; 45% non-White, and 23% Hispanic. The majority (63%) reported traveling >30 min to their treatment, with 48% reporting travel costs >$20 per visit. Six percent reported difficulty receiving treatment due to cost, and 23% reported difficulty getting to visits due to other conditions or disabilities. The majority (87%) reported having access to a computer or electronic device; 99% of those had internet access and 81% were comfortable using the internet. Of those who had prior video visits (59%), almost all (97%) reported that video visits addressed their issues/questions well. About a quarter of the patients who had not had a video visit reported that they would prefer to have video visits about a cancer-related issue rather than going into the office. For those who preferred a video visit (n=18), top reasons included elimination of travel, convenience, and not feeling rushed. Top barriers among those who expressed hesitance (n=23) included lack of access to necessary technology, not knowing how to use the technology, concern about getting the same level of care, or preference for in-person communication. Similar to video visits, 52% participants reported that they had a scheduled telephone visit with their oncologist instead of going to the office; 98% reported that their issues were either somewhat or very well addressed. Conclusions: In this cross-sectional study amongst a racially, ethnically and socioeconomically diverse population, we found that most patients with cancer on active treatment had access to telehealth and were satisfied with telehealth visits. Those who had not utilized telehealth were interested given convenience and elimination of travel. We found minimal barriers to telehealth access in this diverse urban population. Telehealth may offer an adjunct to reduce financial and logistic barriers to cancer care.

Patient interest in clinical trials and remote technology among a diverse oncology patient population.

389 Background: Existing research describes a number of barriers limiting cancer clinical trial enrollment, including time constraints and financial burden, particularly among under-represented populations. In this study, we sought to assess the relationship between the use of remote technology in clinical trials and patient interest in trial participation amongst oncology patients at an urban academic medical center. Methods: We administered a 60-question, cross-sectional, in-person survey to adult patients with a solid tumor or hematological malignancy diagnosis on active treatment at Columbia University Irving Medical Center between 1/2023 and 2/2024. The survey assessed patient demographics, telehealth access, and interest in using telehealth as part of routine care and clinical trials. Demographics including age, gender, race/ethnicity, marital status, income, insurance type, education level, and cancer type were self-reported. Results: The survey was administered to 100 oncology patients. The mean age was 61 years; 51% were female; 45% non-White and 23% identified as Hispanic. The majority (87%) reported having access to a computer or electronic device; 99% of those having internet access and 81% being somewhat or very comfortable using the internet. Forty seven percent of patients had been offered a cancer clinical trial by their oncology provider, and 19% had participated or were currently participating in a clinical trial. Of the 53% of patients who had not been offered a clinical trial or did not know, 64% reported they would consider participating in a trial recommended by their oncologist. Among all respondents, 52% of patients reported it would make no difference in their decision to participate in a trial if they learned about the risks and benefits remotely (phone or video), 28% were somewhat more or much more likely to participate learning about the risks and benefits remotely, and 20% were somewhat less or much less likely to participate under these conditions. Seventy five percent of respondents would be willing to sign consent for a trial remotely. Sixty four percent of respondents were not willing to spend over an hour traveling to a trial site, citing time, cost, family, and work obligations as reasons for limiting travel. The majority of respondents (>50%) indicated that they would be more likely to participate if the trial used remote technology to decrease the need to travel to a trial site. Conclusions: In this cross-sectional study amongst a diverse patient population, we found that the majority of oncology patients on active treatment have access to telehealth, express interest in clinical trials despite barriers to participation, and would be more likely to enroll in trials if remote communication reduced the amount of travel time for trial participation. Decreasing the logistical burden of cancer clinical trials may increase patient access and diversity in trial participation.

Bridging the Telehealth Digital Divide With Collegiate Navigators: Mixed Methods Evaluation Study of a Service-Learning Health Disparities Course.

Limited digital literacy is a barrier for vulnerable patients accessing health care. The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals.

Telehealth in Libraries: The Creation of a Novel Pre-Implementation Workbook

ABSTRACT Telehealth services are a growing aspect of the US healthcare delivery system. Some rural patients, however, lack proper internet speed in their home to access telehealth services and need alternative telehealth access points. Public libraries can be an alternative telehealth access point due to their access to high-speed internet services; however, these programs often experience limited success due to a lack of planning with community health providers and local health organizations. This article describes a novel workbook that guides public libraries to collaborate with community stakeholders when considering the implementation of telehealth services. Development of the workbook leveraged expertise of library and public health professionals. The workbook is currently free to download and updated versions will be available as more knowledge is gained in the field.

Telehealth insights from an integrated care system.

The COVID-19 pandemic accelerated telehealth expansion trends as policy makers instituted flexibilities and coverage changes. Federal telehealth flexibilities expire, however, at the end of 2024. To decide whether to extend those flexibilities, policy makers need information about consumer telehealth preferences, impacts of telehealth on care usage and quality, and telehealth accessibility for the full diversity of patients. Research from one of the nation's largest integrated, value-based health systems provides insights. Findings suggest that telehealth utilization has dropped since the peak of the pandemic but remains higher than prepandemic levels. Telehealth appears to be replacing in-person visits rather than leading to more total visits. Patients generally prefer in-person care but many like having the option to use video- and phone-based telehealth, and both video- and phone-based care appear to be helping patients access primary care. An integrated, value-based care approach may assist a diverse range of patients in accessing telehealth services. Action is still needed, however, to ensure that the full diversity of patients can easily access telehealth offerings. Based on experiences within our health system, we recommend that policy makers maintain public and private payer coverage for video- and phone-based telehealth services; encourage well-designed value-based payment models to simplify and expand telehealth access; improve broadband accessibility and broadband and device affordability so that all patients can access telehealth services; and hold digital health to equivalent high standards for care quality, safety, patient satisfaction, clinical outcomes, and health equity as in-person care.

Telehealth Availability for Mental Health Care During and After the COVID-19 Public Health Emergency

Telehealth services expanded rapidly during the COVID-19 public health emergency (PHE). To evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE. In this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024. Callers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared. During W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics. Based on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.

Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A Developmental Behavioral Pediatrics Research Network Study.

Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic. We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed). A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83). At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.

APA Members Urge Congress To Protect Telehealth Access

APA Members Urge Congress To Protect Telehealth Access

Disparities in Telehealth Offer and Use among U.S. Adults: 2022 Health Information National Trends Survey.

Objective: Understanding the sources of telehealth disparities can inform efforts to ensure equity. This study examines disparities in telehealth offer and use to understand the role of health care providers in increasing telehealth access. Methods: This cross-sectional analysis of the 2022 Health Information National Trends Survey (n = 5,295) used survey-weighted proportions to characterize telehealth use and multivariable logistic regressions to test associations of sociodemographic and social determinants with (1) telehealth offer and (2) use among those offered the option. Results: Among U.S. adults, 57% were offered telehealth, 80% of whom used it. Technology difficulties and privacy concerns were barriers for 15%-20% of U.S. adults. Compared to telehealth users, most nonusers preferred in-person care (25% versus 84%). Age, education, geographic location, and broadband internet access were related to telehealth offer, whereas no significant disparities emerged in telehealth use. Conclusions: Telehealth use is widespread, but structural and provider-level engagement are needed to achieve equity.

Barriers to Remote Burn Care Delivery

Abstract Mounting evidence supports the use of telehealth to improve burn care access and efficiency. However, barriers to telehealth use remain throughout the United States and may disproportionately affect specific populations, such as rural and non-English-speaking patients. This study analyzes the association between physical proximity to burn care and determinants of telehealth access. The relationship between telehealth-associated measures and proximity to burn care was analyzed with linear regression analysis. County-level data was sourced from the Agency for Healthcare Research and Quality's Social Determinants of Health Database (2020) and the American Community Survey (2021). County-level distances to the nearest American Burn Association (ABA)-verified burn center were calculated based on verified centers listed in the ABA burn center directory (n = 59). A subsequent analysis was performed on income-stratified datasets available for subset counties. Distance was negatively correlated with access to a smartphone (P &lt; 0.0001), broadband internet (P &lt; 0.0001), and cellular data plan (P &lt; 0.0001) and positively correlated with the percent of households with no computing device (P &lt; 0.0001) and no internet access (P &lt; 0.0001). Analysis of income-stratified data revealed similar results. The percent population not speaking English well (P &lt; 0.0001) at all (P = 0.0009) and the proportion of limited English-speaking households (P = 0.0001) decreased as a function of distance. People living furthest from an ABA-verified burn center in the United States are less likely to have adequate access to critical telehealth infrastructure compared to their counterparts living closer to a burn center. However, income impacts overall access and the degree to which access changes with proximity. Conversely, language-associated barriers decrease as distance increases.

Telehealth access and experiences of older adults with HIV during the COVID-19 pandemic: Lessons for the future.

Telehealth services are proposed to improve access and retention to care for people with HIV (PWH). Yet the rapid uptake of telehealth services during the COVID-19 pandemic created equity concerns, especially for already vulnerable populations. Older PWH may face a combination of barriers to telehealth but also stand to benefit given social isolation and the need for multimorbidity management. Few studies have focused on this population, and we aimed to assess the telehealth capability and experiences of older PWH at an urban HIV clinic. We did this in two ways: (1) we contacted PWH aged ≥65 via telephone about telehealth capabilities and (2) we conducted focus groups with older PWH who transitioned from in-person to virtual classes affiliated with the clinic. Among 179 PWH aged ≥65, 80 answered the telehealth questions. Among those who answered, 91% were male with a mean age of 69 (SD 3.0), and 55% were White. One-third did not have internet access or an email address. A total of 65% had at least one telehealth-capable device but 12.5% of respondents with a device did not know how to use it. Thirteen older PWH participated in focus groups with a mean age of 64 (SD 6.9) and 44% female. Themes were grouped into benefits (social/emotional connection and convenience) and challenges (technological barriers and missed in-person experience). Participants preferred in-person classes but felt telehealth was a good alternative for mitigating isolation. Telehealth gave those with mobility and transportation issues improved access to supportive services. As the COVID-19 public health emergency ends, hybrid options should be considered to improve access for older PWH and address social isolation. Ensuring equitable access to devices and digital literacy training will be critical to ensure services can be utilized.

Maternity Care Deserts and Postpartum Outcomes: Bridging the Gap in Maternal Health Care in Florida [ID 2683485

INTRODUCTION: Over 2.2 million women of reproductive age live in areas, referred to as maternity care deserts (MCD), with inadequate access to postpartum care services. Furthermore, deaths occurring during the postpartum period account for over half of all pregnancy related deaths. This analysis serves to provide an overview of the intricate relationship between health care access and postpartum health while exploring the increased risk of delayed detection of postpartum complications and the association to increasing maternal mortality rates. METHODS: Data provided by the Area Health Resource File were used to identify counties in Florida that met the criteria of a designated MCD. Data collected on all pregnancy-related deaths verified by the Florida Department of Health (2020–2021) and geographic codes for MCD were used to identify significant associations. RESULTS: This study collected data from a total of 1,938 pregnancy related deaths. A significant increase in the number of postpartum related deaths was during that time (75%). More than a quarter were in MCD (26%). An association of postpartum related deaths with MCD showed an increase (22%). 1 in 10 women living in MCD reported to not receive a postpartum care visit, these counties were also noted to be more likely to have limited telehealth access (30%). CONCLUSION: Maternity care desert limitations to postpartum care reduce prevention efforts, increase risk for delayed complications to go undetected, and contribute to the maternal mortality rates. Potential solutions include policy revisions to expand telehealth access and efforts to increase the awareness of the importance of postpartum care.

Translating Value Across Telehealth Stakeholders: A Rapid Review of Telehealth Measurement Evidence and a New Policy Framework to Guide Telehealth Researchers.

Introduction: The surge in virtual care during the pandemic was accompanied by an increase in telehealth data of interest to policy stakeholders and other health care decision makers. However, these data often require substantial preprocessing and targeted analyses to be usable. By deliberately evaluating telehealth services with stakeholder perspectives in mind, telehealth researchers can more effectively inform clinical and policy decision making. Objective: To examine existing literature on telehealth measurement and evaluation and develop a new policy-oriented framework to guide telehealth researchers. Materials and Methods: A systematic rapid review of literature on telehealth measurement and evaluation was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The findings were analyzed and applied to the Supporting Pediatric Research on Outcomes and Utilization of Telehealth Evaluation and Measurement (STEM) Framework through the lens of key health care delivery decision makers to create a STEM Policy Framework Results: An initial search yielded 2,324 peer-reviewed articles and gray literatyre from 2012 to 2022, of which 56 met inclusion criteria. These measured and evaluated telehealth access (41.5%), quality (32.1%), cost (15.1%), experience (5.7%), and utilization (5.7%), consistent with the STEM Framework domains, but there was no universal approach. The STEM Policy Framework focuses this literature by describing data measures for each domain from the perspectives of five stakeholders. Conclusions: Literature describing measurement and evaluation approaches for telehealth is limited and not standardized, with few considering policy stakeholder perspectives. With this proposed STEM Policy Framework, we aim to improve this body of literature and support researchers seeking to inform telehealth policy through their work.

Association of Pre-Pandemic Telehealth With Emergency Department and Telehealth Usage During the Pandemic.

Objectives Aims were to quantify the association of pre-COVID-19 pandemic telehealth use and separately: 1) likelihood of an emergency department (ED) visit, 2) likelihood of a telehealth visit in older people during the pandemic. Design A retrospective cohort study to measure odds ratios (ORs) of telehealth usage before the pandemic and likelihood of an ED visit and telehealth visit during the study period. Setting and Patients Adults 65 years of age and older (N = 39,214) in the University of California COVID Research Data Set (UC CORDS). Main Outcomes Primary outcome was occurrence of one or more ED visits. Secondary outcome was occurrence of one or more telehealth visits. Results A telehealth visit before the pandemic was associated with reduced likelihood of an ED visit with an OR of 0.33 (95% confidence interval [CI] 0.200.55). Pre-pandemic telehealth was associated with an increased likelihood of telehealth use during the pandemic with an OR of 4.66 (95% CI 3.52-6.18). Conclusion Older people who utilized telehealth before the pandemic were less likely to receive emergency care and were more likely to use telehealth during the pandemic. Approaches to enhance and measure telehealth access for older people are necessary.

Mental healthcare access among US adults with vision impairment and depression and/or anxiety symptoms

BackgroundAlthough individuals with vision impairment are at greater risk for depression and anxiety, there has been limited study of mental healthcare utilization among this population. ObjectivesTo address this gap, this pooled cross-sectional study estimates the prevalence of mental healthcare utilization among individuals with vision impairment during the COVID-19 pandemic. MethodsWe calculated adjusted relative risk ratios and 95% confidence intervals of depression and/or anxiety symptoms and mental healthcare utilization using multinomial logistic regression, accounting for demographics, social determinants of health, and survey week. The population-based, U.S. Census Bureau Household Pulse Survey was administered April 2021–March 2022. Participants included 800,935 US adults (weighted population: 174,598,530) ResultsAdjusting for other factors, adults with vision impairment were more likely to report depression symptoms (RRR: 2.33; 95% CI: 2.03–2.68), anxiety symptoms (RRR: 2.12; 95% CI: 1.94–2.33, and comorbid depression and anxiety symptoms (RRR: 3.77; 95% CI: 3.51–4.04) compared with individuals with no vision impairment. Among individuals reporting anxiety or depression symptoms, individuals with vision impairment (RRR: 1.46; 95% CI: 1.35–1.59) were more likely to lack of mental healthcare utilization compared with individuals with no vision impairment. ConclusionFindings suggest that individuals with vision impairment are at increased risk for depression and/or anxiety symptoms and report reduced mental healthcare utilization compared with individuals without vision impairment. Additional programs and policies are needed to improve mental healthcare utilization among individuals with vision impairment and depression and/or anxiety symptoms, such as increased telehealth accessibility and coordination of behavioral health and ophthalmology services.

Telehealth Experiences of Autonomic Dysfunction and Parkinson's Disease Patients

Objective We aim to characterize the telehealth care experiences of autonomic dysfunction and Parkinson’s disease (PD) patients. Background Telemedicine is a popular modality for receiving healthcare. Due to its rising use, ensuring efficacy, satisfaction, and safety is important. Current literature finds high satisfaction, benefitted physical and emotional health, and desired feasibility amongst PD patients. While results are promising, there still exists a dearth of literature describing the experiences of autonomic dysfunction patients as a whole and including qualitative data in analysis of care experiences. Design/Methods We conducted a descriptive cross-sectional study using anonymous, survey responses from autonomic dysfunction and PD patients within a large health system. The study questionnaire included both Likert-scale prompts and open responses. Quantitative and qualitative data analyses were incorporated in discussed findings. Results Twenty-five patients with either autonomic dysfunction or PD diagnoses who successfully completed the questionnaire were included. Over 80% of participants were confidently able to access medical appointments and providers via telehealth services. 88% accessed telehealth services without others’ assistance. Conversely, 68% did not agree that telehealth appointments were accessible during impacted internet connection. 92% of respondents, however, felt satisfied with the quality of care from telehealth appointments, with 76% finding the care comparable to in-person visits. Notably, 76% experienced improved care access to care and also had their needs met from telehealth. Among open responses, 43% highlighted how physical barriers and distance hindered in-person attendance. Four responses discussed affected fine motor movements limiting telehealth access. Three preferred in-person appointments, denoting the importance of thorough physical exams. Conclusions Telehealth effectively meets autonomic dysfunction and PD patients’ needs comparably to in-person visits, improves access to care, and delivers high satisfaction. This modality still proves inadequate during limited internet connection and for those with impacted fine motor skills. While telehealth holds promising utility for autonomic dysfunction and PD patients’ care, continued study into furthering accessibility for patients of all abilities and technological constraints is still warranted.