Adoption Of Telehealth Research Articles

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.

Trends in Emergency Department Capacity and Utilization (2005 -2022): An Update from California, Pre- and Post-COVID-19

This study investigates long-term trends in hospital emergency department (ED) capacity and utilization in California, focusing on the impact of the COVID-19 pandemic. Utilizing data from the California Department of Health Care Access and Information (HCAI) and the U.S. Census Bureau, we analyzed trends over an 18-year period (2005-2022), segmented into pre-pandemic (2005-2019), pandemic (2020-2021), and post-pandemic (2022) phases. Adjusting for population growth, our findings indicate a 7.3% decrease in total admissions and a 14.0% reduction in total inpatient days. Conversely, ED visits increased by 16.1%. Despite an 8.5% decrease in the number of hospitals with EDs, ED treatment stations expanded by 36.3%. The average number of ED visits per treatment station decreased by 10.2%, suggesting improved capacity utilization. Additionally, the number of hospitals with designated trauma centers increased by 11.5%. The COVID-19 pandemic significantly disrupted these trends, initially causing sharp declines in ED visits and total admissions in 2020. However, by 2022, ED visits and inpatient days rebounded close to pre-pandemic levels. The pandemic also accelerated the adoption of telehealth, which partially offset the burden on EDs. Despite this, the average inpatient length of stay increased, indicating more complex or severe cases requiring longer hospitalization. Overall, our study highlights the critical role of EDs in hospital operations, with a growing reliance on EDs for hospital admissions, which rose from 43% in 2005 to 68% in 2022 for non-maternity patients. These findings underscore the need for strategic planning to enhance ED capacity and efficiency, ensuring resilience against future public health emergencies. The economic implications of rising healthcare costs and the essential nature of ED services in contract negotiations with commercial health plans are also discussed, emphasizing the strengthened bargaining position of hospitals due to the indispensable nature of emergency services. Further research is needed to explore alternative care models and payment schemes to improve efficiency and reduce healthcare costs.

Key Stakeholders’ Perspectives on Implementation and Scale-up of Telehealth in HIV Care in Harare, Zimbabwe

The World Health Organisation recommends telehealth as an alternative to help reach remote or underserved areas. Telehealth adoption is therefore key to ending the HIV pandemic. Successful implementation and scale-up of telehealth heavily rely on stakeholders’ involvement. This study explored key stakeholders’ perspectives on the implementation and scale-up of telehealth in HIV care in Harare. In-depth interviews were conducted with professionals within the Ministry of Health and Childcare and its partners, between May and August 2023. Fourteen purposively selected stakeholders were interviewed. Thematic approach to analysis with a coding framework guided by Consolidated Framework for Implementation Research was adopted. Key stakeholders perceived telehealth as a potentially effective intervention, which can improve health delivery. Key stakeholders cited the following challenges for implementation and scale-up of telehealth in HIV care: poor internet and mobile network; financial challenges; and unavailability of policies. Key stakeholders suggested the following strategies to the successful implementation and scale-up: multi-sectoral collaboration for reliable and affordable mobile and internet connectivity; policy formulation, donors’ engagement; and recruitment of competent staff. The study findings showed the confidence of key stakeholders in Harare to effectively sustain telehealth in HIV intervention. Despite its promising potential, significant hurdles to telehealth implementation exist and should be addressed to realise the full potential. Further research incorporating telehealth end-users is recommended, to fully understand challenges and hence inform policy. Keywords: HIV; Key Stakeholders; Telehealth; Utilisation.

PERCEPTIONS OF HOME HEALTH AIDES (HHA) CARING FOR PERSONS LIVING WITH DEMENTIA (PLWD) ABOUT ADOPTION OF TELEHEALTH

Abstract Home healthcare agencies serve a large and growing population of Persons living with Dementia (PLWD). The COVID-19 pandemic led to rapid adoption and use of telehealth services in the delivery of home healthcare, allowing patients to visit with home healthcare clinicians remotely using virtual technology. Yet, concerns remain about feasibility of telehealth for PLWD on HHC, who largely depend on home health aides to communicate their care concerns with the health care teams. We interviewed 25 HHAs to PLWD between June and August 2020 about their experiences with telehealth as part of a larger study focused on HHA informed care plans for PLWD. Interviews were recorded, transcribed, translated and analyzed using conventional content analysis. We interviewed 25 HHAs employed by 4 unique home healthcare agencies. HHAs had a mean age of 49.8 (± 9.1), 24 (97%) female, 11 (44%) Black, 12 (48%) Hispanic. Twelve HHAs were interviewed in Spanish. The main themes identified were: (1) preference for telehealth platforms that include video conferencing to enhance human interactions, (2) preference for telehealth as a supplement, not substitute, for nursing visits, (3) additional burden of using the tablet or computer while care for PLWD and (4) concerns about inadequate training needed to use telehealth. HHAs expressed concerns about the need to not substitute in person home visits with Telehealth. As home healthcare agencies consider best approaches to integrate telehealth into their care delivery models, communication with HHAs remains key to develop strategies that prioritize the care needs of PLWD.

Exploring patients' experiences with telehealth in obstetrics care during the COVID-19 pandemic: A qualitative study.

The aim of this study was to evaluate patients' experiences with telehealth provision of obstetrics and gynecology care during the COVID-19 pandemic qualitatively. In this study, a qualitative research design, namely descriptive phenomenology, was employed. Participants were recruited from the OB department at UMass Memorial Medical center in Worcester, MA, between 6/2020 and 7/2020. Between June 2020 and July 2020, in-depth interviews were conducted with 18 women receiving care at the Obstetrics and Maternal and Fetal Medicine clinics. Data were analyzed using qualitative thematic analysis, as outlined by Braun and Clarke. Telehealth is a feasible and safe health-care tool that is available during these unprecedented times. This study provided qualitative evidence based on patients' perspectives and experiences. Participants' meanings in relation to their experiences of using telehealth services emerged from the data in four themes: the overall experience of using modern telehealth platforms, telehealth and its perceived benefits, telehealth and its perceived challenges, and telehealth and its potential future use. While this study highlights areas in telehealth implementation that require improvement, the overall positive experiences and consistent perceived benefits of most participants suggests that telehealth can be an important tool in healthcare delivery for appropriate patients and situations moving forward in a post-pandemic world. During the global pandemic, telehealth has been recognized to have the potential to play a critical role in healthcare delivery. Establishing qualitative evidence-based practices in the emerging field of telehealth for OB services is pivotal to mitigate potential safety, feasibility, and cost issues that could be associated with the rapid adoption of telehealth. Yet, this qualitative study However highlighted several challenges that are necessary to be addressed in order for telehealth to meet maximum effectiveness and functionality in the future.

Nursing Practice and Telehealth in School Health Services: A Scoping Review.

The COVID-19 pandemic has propelled the adoption of telehealth in school settings, emphasising the pivotal role of nurses. This review explores the last decade's evidence on telehealth interventions in school nursing practice; Methods: Following Joanna Briggs Institute guidelines, we conducted a systematic search in PubMed, CINHAL, and Web of Science in March 2023. Out of 518 articles across 21 journals, 32 satisfied the review criteria. The selection process rigorously adhered to PRISMA-ScR guidelines for scoping reviews; Results: The results were categorised into three main areas: (a) the purpose of telehealth and intervention strategies, (b) the role of nursing in school-based telehealth practice, and (c) perceived benefits and limitations of school-based telehealth studies. Telehealth interventions encompass health promotion, mental health management, and early diagnosis. School nurses play a multifaceted role, including management, education, and remote monitoring. While telehealth offers advantages like improved health and cost savings, challenges include digital literacy, device access, and costs; Conclusion: This review underscores the crucial role of telehealth in schools for enhancing healthcare delivery in educational settings. However, more empirical evidence is required to specify nurses' contributions to school-based telehealth interventions. Promoting their leadership through stakeholder collaboration is essential. Further research should address challenges and opportunities in school nursing practice, enriching healthcare in educational settings.

Telehealth Use Among Adults with Sickle Cell Disease before and during the COVID-19 Pandemic in the United States

Introduction: Individuals living with sickle cell disease (SCD) have suffered from a lack of access to care, which is strongly associated with poor quality of care and negative health outcomes. The COVID-19 pandemic has likely further limited these patients' access to regular care. At the same time, the use of telehealth has rapidly expanded, which has been shown to improve access to care for many conditions. However, the pattern of adoption of telehealth among adult patients with SCD is little known. This study aimed 1) to examine the use of telehealth visits, along with in-person visits, among U.S. adults with SCD before and during the COVID-19 pandemic and 2) to identify patient subgroups that used a telehealth outpatient visit during the first year of the pandemic (03/2020-02/2021). Methods: This retrospectivestudy used commercial insurance claims data from the Merative™ MarketScan ® Research Databases between 1/1/2019 and 12/31/2021. Individuals were included if they were between 18 and 62 years old, had ≥3 inpatient or outpatient claims with a SCD diagnosis, had no cancer diagnosis, and were enrolled in the data at least for 11 months each year of the study period. For the first objective, the number of telehealth and in-person outpatient visits made by the study population were measured each month throughout the study period. For the second objective, the outcome was whether or not a study individual used a telehealth visit during the first year of the pandemic (03/2020 to 02/2021) with any diagnoses. Demographic (age and gender) and socioeconomic (employment classification and status, geographic region, and rural vs. urban area) characteristics and baseline SCD-related outpatient visits 1-year prior (03/2019-02/2020) were measured and used as covariates when appropriate. Descriptive and multiple logistic regression analyses were performed. Employment classification and status were not included in the multiple logistic regression analysis due to a large number of other or unknown values. Results: Of the 846 SCD patients (mean [SD] age = 37.2 [12.8], 62.4% female) included, 342 (40.4%) used a telehealth visit during the pandemic. Before the shutdowns implemented in 03/2020, the mean number of outpatient visits was 1,172.4 [SD=69.9] per month; 1.1 [SD=1.2] (0.1%) were telehealth and 1,171.3 [SD=69.3] (99.9%) were in-person (Figure 1). During the first year of the pandemic (03/2020-02/2021), the mean outpatient visits were 1,243.3 [SD=154.7] per month; 67.7 [SD=22.2] (5.4%) were telehealth and 1,175.6 [SD=168.9] (94.6%) were in-person. After the first year, overall outpatient visits increased to 1,419.4 [SD=96.87] per month due to increases in in-person visits (1,357.1 [SD=92.0] per month) and a slightly decreased level of telehealth visits (62.3 [SD=10.3] per month). Patient characteristics associated with a higher likelihood of using telehealth include: age 35-44 (compared to 18-34; odds ratio [OR]: 1.466, 95% CI: 1.102-2.123, p=0.0433), female (compared to male; OR: 1.774, 95% CI: 1.321-2.399, p=0.0002), living in the West (compared to the South; OR: 1.887, 95% CI: 1.015-3.509, p=0.0448), and 13 or more outpatient visits 1 year prior to the pandemic (compared to 0-3 visits; OR: 1.722, 95% CI: 1.138-2.606, p=0.0101), whereas living in the North Central (compared to the South; OR: 0.538, 95% CI: 0.349-0.829, p=0.0050) or rural area (compared to urban; OR: 0.505, 95% CI: 0.336-0.759, p=0.0010) were associated with less likelihood of using telehealth, after controlling for other covariates. Conclusion : Using nationally representative data, this study found that telehealth use among adults with SCD in the U.S. rapidly increased immediately after the shutdown orders in March 2020, decreased in a few months, and then remained steady afterwards. When a patient visit can be effectively conducted via telehealth, such as a follow-up visit for continued treatment, efforts focused on increasing telehealth use among young adults, males, those living in the North Central and/or rural areas could improve access to regular care, which could lead to better health outcomes.

Distribution of a Remote Medical Exam Device Associated with an Increase in Telehealth Use.

Background: The COVID-19 pandemic accelerated telehealth adoption, but its effects on care quality and costs remain unclear. This study evaluates a remote patient monitoring device's impact on utilization and spending. Methods: A large insurer launched a pilot program involving 2,880 households, representing 6,731 members in three states. Administrative claims data compared participant households to a matched group lacking necessary contact information for participation. Results: Participants had a 0.19 per member (p = 0.03) increase in telehealth visits and a 0.19 per member (p = 0.08) decrease in outpatient in-person visits relative to nonparticipants during the post 6-month period. No significant differences were observed in total outpatient and emergency department visits or total spending. Subgroup analyses revealed a significant reduction in telehealth visits followed by in-person outpatient visits in households with younger children (-9.1%; p < 0.05). Conclusion: This evaluation suggests that remote devices may boost telehealth utilization without increasing costs.

Temporal Trends in Telehealth Availability in Mental Health Treatment Settings: Differences in Growth by State Rurality, 2015-2020.

We sought to investigate temporal trends in telehealth availability among outpatient mental health treatment facilities and differences in the pace of telehealth growth by state urbanicity and rurality. We used the National Mental Health Services Survey (2015-2020) to identify outpatient mental health treatment facilities in the US (N = 28,989 facilities; 2015 n = 5,018; 2020 n = 4,889). We used logistic regression to model telehealth, predicted by time, state rurality (1 to 10% rural, 10 to < 20%, 20 to < 30%, or [Formula: see text] 30%), and their interaction, and adjusted for relevant covariates. We estimated the predicted probability of telehealth based on our model. We estimated effects with and without data from 2020 to assess whether the rapid and widespread adoption of telehealth during the COVID-19 pandemic changed the rural/urban trajectories of telehealth availability. We found that telehealth grew fastest in more urban states (year*rurality interaction p < 0.0001). Between 2015 and 2020, the predicted probability of telehealth in more urban states increased by 51 percentage points (from 9 to 61%), whereas telehealth in more rural states increased by 38 percentage points (from 23 to 61%). Predicted telehealth also varied widely by state, ranging from more than 75% of facilities (RI, OR) to below 20% (VT, KY). Health systems and new technological innovations must consider the unique challenges faced by urban populations and how best practices may be adapted to meet the growing urban demand. We framed our findings around the need for policies that minimize barriers to telehealth.

Telehealth Use and Healthcare Utilization Among Individuals with Type 2 Diabetes During the COVID-19 Pandemic: Evidence From Louisiana Medicaid Claims.

The impact of telehealth use on healthcare utilization is limited, especially among Medicaid beneficiaries with type 2 diabetes. Considering the rapid adoption of telehealth during the COVID-19 pandemic, this study examined associations between telehealth use and healthcare utilization among Medicaid beneficiaries with type 2 diabetes. Using Louisiana Medicaid claims data from March 2019 to August 2021, the associations were examined using a difference-in-difference model with propensity score weighting. Demographic characteristics, baseline comorbidities and healthcare utilization, and zip code level environmental factors were included in the analysis. The monthly frequency of healthcare services, including in-person outpatient visits, inpatient visits, emergency department (ED) visits and hemoglobin A1C (HbA1C) tests, were measured as outcomes. Several sensitivity analyses were conducted across different subgroups. We included 48,992 beneficiaries with type 2 diabetes in the study of 27,340 beneficiaries in the telehealth group and 21,652 beneficiaries in the non-telehealth group. Of 1000 beneficiaries per month, the telehealth group had significantly more utilization compared to the non-telehealth group, with an increase of 195.049 in-person outpatient visits (95% CI: 166.169 to 223.929, p < 0.001), 3.816 inpatient visits (95% CI: 2.539 to 5.093, p < 0.001), 10.499 ED visits (95% CI: 7.287 to 13.712, p < 0.001) and 14.153 HbA1c tests (95% CI: 11.431 to 16.875, p < 0.001, respectively. Excluding beneficiaries who had ED or inpatient visits in the 30days prior to receiving telehealth visits, overall ED visits significantly decreased for the telehealth group versus the non-telehealth group over time, by 9.456 visits (95% CI: - 12.356 to - 6.557, p < 0.001) per 1000 beneficiaries per month on average. The study found that telehealth was associated with a significant increase in healthcare utilization in general but has the potential to decrease ED and inpatient utilization for some groups among low-income populations with diabetes.

Social Determinants of Health and Patients' Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey.

Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. This pilot study aimed to understand the social determinants of patients' adoption of telehealth in the context of the pandemic. A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). The results showed that social determinant factors-safe neighborhood and built environment (P=.01) and economic stability (P=.05)-are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users' intention to use technology for both variables. This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients' digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health.

Reframing Equity: A Multi-Perspective Analysis of Telehealth Screening Tools Through the Lens of Patients and Clinicians

Background: Telehealth usage increased dramatically during the COVID-19 pandemic, but equitable access remains a concern. Patients lacking technology access, skills, and digital literacy may not benefit fully. Validated telehealth literacy screening instruments are lacking. This study evaluated existing tools from patient and clinician perspectives. Methods: Five telehealth literacy screening tools were identified through a literature review: 1) Digital Literacy Self-Assessment Tool (DLSA), 2) Electronic Health Literacy Scale (eHEALS), 3) Digital Health Literacy Scale (DHCLS), 4) Telehealth Literacy Screening Tool (TLST), and 5) University of Alabama-Birmingham Technology Comfort Survey (TCS). Patients (n=44) and clinicians (n=24) completed an online survey rating each tool across domains of 1) User experience, 2) Engagement, 3) Relevance, and 4) Health literacy. Results: Clinicians overall had greater technology comfort and more digital healthcare usage than patients. Patients ranked TCS highest overall, while clinicians preferred DHCLS. TLST performed well for both groups. All participants ranked eHEALS lowest. Patients valued simplicity and clarity while clinicians favored brevity and clinical focus. Conclusion: Perspectives differed between patients and clinicians regarding optimal telehealth literacy screening tools. Screening instruments should align with key engagement drivers: access, competency, digital literacy, relevancy, trust, and preferences. Tailored tools co-designed with patients and clinicians can promote equitable telehealth adoption and engagement.

Urgent Follow-up after Outpatient Nonstress Tests and the Potential for Fetal Monitoring at Home.

This study aimed to measure the proportion of patients needing urgent clinical follow-up after an abnormal outpatient nonstress test (NST). We further sought to capture the patient perspective on the acceptability of performing NSTs at home. A retrospective cohort study was performed over a 2-year period to determine the frequency of abnormal NSTs in a hospital-based, antepartum testing unit in patients greater than or equal to 32 weeks' gestation. The proportion of patients who delivered within 24 hours of an abnormal NST was also determined. A cross-sectional, web-based patient survey was conducted to obtain insight into the patient's comfort level with potentially performing NSTs at home. The chart review yielded 665 patients who underwent 2,122 NSTs at greater than or equal to 32 weeks. Of the 2,122 NSTs, 111 were categorized as abnormal and required urgent clinical follow-up, or 5.2% (95% confidence interval [CI] 4.3, 6.3%). Of the 665 patients, 13 delivered within 24 hours of an abnormal NST, or 2.0% (95% CI 1.0, 3.3%). In the web-based survey, the proportion of respondents who would feel comfortable or very comfortable conducting NSTs at home was 87/125, or 69.6% (95% CI 60.9, 77.1%). This study revealed that 5.2% of NSTs performed in a hospital-based antepartum testing unit were abnormal and required urgent clinical follow-up. Of the patients being followed in the antepartum testing unit, 2.0% delivered within 24 hours of an abnormal NST. The majority of the survey respondents indicated they would feel comfortable performing NSTs at home. The present study adds important information regarding the risks and benefits of NSTs at home. · Telehealth for NSTs offers advantages over in-person NSTs.. · The proportion of NSTs that need urgent follow-up was 5.2%.. · A majority of patients are interested in telehealth for NSTs.. · Guidelines are needed before adoption of telehealth for NSTs..

Designing an Efficient Implementation Process for Large Scale Adoption of Telehealth.

Telehealth may be one of the solutions to the increasing demand of healthcare. However, implementation of such systems is a considerable effort, and requires an efficient and systemized process for large scale adoption. This study provides a process for telehealth implementation. Although quantitative studies of implementation processes introduce significant challenges, the study provide initial indications of increasing effectiveness, specifically in time to deployment.

What’s after COVID-19?: Communication pathways influencing future use of telehealth

ObjectiveTelehealth usage for healthcare encounters has increased dramatically due to the coronavirus disease (COVID-19) precautions. As the pandemic health threat subsides, it is important to understand how telehealth encounters are perceived by users. In this study, we explore how patient-centered communication (PCC), and media and organizational factors, influence patients’ intentions to use telehealth in the future. MethodsAn online survey was conducted among 326 adult patients who reported visiting a healthcare provider using telehealth within the past 12 months. Structural equation modeling explored how contextual factors influenced patients’ adoption of telehealth. ResultsPCC and ease of use indirectly predicted telehealth adoption through enhanced patient satisfaction and sense of care continuity. Sense of security indirectly predicted telehealth adoption via its association with enhanced rating of care quality. ConclusionThe functionality of telehealth technology does not solely determine patients’ telehealth adoption. Instead, positive healthcare experiences, facilitated by organizational support, quality media designs, as well as patient-centered communication, are associated with telehealth adoption. Practice implicationsHealthcare providers should strategically improve telehealth-related communication processes that can lead to better patient health outcomes.

Telemedicine in Otolaryngology in the Context of the End of the COVID-19 Public Health Emergency.

At the onset of the COVID-19 pandemic, the US Department of Health and Human Services implemented a range of flexibilities to expedite the adoption of telehealth. As our specialty moved past the height of the pandemic and the use of telehealth transitioned from a necessity to a convenience, numerous health care providers (physicians, advanced practice providers, speech-language pathologists, and audiologists) recognized its benefits and continued to offer these services. In May 2023, the current administration terminated the COVID-19 public health emergency declaration, with some telehealth guidelines in effect until December 31, 2023, and others extended through December 31, 2024. Amidst the changing telehealth landscape, the objective of this commentary is to explain policy implications on Otolaryngology-Head and Neck Surgery and provide insight into how to best implement telehealth under these new guidelines.

The role of primary care during the pandemic: shared experiences from providers in five European countries

BackgroundThe COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience.MethodsThe role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care.ResultsPrimary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues.ConclusionPrimary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.

Telehealth Adoption Among Rehabilitation Specialists

This article aims to provide virtual care solutions to address social determinants of health and expand access to care for underserved populations. The article highlights virtual care enhancements and strategies to extend the geographic reach of clinicians into home and community settings for greater health equity. It supports the use of telehealth in meeting the health care needs of underserved communities facing barriers to access, as well as provides integrated and coordinated high-quality care. Finally, this article describes an organization's telehealth journey and offers practical guidance for clinicians on how to successfully implement and scale telehealth services.

Barriers Associated With Missed Palliative Care Telehealth Visits.

Background: The COVID-19 pandemic accelerated the adoption of telehealth in palliative care. While this technology showed efficiencies in healthcare delivery, it also unmasked inequalities affecting the socially disadvantaged. Objective: To identify factors associated with missed telehealth visits. Methods: We reviewed telehealth visits between April 1, 2020 and March 31, 2021 at a palliative care clinic. Disease-related and demographic information were recorded, including residency in community outreach zones (COZ)-zip code clusters known for healthcare underutilization. We categorized patients with at least one missed visit as "any miss" (AM), and those with at least three scheduled visits and missed at least 50% as "pattern miss" (PM). Results: Of 1225 scheduled telehealth (i.e., audiovisual) visits, there were 802 completed, 52 missed initial and 371 missed follow-up encounters. Among 505 unique patients, 363 (72%) were receiving cancer treatment, 170 (34%) had multiple insurance, 87 (17%) lived in COZ, 101 (20%) were AM, and 27 (5%) were PM. Patients in COZ had significantly higher risk of PM vs those outside (OR = 2.56, 95% CI: 1.06-5.78, P = .03). Patients with multiple insurance had significantly higher risk of PM vs those with single or no coverage (OR = 3.06, 95% CI: 1.40-6.93, P = .006). Patients on treatment had significantly higher risk of AM vs those not in treatment (OR = 1.75, 95% CI: 1.05-3.06, P = .04). Conclusion: We identified living in areas with healthcare underutilization, active cancer treatment, and multiple insurance coverage as barriers to telehealth visits. Measures are necessary to attenuate disparities in accessing palliative care via telehealth.

Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation.

Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability.