Clinical Telehealth Research Articles

Carbon Emission Reduction Associated With Utilisation Of Telehealth In Outpatient Clinics In An Australian Quaternary Health Service

Objective: To assess the impact of implementing telehealth in outpatient clinics on the carbon emissions associated with the delivery of health care. Design & Setting: Retrospective cohort study in large metropolitan quaternary referral health service from January 2021- December 2022. Participants: All patients who attended an outpatient clinic appointment during the study period, either in-person, via telehealth or via telephone. Main outcome measures: The estimation of carbon emissions in tonnes (t) of CO2-equivalent (CO2-e) associated with in-person and telehealth appointments based on emissions associated with travel, telehealth platform usage and N95 mask usage. Results: There were 571,121 outpatient clinic appointments during the study period. Of the appointments, 251,458 (44%) were conducted remotely, resulting in an estimated reduction in 3,629t of CO2-e emissions in the two-year period. Telehealth consultations in this time contributed 4.5t of CO2-equivalent emissions. The total emission usage of telehealth clinic was only 0.12% of emissions generated from face-to-face clinic appointments. Conclusion: Telehealth offers the opportunity of substantial carbon emissions reduction within the healthcare sector, while also providing cost and time-saving benefits for healthcare services and patients. Limitations include generalisation of transportation modes and the retrospective nature of the data collection.

Ten Years of Bipolar Telehealth: Program Evaluation of a Team-Based Telemental Health Clinic.

Objectives: Telemental health via videoconferencing (TMH-V) can overcome many of the barriers to accessing quality mental health care. Toward this end, in 2011, the U.S. Department of Veterans Affairs (VA) established the National Bipolar Disorders TeleHealth (BDTH) Program to provide expert mental health consultation and treatment to Veterans with bipolar spectrum disorders. Methods: Initial analyses of BDTH services suggested that participants had positive changes in quality-of-care indices and clinical outcomes; however, that evaluation was based on a limited sample of both participants and VA medical centers. We were able to confirm and expand upon those early results by using nearly eight times the number of participants and more than twice as many medical centers. Results: For the 2,456 Veterans who completed the intake to our program, there were significant improvements in some of the quality metrics (e.g., lithium use) and a 54% reduction in positive suicide screens (p < 0.05). The Veterans who completed the initial and postprogram assessments (n = 815) reported a 16.6% reduction in manic symptoms (p < 0.001), a 29.3% reduction in depressive symptoms (p < 0.001), and a 21.2% reduction in mood episodes (p < 0.001). Additionally, these Veterans demonstrated significant improvements (p < 0.001) in mental health-related quality of life between the two assessments. Conclusions: These analyses provide further support for the general effectiveness and safety of telemental health via videoconferencing. Future research should examine the generalizability of these findings across various subgroups (e.g., minority patients, patients in rural areas), populations, and health care systems.

The impact of a pediatric malnutrition telehealth clinic on anthropometric measurements in children aged 6–59 months in rural Guatemala

The impact of a pediatric malnutrition telehealth clinic on anthropometric measurements in children aged 6–59 months in rural Guatemala

Patients' experience of telehealth clinics during the COVID-19 pandemic: Cross-sectional study.

Globally, the Coronavirus disease (COVID-19) pandemic in 2019 has accelerated the adoption of telehealth technologies. The implementation of the Saudi Telemedicine Network (STN) and other digital health initiatives, such as the telehealth clinic (THC) at King Abdullah bin Abdulaziz University Hospital (KAAUH), exemplifies this trend in Saudi Arabia. The aim of this study was to explore the patients' experience of THC in KAAUH during the COVID-19 pandemic and their' beliefs about their readiness to replace the traditional onsite clinical visits with THC from March to September 2020. A cross-sectional study targeted all 1398 patients who utilized THC at KAAUH. A self-administrated, validated survey collected the data. The survey used a Likert scale and included questions on satisfaction with THC services and the perceived effectiveness of telehealth as a substitute for in-person visits. The collected data was analyzed using frequency and percentage. A total of 252 patients responded to the THC postvisit survey. Overall, 217 patients (86%) were satisfied, 32 patients (13%) were dissatisfied, and only 3 patients (1%) were neutral about THC. Most patients (65.5%) agree that THC provided enough information about their health conditions, which can substitute for clinical visits. About 18.3% of patients were neutral, while 16.3% disagreed with the effectiveness of THC services and believed that they could not replace onsite visits. During the COVID-19 pandemic, most patients were satisfied at KAAUH-THC in Saudi Arabia and believed that it could replace the onsite visit to a physician's clinic. The 2 main causes of the patient's belief that THC could not replace an onsite clinical visit were: First, nonadherence to appointments led to missed calls and a complete medical service. Second, the patient's perception is that a physical examination and lab investigation cannot be completed through THC.

Establishing a Graft-Versus-Host Disease (GVHD)-Focused Multidisciplinary Telehealth Clinic

Graft-versus-host disease (GVHD) is a complication following allogeneic hematopoietic cell transplant that frequently causes multiorgan affection and decrease in quality of life. Global assessment and care of these patients require a multidisciplinary approach, but access to focused clinics is limited given their scarcity and location in major cities, as well as mobility and transportation challenges that frequently affect these patients. Thus, we established a multispecialty GVHD telehealth (TH) clinic and hypothesized that a virtual platform will expand access to clinical care in children and adults. The clinic team members included BMT specialist, nursing, dermatologist, dentist, nutritionist, physiatrist, research personnel, and others as needed. We evaluated all GVHD-related visits (in-person and TH) conducted in a single center from 01/2022 to 12/2022. Ninety-three patients received a total of 308 visits, and one-third were via TH. Approximately half of the in-person group had at least 1 TH visit, and 10 patients were seen exclusively via TH. Most patients had advanced chronic GVHD. More male patients were seen in GVHD clinic, but female patients had increased in clinic visits via TH (41% TH versus 32% in-person). One-third of clinic visits were from patients of racial and ethnic minorities. While only 6% (n = 12/217) of in-person visits were for patients living >100 miles from the center, 34% (n = 31/91) of TH visits were from far distances including out-of-state. At baseline, the most common patient-reported symptoms in a subset of patients included fatigue, disturbed sleep, and distress. Fifteen patients completed a follow-up symptom survey and reported significantly reduced distress regarding their GVHD (P = .02), although other symptoms remained stable. A multidisciplinary TH clinic provided care for adult and pediatric patients with GVHD. We demonstrated preliminary feasibility of building a robust TH platform with a collaborative multispecialty approach that allowed access and continuity of medical care. Gender inequalities were reduced, and distance to our center represented a lesser barrier to attending specialized care via TH. Additionally, patients reported a significant reduction in distress. Our findings support the ongoing development of a virtual platform to improve access to specialized GVHD care.

Abstract PO3-27-09: A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population

Abstract INTRODUCTION An estimated 13% of women will be diagnosed with breast cancer at some point in their lifetime. There are non-modifiable and modifiable risk factors including family history, genetics, obesity, and estrogen exposure. Interventions that reduce breast cancer risk and/or mortality include screening, chemoprevention, and lifestyle modification. A recent national survey shows that there are significant gaps in providing breast cancer prevention care for female Veterans. We describe the creation of a multi-disciplinary telehealth clinic aimed at reducing breast cancer risk in a high-risk female Veteran population. METHODS The breast cancer prevention clinic (BCPC) team consists of a medical oncologist, geneticist, genetic counselor, dietician, psychologist, and nurse navigator. High risk women are identified through a combination of screening questionnaires at annual mammography and genetics or primary care provider (PCP) evaluation, then referred to the clinic. Criteria for referral include age &amp;gt;=35, Gail 5 year risk &amp;gt;= 1.7%, Tyrer-Cuzick 10 year risk &amp;gt;= 5%, or history of thoracic radiation. At the BCPC telehealth visit, the medical oncologist makes individualized recommendations about chemoprevention by discussing the risks and possible complications of therapy. Use of screening magnetic resonance imaging (MRI) is also recommended to women with lifetime Tyrer-Cuzick score &amp;gt; 20%. Within the same visit, patients meet with a dietician to discuss nutrition modification, and a psychologist to address psychosocial barriers to lifestyle change. Those who start chemoprevention attend a 3 month follow-up with a nurse navigator to discuss tolerability and side effects. Subsequently, the patient’s PCP becomes responsible for management of chemoprevention and annual breast MRI. RESULTS Between January and December 2022, 33 patients were seen in BCPC. Patients had an average age of 52 years (range 42-70), Gail 5-year score of 2.53%, Tyrer-Cuzick 10-year score of 6.65%, and Tyrer-Cuzick lifetime score of 21.5%. Thirteen patients (39.4%) started chemoprevention, the majority of which were selective estrogen receptor modulators (SERM). Nine reported starting the medication at the 3 month follow-up appointment. The most reported side effect was hot flashes in 67%, although only the majority had mild symptoms. Three reported weight gain and one reported vaginal dryness. None reported worsening arthralgia or fatigue. Despite the low incidence of severe symptoms, only 3 continued to fill the medication at the time of chart review in August 2023. Twenty (60.6%) patients did not initiate chemoprevention. Four (20%) did not qualify due to cardiovascular or thrombotic risk factors, and three (15%) did not qualify due to concurrent use of hormone replacement therapy. Two (10%) elected not to start chemoprevention because they were planning for risk reducing mastectomies. Eleven (55%) did not initiate chemoprevention due to patient preferences and concern for side effects. Twenty-eight patients were recommended to obtain breast MRI in addition to mammogram for yearly screening. At time of chart review, 15 had at least one screening breast MRI ordered by PCP after BCPC visit, with 10 MRIs performed. CONCLUSIONS The unique interdisciplinary model of our breast cancer prevention clinic allows for a comprehensive and personalized evaluation for high-risk female Veterans on interventions to reduce their breast cancer risk. However, the current model does not ensure long-term compliance with these interventions. Studies have shown that more frequent/short-term follow up may improve compliance with endocrine therapies. Future directions include clinic expansion and providing additional follow-up with the multidisciplinary team to promote continued adherence to BCPC interventions. Citation Format: Hanqing Shang, Sarah Ansari, Shweta Dhar, Mahdieh Irranejadparizi, Stacey Edwards, Jessica Honkomp, Meagan Siehr, Bethany Aiena, Mary Nikityn, Diana Bearden, Deleene Menefee, Sita Bushan. A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-09.

Implementation of a Pilot PharmD Medication Optimization Telehealth Clinic Within a Veterans Affairs System.

Background Patients older than 65 years of age with an anticipated life-expectancy of 12 months or less may have complex medication regimens and an increased risk of adverse drug reactions, and drug-drug interactions. Within the Department of Veterans Affairs, a commonly used medication optimization model is known as the VIONE methodology. Objective This project aimed to pilot implementation of board-certified clinical pharmacist practitioners utilizing the VIONE model within a patient-aligned care team targeting patients 65 years of age and older. Methods The population was identified through the VIONE dashboards. Veteran inclusion criteria included five or more medications, a VIONE risk score of 5 or greater, and CAN scores of greater than 90. The project team reached out via telephone to the patients for a medication regimen review and a 14-day follow-up call. Primary outcomes were quantity of medications discontinued per patient, classes of medications that were discontinued, number and encounter time spent, and cost avoidance over 1 year. Secondary outcomes were VIONE classification of medications, VIONE discontinuation reason, number of recommendations given and accepted by primary provider, and safety analysis. Results There were 53 patients who were successfully contacted via telephone. The top four most discontinued medication classes included 1) vitamins/supplements, 2) ophthalmology medications, 3) gastrointestinal medications, and 4) non-controlled analgesic medications. During the project period the potential cost avoidance over 1 year was $17,716. CONCLUSION: This project demonstrated that usage of VIONE methodology ensures medication optimization with minimal harm and provides significant cost savings in the ambulatory care setting.

A Nurse-Led Employee Health Telehealth Clinic During the COVID-19 Pandemic

A Nurse-Led Employee Health Telehealth Clinic During the COVID-19 Pandemic

A complementary medicine student-led telehealth clinic: evaluating learning & teaching perceptions

ObjectivesThis study evaluates a multi-centered complementary medicine (CM) student-led telehealth clinic during the COVID-19 pandemic. Likert and qualitative responses explore student and educator learning and teaching perceptions of the implementation of a successful telehealth clinic.Results51 students and 17 educators completed the survey. Respondents agreed that support from educators (90%) and orientation (70%) assisted effective performance. Over 90% (93%) of all respondents supported telehealth in student-led clinics, whilst 87% encountered barriers such as technical and infrastructure issues. Respondents agreed that telehealth practice skills improved in case history taking (90%), treatment (90%) and building patient rapport (60%). Respondents (61%) disagreed that physical examination was effectively performed, and 100% of respondents agreed telehealth was a valuable learning experience. This study is the first to explore student and educator perceptions of telehealth in an Australian University multi-centered CM student-led clinic. To be successful in an educational environment, students and educators require digital literacy and adequate telehealth practice infrastructure. Whilst some in-person practice skills are transferable to telehealth, educators need to adapt curriculum to ensure counselling and physical examination skills are specifically taught for virtual consultations. Telehealth in clinical practice requires continued investigation and educational development.

A Building Blocks Approach to Implementing a Telehealth Clinic Model to Improve Primary Care Access in the Philippines: A Large-scale Pilot Project

A limited number of healthcare workers and cost constraints limit primary care access in the Philippines. To test telehealth as a low-cost and effective solution, a large-scale digital health clinic was implemented in the selected urban and rural communities. In collaboration with local authorities, our pilot telemedicine clinic was implemented for 3 days in January 2023. Patients were registered and their vitals were assessed before they were seen by a remote United States-based licensed physician who provided recommendations for treatment. Medical devices with real-time streaming capabilities, such as electronic stethoscopes, were utilized to enhance remote examinations. A total of 322 patients were treated at the telehealth clinic, of which 218 completed a population health survey. A large proportion of patients had a doctor visit more than 12 months prior (39.2%) and had not received a dental examination (86.3%) or an eye examination within the past year (84.4%). Most patients had access to a smartphone (69.7%). A lower proportion had access to an internet connection that was sufficient for video calls (57.9%) or a laptop (8.5%). Our clinic demonstrated that telehealth is a feasible solution to improve primary care access for disadvantaged communities in the Philippines.

A Focused Multidisciplinary Telehealth Clinic Increased Patient Access and Significantly Reduced Distress in Patients with Gvhd.

A Focused Multidisciplinary Telehealth Clinic Increased Patient Access and Significantly Reduced Distress in Patients with Gvhd.

Come As You Are?: Democratizing Healthcare Through Black Church-Telehealth Initiatives

Drawing from the phrase “come as you are,” which is frequently used in Black Churches to encourage and welcome people to church spaces for spiritual restoration and healing irrespective of their various social and economic dispositions, this Article aims to describe how telehealth partnerships with community organizations, such as Black Churches, can help democratize healthcare.&#x0D; In this project, I develop two models for Black Church-Telehealth Initiatives—a Telehealth Clinic on the Church’s campus and a Designated Telehealth Space with the requisite technology to facilitate telehealth encounters—to argue that Black Church-Telehealth Initiatives can help address certain social determinants of health, such as medical mistrust and the digital divide. The Telehealth Clinic would be a licensed medical facility where patients are assisted by medical personnel with seeing a remote physician via the appropriate technology (e.g., computer, video conference software, internet access, and medical devices to obtain certain biometric data). The Designated Telehealth Space, on the other hand, would be a room equipped with non-medical technology that is open to community members without access to the requisite technology for telehealth encounters.&#x0D; Black Churches are already important locations for promoting healthcare and can help further democratize healthcare via telehealth, if certain legal hurdles can be resolved. By exploring federal and state law and policy, I examine the legal barriers to telehealth expansion in general, and legal hurdles specific to these initiatives. This Article argues that federalism principles and widespread variation amongst state laws on physician licensure may make it more difficult to democratize healthcare via telehealth. Moreover, depending on the extent of the religious affiliation, Black Church-Telehealth Initiatives may fit into broader trends toward an increased alignment of healthcare institutions with religious organizations and their doctrines. Finally, legal and policy reforms are needed to address certain federal and state limitations on Medicare and Medicaid reimbursement, which may deter healthcare providers from collaborating with Black Churches to establish this Article’s initiatives. This makes the need for regulatory reform urgent. Indeed, as healthcare organizations partner with community organizations to expand access to telehealth, creative legal solutions will be required to subject those community organizations to important health laws and policies—including medical privacy and confidentiality laws—without stifling innovation and collaboration.

Evaluation of Nurse Navigator Support for Patients During Telehealth Neurosurgery Clinics.

Telehealth clinics have been used in many specialities, including neurosurgery, to improve access for patients in rural communities. The introduction of nurse navigators involved with the patient before, during and after the clinic was evaluated. Clinics were held in a rural hospital with a nurse navigator present in the clinic with the patient, and the physician consulting remotely. A patient satisfaction survey and audit were conducted following ten telehealth clinics. Twenty-one new patients were able to be contacted out of 31 (68%) with an 11 question structured survey. Eighteen out of 21 (86%) stated they were satisfied with the quality of the clinic compared with an in-person clinic. Overall satisfaction scores of 7-10 were scored by 18/21 patients (86%) on a scale of 1-10. An estimated 10785 km of travel was saved for patients going to a rural hospital clinic rather than the neurosurgical centre. This study shows that the supportive role of nurse navigators throughout the patient telehealth clinic pathway merits further continuing evaluation.

Tackling efficiency in a high demand orthopaedic clinic.

Surgical outpatient clinics continuously face challenges in delivering efficient and effective care. An expanding population and chronic staff shortages makes sustainability critical. The primary objective of this study was to identify modifiable factors contributing to longer wait times in an orthopaedic outpatient clinic. A single-centre prospective observational cohort study was conducted at Western Australia's state trauma centre. Over a four-week period, clinicians completed forms identifying delays in clinic, and clinic numbers were captured through an electronic booking system. Data was analysed using SPSS v27. Face-to-face (FTF) and telehealth (TH) clinic volumes grew by 18.9% and 361.1% respectively between 2018 and 2022. For the study period, 754 forms were completed for attending clinic patients. This captured 42.4% and 96.8% of FTF and TH actual attendance. The average wait time for doctor consultation was 63.9 min. Wait times significantly reduced when x-rays were performed prior to clinic (P < 0.001), and when an unaccredited registrar held the on-call phone (P < 0.001). Trauma clinics ran overtime in 95% of cases compared to elective clinics in which 25% ran overtime. The golden staffing ratio was one doctor for 13 patients. TH experienced few delays related to technological fault. This study demonstrates that clinic volume continues to rise. It highlights the demand for adequate staffing and identifies several modifiable factors that influence clinic efficiency. It demonstrates the growth of TH as an alternative modality for outpatient surgical services and its potential for future expansion.

Telehealth Implementation and Teaching Strategies During COVID-19 and Beyond in Gait, Balance, and Mobility Clinic for Community-Dwelling Older Adults

COVID-19 provided an opportunity to determine the effectiveness of telehealth physical therapy as part of a pro bono gait balance and mobility clinic. The aim of this case study is 2-folds—(1) to provide evidence for clinicians on telehealth physical therapy implementation while using mobile health platform and remote patient monitoring for a community-dwelling older adult with gait and balance disorder and (2) to provide evidence for clinical educators on telehealth-based teaching strategies to implement virtual clinical education for treating geriatric patient population. It is also important to note that this telehealth clinic model may be applicable outside of this patient population as well.

Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study.

Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women's concerns. This study aimed to assess pregnant women's attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women's preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.

Participant Satisfaction of a Community-based Telehealth Clinic for Atopic Dermatitis.

Atopic dermatitis (AD), a chronic, relapsing inflammatory disease that affects more than 30 million children and adults in the US, disproportionally impacts African American (AA) and Hispanic children, with a higher prevalence of severe AD in these populations than in white children.1,2 Visits to urgent care, emergency departments, and hospitalizations for AD in the United States were more common among AA and Hispanic adults, and those with lower socioeconomic status.1,3 In Washington DC, outcomes and access to care among the District's poor and underrepresented minorities lag far behind other groups. Ward 8, for example, which is 89% Black, has the District's highest per capita rate of coronavirus-related deaths - 6 for every 10,000 residents.4 These disparities have been long-lived and pervasive in all areas of medicine, including dermatology.5.

Comparative analysis of a private telehealth clinic and country-wide COVID-19 patient management results

The first majorly destructive pandemic of the twenty-first century broke out due to the spread of Severe Acute Respiratory Syndrome Coronavirus 2 worldwide. Remote management was put in place to efficiently assess the patients to prevent unnecessary hospitalization and educate the infected on the red flags. This study is a retrospective case control study that will contain a retrospective include analysis of medical records of 13,174 pediatric and adult patients with a laboratory-confirmed diagnosis of Coronavirus Disease and were undergoing remote management at REDMED online clinic in the period of July, 2021 and March, 2022. The retrieved data will be analyzed in specific detail and the hospitalization rate will be compared with country-wide results. The analysis helped us conclude, that there is a statistically significant difference between the country-wide hospitalization rate (16.8% by December 31, 2021 and 15.1% by July, 2022) and hospitalization rate (total mean value—1.8%) recorded at REDMED (×2 = 2123.488, df = 1, p < 0.0001 and ×2 = 1824.761, df = 1, p < 0.0001). This type of discrepancy requires further investigation. However, we have a reason to believe that direct communication with your doctor through an application might be the reason for being compliant and trusting the service provider. Well-managed and organized telemedicine is an efficient tool to manage Coronavirus or other Infectious Diseases remotely, especially when direct patient-to-doctor audiovisual communication is enabled..

Implementation of a Cardiology Telehealth Clinic to Expedite Review Following Emergency Department Presentation: A Single Centre Experience

Implementation of a Cardiology Telehealth Clinic to Expedite Review Following Emergency Department Presentation: A Single Centre Experience

A Retrospective Comparison of HIV Pre-exposure Prophylaxis (PrEP) Outcomes Between a Pharmacist-led Telehealth Clinic and In-person Clinic in a Veteran Population.

Pre-exposure prophylaxis (PrEP) reduces human immunodeficiency virus (HIV) transmission through sexual contact by at least 90% when taken as prescribed. This retrospective cohort study evaluated differences in adherence to PrEP medication and monitoring between the physician- and nurse practitioner (NP)-led in-person setting and the pharmacist-led telehealth setting among patients followed by the infectious diseases clinic at the VA Eastern Colorado Health Care System from July 2012 to February 2021. The primary outcomes were PrEP tablets filled per person-year, serum creatinine (SCr) tests per person-year, and HIV screens per person-year. Secondary outcomes included sexually transmitted infection (STI) screens per person-year and patients lost to follow-up.149 patients were included in the study, with 167 person-years in the in-person cohort and 153 person-years in the telehealth cohort. Adherence to PrEP medications and monitoring was similar between in-person and telehealth clinics. PrEP tablets filled per person-year was 324 in the in-person cohort and 321 in the telehealth cohort (RR = 0.99; 95% CI, 0.98-1.00). SCr screens per person-year was 3.51 in the in-person cohort and 3.37 in the telehealth cohort (RR = 0.96; 95% CI, 0.85-1.07). HIV screens per person-year was 3.55 in the in-person cohort and 3.38 in the telehealth cohort (RR = 0.95; 95% CI, 0.85-1.07). There were no new HIV infections. Additionally, patients were less likely to be lost to follow-up when followed via telehealth (11.9% vs. 30.0%), Χ2 (1, N = 149) = 6.85, p = 0.009. These findings indicate that pharmacist-driven delivery of PrEP via telehealth can be used to increase access to PrEP without sacrificing quality of care.