Expansion Of Telehealth Research Articles

Remote Patient Monitoring in Diabetes: How to Acquire, Manage, and Use All of the Data.

The ability of patients and health care providers to use various forms of technology for general health has significantly increased in the past several years with the expansion of telehealth, digital applications, personal digital devices, smartphones, and other internet-connected platforms and devices. For individuals with diabetes, this also includes connected blood glucose meters, continuous glucose monitoring devices, and insulin delivery systems. In this article, the authors outline several steps to facilitate the acquisition, management, and meaningful use of digital diabetes data that can enable successful implementation of both diabetes technology and telehealth services in primary care clinics.

Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic.

The COVID-19 pandemic resulted in widespread telehealth expansion. To determine telehealth uptake and potential sociodemographic differences in utilization among people with HIV (PwH), we examined HIV care appointments at the University of Chicago Medicine, an urban tertiary hospital. Visits between March 15th and September 9th for 2019 and 2020 were categorized as in-person, telehealth, and within telehealth, video, and phone. Differences in visit types were modeled using logistic regression to examine associations with demographics, insurance type, and HIV risk transmission category. Telehealth appointments were more likely for those aged 46–60 versus those 31–45 [46–60; AOR 1.89 95% CI (1.14, 3.15)]. Black race and participants of other races were less likely to use telehealth compared to whites [Black: AOR 0.33 95% CI (0.16, 0.64), other: AOR 0.10 95% CI (0.02, 0.34)]. Future studies should continue to examine potential disparities in telehealth use among PwH, including age and racial differences.

Non-English Language Preference Associated With Decreased Rheumatology Telehealth Use During the COVID-19 Pandemic.

ObjectiveThe study objective was to assess sociodemographic disparities in telehealth use among patients in an urban adult rheumatology clinic during the coronavirus disease 2019 (COVID‐19) pandemic.MethodsIn this retrospective cohort study, patient‐level sociodemographic data associated with all rheumatology visits in the following two periods were reviewed: pre‐COVID‐19 (March 1, 2019 to February 28, 2020) and COVID‐19 (April 1, 2020 to March 31, 2021). Data were extracted from the electronic health record. Multivariable logistic regression analyses were performed to determine sociodemographic factors associated with video visits during the COVID‐19 period.ResultsIn the pre‐COVID‐19 period, 1503 patients completed 3837 visits (100% in person). In the COVID‐19 period, 1442 patients completed 3406 visits: 41% in person, 30% video, and 29% telephone only. Several factors were associated with decreased video use: preference for Spanish language (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.15‐0.47) or other non‐English languages (aOR 0.34, 95% CI 0.21‐0.55), Black or African American race/ethnicity (aOR 0.50, 95% CI 0.35‐0.73), Medicaid payer, and increasing age.ConclusionDecreased video visit use among rheumatology patients was associated with non‐English language preference, minority race/ethnicity, increasing age, and indicators of low income. Rapid deployment and expansion of telehealth during the COVID‐19 pandemic likely has improved access for some but widened preexisting disparities for others. As medical care evolves toward ongoing digital care delivery, clarifying and addressing causes of telehealth disparities is essential for delivering equitable health care.

Audio-Only Telehealth Now Approved Permanently for Mental Health/Substance Use Services

Audio-Only Telehealth Now Approved Permanently for Mental Health/Substance Use Services

Pandemic Implications on Health – An Indian Perspective

The paper is aimed at understanding the impact of Covid on Healthcare. Using the key informant method, healthcare experts' views were obtained and reviewed. The result of the study indicates the need for strengthening Manpower, promoting alternative medical systems, encouraging self-reliance in research and development, digital healthcare, advanced diagnostic support services, and mental health support systems for India. The positive impacts were the expansion of telehealth, remote health care has become a reality, social cohesion, and conscience among people helping to understand the existing gaps in the health care system and recognition of indigenous medical health care. The negative impacts are difficulty in procuring additional manpower, equipment, consumables, and other resources, lack of adequate medical equipment, and differential distribution of services between urban and rural areas. Based on the review suggestion a pandemic preparedness policy framework to deal with the pandemic changes/issues required to be attended to in terms of Quality healthcare, Safety, Infrastructure, and public health, will be proposed. The study also aspires to be of interest to training and developmental organizations, policymakers, and stakeholders of health care institutions to work towards improving the quality of healthcare and enhancing pandemic preparedness.

Associations of Telehealth Care Delivery with Pediatric Health Care Provider Well-Being.

Background The rapid, large-scale deployment of new health technologies can introduce challenges to clinicians who are already under stress. The novel coronavirus disease 19 (COVID-19) pandemic transformed health care in the United States to include a telehealth model of care delivery. Clarifying paths through which telehealth technology use is associated with change in provider well-being and interest in sustaining virtual care delivery can inform planning and optimization efforts. Objective This study aimed to characterize provider-reported changes in well-being and daily work associated with the pandemic-accelerated expansion of telehealth and assess the relationship of provider perceptions of telehealth effectiveness, efficiency, and work–life balance with desire for future telehealth. Methods A cross-sectional survey study was conducted October through November 2020, 6 months after the outbreak of COVID-19 at three children's hospitals. Factor analysis and structural equation modeling (SEM) were used to examine telehealth factors associated with reported change in well-being and desire for future telehealth. Results A total of 947 nontrainee physicians, advanced practice providers, and psychologists were surveyed. Of them, 502 (53.0%) providers responded and 467 (49.3%) met inclusion criteria of telehealth use during the study period. Of these, 325 (69.6%) were female, 301 (65.6%) were physicians, and 220 (47.1%) were medical subspecialists. Providers were 4.77 times as likely (95% confidence interval [CI]: 3.29–7.06) to report improved versus worsened well-being associated with telehealth. Also, 95.5% of providers (95% CI: 93.2–97.2%) wish to continue performing telehealth postpandemic. Our model explains 66% of the variance in telehealth-attributed provider well-being and 59% of the variance for future telehealth preference and suggests telehealth resources significantly influence provider-perceived telehealth care effectiveness which in turn significantly influences provider well-being and desire to perform telehealth. Conclusion Telehealth has potential to promote provider well-being; telehealth-related changes in provider well-being are associated with both provider-perceived effectiveness of telemedicine for patients and adequacy of telehealth resources.

Future challenges in rheumatology - is telemedicine the solution?

The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional ‘face-to-face’ visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.

Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programs

BackgroundCystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models. MethodsAdult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth. ResultsNinety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion. ConclusionDuring the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.

Strategies for implementation of virtual home visitation in the United States

Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high-tech and high-touch service delivery option. Families can receive evidence-based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well-documented engagement barriers to digital health/computer-mediated interventions exist across treatment modalities and technology platforms. Semi-structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice-based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth-based home visitation. Findings include evidence that providers should be able to move between telehealth and on-ground service provision with relative ease.

The toll of cascading crises on Lebanon's health workforce

The toll of cascading crises on Lebanon's health workforce

Rapid Practice Change During COVID-19 Leads to Enduring Innovations and Expansion of Integrative Oncology Services

The COVID-19 pandemic forced cancer programs and practices to rapidly adapt how they deliver integrative oncology services that help patients manage symptoms and optimize their quality of life. Additional stressors imposed by COVID-19 increased the need for mind-body practices, natural products, and lifestyle modifications. However, literature on best practices for the provision of integrative oncology services during a pandemic is sparse. Our article seeks to describe strategies, challenges, and enduring innovations for successful integrative oncology practice during and beyond the COVID-19 crisis. Effective strategies include expanded telemedicine, online resource libraries, virtual interactive groups and classes, and additional infection prevention protocols. We also describe telemedicine challenges, such as technical difficulties and access to technology, “Zoom fatigue,” inability to perform hands-on physical exams, distractions outside the clinical environment, and obstacles to maintaining a virtual therapeutic relationship. Leveraging its skilled facilitators, Levine Cancer Institute in Charlotte, N.C., overcame many of these challenges through proactive responses, flexibility—demonstrated by staff and patients—and the use of virtual platforms. Our experience led to enduring telehealth expansion, livestream groups and classes, on-demand digital repositories of integrative practices, and targeted services delivered at the most clinically appropriate time(s). These insights may be adapted by other institutions to maintain integrative oncology services during and after unprecedented events, like a global pandemic.

Health and Access to Gender-Affirming Care During COVID-19: Experiences of transmasculine individuals and men assigned female sex at birth.

Since the onset of the COVID-19 pandemic, global research has suggested that the pandemic has negatively affected lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) populations, including by limiting health care access. There is little research on the impact of COVID-19 among transmasculine persons and men assigned female sex at birth (AFAB) in the United States, who face unique health care challenges outside of the pandemic context. Between May and June of 2020, 20 transmasculine individuals and AFAB men who have sex with men participated in semi-structured interviews about their experiences during the early months of the COVID-19 pandemic. Participants were asked how the pandemic affected their access to health care, overall health, and well-being. Interviews were analyzed using an inductive, thematic approach. Participants reported reduced access to in-person health care, which in some cases meant overdue hormone-related bloodwork and unmet health care needs. Most participants reported that they were able to maintain their testosterone regimen, although some were concerned about future access, citing anxiety about potential shortages. Three participants reported canceled or deferred gender-affirming procedures, which they were uncertain would be rescheduled soon. Participants generally reported that the expansion of telehealth improved access to care, particularly for gender-affirming psychotherapy that was otherwise inaccessible or inconvenient prior to the pandemic. Other salient themes include the pandemic’s impact on health behaviors and daily routines. Although the COVID-19 pandemic created new challenges for maintaining health, it also expanded access to gender-affirming health care, largely through the expansion of telehealth. Our findings provide new insights for supporting the health of transmasculine individuals and AFAB men.

COVID-19 Pandemic Influence on Medical Oncology Provider Perceptions of Telehealth Video Visits.

The COVID-19 pandemic necessitated a rapid expansion of telehealth use in oncology, a specialty in which prior utilization was low in part because of barriers perceived by providers. Understanding the changing perceptions of medical oncology providers during the pandemic is critical for continued expansion and improvement of telehealth in cancer care. This study was designed to identify medical oncology providers' perceptions of telehealth video visits as influenced by the COVID-19 pandemic. We conducted semi-structured interviews with medical oncology providers from November 20, 2020, to January 27, 2021, at the Sidney Kimmel Cancer Center at Thomas Jefferson University, a National Cancer Institute-designated cancer center in an urban, academic health system in Philadelphia, PA. We assessed provider perceptions of the impact of the COVID-19 pandemic on (1) provider-level comfort and willingness for telehealth, (2) provider-perceived patient comfort and willingness to engage in telehealth, and (3) continued barriers to successful telehealth use. Volunteer and convenience sampling resulted in the participation of 25 medical oncology providers, including 18 physicians and seven advanced practice providers, in semi-structured interviews. Of the 25 participants, 13 (52%) were female and 19 (76%) were White, with an average age of 48.5 years (standard deviation = 12.6). Respondents largely stated an increased comfort level and willingness for use of video visits. In addition, respondents perceived a positive change in patient comfort and willingness, mostly driven by convenience, accessibility, and reduced risk of COVID-19 exposure. However, several reported technologic issues and limited physical examination capability as remaining barriers to telehealth adoption. The rapid adoption of telehealth necessitated by the COVID-19 pandemic has increased provider-level and provider-perceived patient comfort and willingness to engage in video visits for cancer care. As both providers and patients increasingly accept telehealth across many use cases, future work should focus on further addressing technology and physical examination barriers and ensuring continued reimbursement for telehealth as a routine part of covered care.

Managing Scarcity: Innovation and Resilience During the COVID-19 Pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic remains a disruptive force upon the health care system, with particular import for thoracic surgery given the pulmonary pathophysiology and disease implications of the virus. The rapid and severe onset of disease required expedient innovation and change in patient management and novel approaches to care delivery and nimbleness of workforce. In this review, we detail our approaches to patients with COVID-19, including those that required surgical intervention, our expedited and novel approach to bronchoscopy and tracheostomy, and our expansion of telehealth. The pandemic has created a unique opportunity to reflect on our delivery of care in thoracic surgery and apply lessons learned during this time to “rethink” how to optimize resources and deliver excellent and cutting-edge patient care.

Clinician and Health Care Leaders' Experiences with-and Perceptions of-COVID-19 Documentation Reduction Policies and Practices.

Background Substantial strategies to reduce clinical documentation were implemented by health care systems throughout the coronavirus disease-2019 (COVID-19) pandemic at national and local levels. This natural experiment provides an opportunity to study the impact of documentation reduction strategies on documentation burden among clinicians and other health professionals in the United States. Objectives The aim of this study was to assess clinicians' and other health care leaders' experiences with and perceptions of COVID-19 documentation reduction strategies and identify which implemented strategies should be prioritized and remain permanent post-pandemic. Methods We conducted a national survey of clinicians and health care leaders to understand COVID-19 documentation reduction strategies implemented during the pandemic using snowball sampling through professional networks, listservs, and social media. We developed and validated a 19-item survey leveraging existing post-COVID-19 policy and practice recommendations proposed by Sinsky and Linzer. Participants rated reduction strategies for impact on documentation burden on a scale of 0 to 100. Free-text responses were thematically analyzed. Results Of the 351 surveys initiated, 193 (55%) were complete. Most participants were informaticians and/or clinicians and worked for a health system or in academia. A majority experienced telehealth expansion (81.9%) during the pandemic, which participants also rated as highly impactful (60.1–61.5) and preferred that it remain (90.5%). Implemented at lower proportions, documenting only pertinent positives to reduce note bloat (66.1 ± 28.3), c hanging compliance rules and performance metrics to eliminate those without evidence of net benefit (65.7 ± 26.3), and electronic health record (EHR) optimization sprints (64.3 ± 26.9) received the highest impact scores compared with other strategies presented; support for these strategies widely ranged (49.7–63.7%). Conclusion The results of this survey suggest there are many perceived sources of and solutions for documentation burden. Within strategies, we found considerable support for telehealth, documenting pertinent positives, and changing compliance rules. We also found substantial variation in the experience of documentation burden among participants.

Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic.

Background: In March 2020, the pandemic added a major barrier resulting in the cancelation of all low vision ocular rehabilitation services. To prevent delay of beginning low vision ocular rehabilitation services, all low vision care was switched to telerehabilitation to home. Methods: Case managers began to cancel all in-person services and offer Veterans Affairs (VA) video connect services to their home. Patients with video access scheduled a home VA video connect telerehabilitation evaluation and therapy assessment. Patients who did not have video access waited to schedule a future in-person low vision appointment (postpandemic). Results: Of the in-person canceled appointments, 54% who scheduled the new home telerehabilitation evaluation were delayed on average 25 calendar days. Patients who waited for in-person low vision care were delayed on average 98, 138, or 153 calendar days. Of the 56 new patients referred for low vision optometry services during this 4-month period (COVID-19), 91% scheduled home low vision ocular telerehabilitation evaluations without delay; 5% waited until in-person clinics were open; and 4% waited until rural VA's and community-based outpatient centers were open. Discussion: Veterans with low vision who live in rural communities have limited access to services unless they are able to travel several miles to a specialty low vision clinic. Low vision ocular rehabilitation telehealth services have been successfully provided at the VA Western New York Healthcare System (Buffalo, NY) low vision clinic. Conclusions: Home low vision ocular rehabilitation telehealth increases access as early as possible once diagnosed with ocular pathology resulting in low vision.

Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study.

BackgroundAt the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020.ObjectiveWe compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020).MethodsWe used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes.ResultsPrior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted.ConclusionsTechnological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.

Pediatric Telehealth Expansion in Response to COVID-19.

Introduction: Telehealth utilization has been steadily increasing for the past two decades and has been recognized for its ability to access rural and underserved populations. The advent of COVID-19 in March 2020 limited the feasibility of in-person healthcare visits which in turn increased telehealth demand and use. However, the long-term impacts of COVID-19 on the telehealth sector of the healthcare industry, and particularly on pediatric healthcare volume demand and subsequent expansion, are yet to be determined.Objective and Methods: To understand the impact of COVID-19 on telehealth utilization, volume demand, and expansion in one large pediatric healthcare system serving greater Dallas-Fort Worth, Texas, data on telehealth clinic visits by month, pre-COVID and post/current-COVID were compared. A quasi-experimental pretest-posttest design analysis compared telehealth visit counts from 54 ambulatory pediatric health specialties. Pre-post new patient counts were also analyzed via chi square.Results: Total telehealth visit counts significantly increased between March–October 2019 (2,033 visits) compared to March-October 2020 (54,276 visits). Mean monthly telehealth visits increased by 6,530 visits, or 2,569.75% over the same time period (p < 0.0001). In October 2020, total telehealth visits were still 1,194.78% above 2019 levels (345 visits in 2019 vs. 4467 visits in 2020).Discussion: Results here show a substantial volume increase in telehealth-delivered pediatric healthcare and resource utilization as a response to COVID-19. This provides a template for permanent adoption of pediatric telehealth delivery post pandemic. Further investigation is needed to determine impacts upon resource allocation, processes, and general models and standard of care to assist facilities and programs to better address the needs of the pediatric populations they serve in the post-COVID era.

Are We Reaching Everyone? A Cross-Sectional Study of Telehealth Inequity in the COVID-19 Pandemic in an Urban Academic Pediatric Primary Care Clinic.

The COVID-19 (coronavirus disease 2019) pandemic brought rapid expansion of pediatric telehealth to maintain patient access to care while decreasing COVID-19 community spread. We designed a retrospective, serial, cross-sectional study to investigate if telehealth implementation at an academic pediatric practice led to disparities in health care access. Significant differences were found in pre-COVID-19 versus during COVID-19 patient demographics. Patients seen during COVID-19 were more likely to be younger, White/Caucasian or Asian, English speaking, and have private insurance. They were less likely to be Black/African American or Latinx and request interpreters. Age was the only significant difference in patient demographics between in-person and telehealth visits during COVID-19. A multivariate regression showed older age as a significant positive predictor of having a video visit and public insurance as a significant negative predictor. Our study demonstrates telehealth disparities based on insurance existed at our clinic as did inequities in who was seen before versus during COVID-19.

Comparing antibiotic prescription rates between in-person and telemedicine visits

To the Editor: The COVID-19 pandemic has necessitated an expansion of telehealth. However, telehealth encounters may contribute to diagnostic uncertainty and alter clinician practice. For instance, studies of direct-to-consumer telehealth visits found that these encounters were associated with higher antibiotic prescription rates and lower concordance with guideline recommendations.1,2