Telehealth Program Research Articles

The Benefit of Virtual Outpatient Rehabilitative Care: a Pilot Study

<h3>Research Objectives</h3> To examine the feasibility of the Live Long Walk Strong (LLWS) rehabilitation program delivered via telehealth. Secondary objectives are to examine the preliminary efficacy of LLWS on mobility and exercise self-efficacy. <h3>Design</h3> Nonrandomized, noncontrolled pilot with 16-week follow-up. <h3>Setting</h3> Ambulatory Care at the VA Boston Healthcare System. <h3>Participants</h3> Community-dwelling Veterans, aged 50 years and older. <h3>Interventions</h3> An evidence-based outpatient rehabilitation program was adapted as a telehealth program during year one of the COVID-19 pandemic. It included 10 sessions with a physical therapist over 8 weeks via VA Video Connect. LLWS uniquely addresses impairments linked to mobility decline and behavior change strategies targeting exercise adoption. <h3>Main Outcome Measures</h3> The primary outcome was feasibility measured by recruitment and retention, number and type of technology problems, and completion of program components. Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC) outpatient mobility measure and the Self-Efficacy for Exercise (SEE) scale. <h3>Results</h3> After contacting 178 primary care patients with self-reported mobility limitations, 21 enrolled in the study (12%). Seven never initiated the study due to intercurrent medical issues (n=5) and delayed disclosure of participation in another exercise study (n=2). Participants averaged 2 technology interruptions. Over 99% of the technology issues were resolved by the PT and fell into 2 broad categories of connectivity and ease of use. Attendance rate was 98% across all intervention visits. We examined the change in self-reported mobility and self-efficacy from baseline through follow-up using linear mixed models with a fixed effect of time. The AM-PAC scores improved from baseline by average of 4.1 points (p = 0.019) at 2 weeks follow-up and remained (4.2 points, p=0.014) at 16 weeks follow-up. This improvement in mobility surpassed clinically meaningful levels. The change in self-efficacy (0.9 points) was not statistically significant. <h3>Conclusions</h3> The telehealth LLWS program appears feasible and capable to produce both short and long term improvements in physical functioning. Its benefits need to be tested in studies scaled to better evaluate efficacy and effectiveness. <h3>Author(s) Disclosures</h3> VA RR&D Merit Award #5I01RX003095-03

Functional Outcomes Following a Telehealth Interdisciplinary Program During COVID

<h3>Research Objectives</h3> To investigate the effectiveness of a telehealth (TH) program on the physical function of patients with chronic pain, and to compare TH to historical in-person treatment outcomes. <h3>Design</h3> A retrospective chart review of outcome data obtained pre-post week treatment duration. <h3>Setting</h3> Academic rehabilitation hospital, outpatient pain management center. <h3>Participants</h3> A sample of 51 consecutive adult patients with chronic pain (n=51) who participated in the TH program and historical data was obtained from a similar group of patients (n=51) who previously completed a comparable in-person pain program. <h3>Interventions</h3> The TH treatment included 1-2 weekly sessions from occupational therapists, psychologists and physical therapists, physical therapy group, for 6 weeks. The in-person program included individual occupational and physical therapy, individual psychology, and group sessions in each discipline, for 6 weeks. <h3>Main Outcome Measures</h3> The following pain region specific outcomes measures were used: Disabilities of the Arm, Shoulder and Hand (DASH), Oswestry Disability Index (ODI), Neck Disability Index (NDI), Lower Extremity Function Scale (LEFS), Tampa Scale for Kinesiophobia (TSK), and Patient Specific Functional Scale (PSFS). All measures were administered at the start of the program and again at discharge. <h3>Results</h3> Paired-samples t-tests showed significant changes on all outcome measures (t's = 2.320 - 12.082, P's = .001 - .045). Cohen's d indicated medium effects for the LEFS, TSK, ODI, NDI, and DASH (d's = .35 - .61), and a large effect for the PSFS (d = 1.79). Independent-samples t-tests were used to compare outcomes (difference scores) between those receiving the TH invention and those who participated in an in-person program. There were no statistically significant group differences on any of the outcomes: LEFS (Mdiff= -0.03, 95%CI [-5.95,5.89], t(53)= -0.010, p=.992), TSK (Mdiff= -1.77, CI [1.54,-4.85], t(70)= -1.161, p=.250), ODI (Mdiff=0.72, CI [-2.80,4.25], t(45)=0.413, p=.681), NDI (Mdiff= -0.40, CI [-6.73,5.93], t(13)= -.136, p=.894), DASH (Mdiff=3.98, CI [-6.38,14.34], t(28)=0.786, p=.438), and PSFS (Mdiff= -0.62, 95%CI [-1.33,0.10], t(91)= -1.714, p=.090). <h3>Conclusions</h3> Findings show preliminary support for the effectiveness of an interdisciplinary pain management telehealth intervention. <h3>Author(s) Disclosures</h3> None

Qualitative Experiences of Trained Medical Student Coaches Delivering a Community-Outreach Telehealth Coaching Program

<h3>Research Objectives</h3> To describe medical student coaches' experiences leading the Community Outreach teleheAlth program for Covid education and Health promotion (COACH). <h3>Design</h3> Qualitative, descriptive study. <h3>Setting</h3> Online via Zoom video conferencing. <h3>Participants</h3> Trained medical student coaches (n = 19) were recruited from the University of British Columbia via convenience sampling. Seventy-four percent of participants were female and had an average age of 25.6. Most participants (57.9%) were from visible minority populations, and 42.1% administered COACH in suburban/rural areas. <h3>Interventions</h3> COACH included six 30-45-minute one-on-one sessions where student coaches promote positive health behaviours to adults ages 65 or older. <h3>Main Outcome Measures</h3> Participants engaged in a 45-to-60-minute semi-structured interview conducted via one-on-one Zoom video-conferencing calls. Interview questions focused on students' experiences delivering COACH, their understanding of various health-related topics (e.g., chronic care, virtual health, and health promotion), and possible impacts on their beliefs and future practice. Interviews were transcribed verbatim and analyzed thematically. <h3>Results</h3> Three main themes emerged from our thematic analysis, including: (1) exploring opportunities for knowledge and skill acquisition (i.e., learning virtual care, health promotion strategies for chronic care, and client-centered care), (2) developing clinical perspective and acumen (i.e., developing a chronic care perspective, overcoming challenges to health coaching, and developing interest in chronic care practice), and (3) learning to appreciate patient care (i.e., becoming a health motivator and appreciating the opportunity to build rapport). <h3>Conclusions</h3> Findings suggest that COACH supported development of knowledge, skill, and confidence in medical school students in areas of health promotion, virtual care, and chronic disease management. These findings also demonstrate promise for the use of health professional students and telehealth in advancing chronic care health services. <h3>Author(s) Disclosures</h3> We report no real or perceived conflicts of interest.

Home-based Telehealth Movement-to-Music Increases Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot RCT

<h3>Research Objectives</h3> Aim 1 was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing Leisure-time Physical Activity (LTPA) and activity participation compared with a waitlist control group in adolescents with cerebral palsy (CP). Aim 2 was to qualitatively evaluate factors that influenced engagement and develop a theory that would inform the development of a more targeted M2M telehealth program. <h3>Design</h3> Randomized controlled trial piloting a 4-week M2M program. Participants were recruited randomized into one of two groups: a) M2M or b) waitlist control, which maintained their daily activities before receiving M2M. <h3>Setting</h3> Recruited from the Children's Hospital of Alabama. <h3>Participants</h3> Recruitment of 58 adolescents (10-19 years of age) with cerebral palsy (GMFCS I-V) occurred from September 2020 to September 2021. <h3>Interventions</h3> M2M incorporated music-oriented routines to improve cardiovascular capacity, muscular strength and endurance, range of motion, and general physical function.M2M videos were organized into weekly playlists. Participants were instructed to complete their playlist 3x/week. <h3>Main Outcome Measures</h3> Changes in activity and LTPA participation were measured pre to post intervention via the Children's Assessment of Participation and Enjoyment (CAPE) total domain scores and active physical recreation domain scores (CAPE-APR), respectively. Changes in scores were compared between groups using analysis of covariance (ANCOVA). A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. <h3>Results</h3> ANCOVA revealed statistically significant between group differences in pre to post change score for CAPE-Intensity (F (1, 47)=5.63, p = 0.022, effect size=0.11) (a.k.a. volume of activity) and CAPE-APR-Intensity (F (1, 47)=8.76, p = 0.0048, effect size=0.17; a.k.a. volume of LTPA). Estimated marginal means revealed that changes were small, in favor of the intervention group. We developed a theory based on 6 factors that affected engagement. <h3>Conclusions</h3> The project established the preliminary efficacy of a scalable telehealth M2M program for increasing LTPA behavior among adolescents with CP and provides a theory for making additional CP-specific modifications before implementation in a larger trial. <h3>Author(s) Disclosures</h3> None to declare.

Telehealth Services for Primary Care and Urgent Care to Support Rural Schools and Students.

Background: School-based health services, particularly those available to underserved and rural communities, remain in high demand. Advancements in telehealth services present clinical resources otherwise typically unavailable to students from rural communities. Methods: Data were collected during 4 semesters on all students receiving primary care or urgent care health services from 8 school-based telehealth programs delivering care to 40 schools across the United States. Results: Across the 4 semesters, 2,769 students received primary care telehealth and 2,238 students received urgent care telehealth. The primary care telehealth services were delivered by a primary care provider with a registered nurse also involved in half of the encounters. In contrast, the urgent care telehealth services were delivered almost exclusively by a registered nurse. Primary care telehealth delivered a variety of services including medication management, counseling, and sports physicals in addition to assessments and evaluations. Urgent care telehealth primarily involved an assessment. Both services returned most students to the classroom without the need for further follow-up, thus reducing or eliminating the need for seeking health care outside of the school setting. Notably, 67.7% of students seeking primary care telehealth services did not have a primary care provider outside of the school, clearly demonstrating the importance of these school-based services in increasing access to basic health care services for these students in rural and underserved communities. Conclusions: Telehealth provides a reliable solution and immediate access to care for students in need of health care, which, in turn, presents advantages to educators and parents.

Abstract 12446: Effectiveness of a Digital Health Enabled Cardiac Rehabilitation Program in Reducing Recurrent Events For Private Health Insurance Patients in Australia

Introduction: Secondary prevention programs are paramount to avoid cardiovascular disease morbidity and mortality. However, they are underutilized. Technology-enabled programs provide a new frontier to break down access barriers and enhance health service delivery. We implemented a telehealth program using a cardiac rehabilitation (CR) mobile app for privately insured patients following a hospitalization for coronary heart disease. Hypothesis: It was hypothesized that patients participating in a digitally-enabled CR program would have improved health behaviors and less recurrent events at 30-days to 12-months post discharge compared with propensity matched controls. Methods: Eligible patients received the Smart-CR mobile app, supplemented with telehealth consultations. Clinical and lifestyle changes, psychological well-being, quality of life and medication adherence were assessed at the beginning and 8-weeks following participation in the program. Using propensity matching methods, we compared rehospitalization and mortality rates of the digital-CR group (n=160) with a traditionally delivered CR group (n=115) and patients who did not undertake any form of CR (n=266). Results: Among 160 patients (35% regional/remote, 70% male and 78% aged over 60 years), physical activity levels increased from 128 minutes/week to 300 minutes/week and systolic blood pressure decreased by 5 mmHg. There were improvements in most other clinical, behavioral and lifestyle risk factors, including functional capacity, depression, anxiety, and quality of life. At 60 days, digital-CR reduced cardiac-related readmissions by 52% (RR 0.48; 95% CI: 0.24 to 0.93) compared to no CR. At 90 days, traditional CR decreased all cause readmissions by 36% (RR 0.64; 95% CI: 0.44 to 0.94) compared to non-attendance to CR. There were no other pairwise differences between groups at 30, 60 or 90 days. Health economic analyses and extended outcomes to 12 months post hospitalization are in process. Conclusion: A remotely delivered, technology-enabled CR program was effective in reducing hospital readmissions and improving cardiovascular risk. A randomized controlled trial is underway to test the generalizability of these findings in community participants.

Developing School-based Telehealth Programs as an Equity Strategy for Education and Health Care.

School-based telehealth programs have shown potential to address both educational and health needs of elementary students in North Carolina. A Cone Health prototype in areas of endemic poverty and low health literacy allowed for the creation of on-demand care that kept children in school, decreased early dismissals, and reduced the burden and cost of urgent health care on families.

HOME MONITORING & TELEHEALTH EDUCATION FOR ASTHMA DISEASE MANAGEMENT

<h3>Introduction</h3> Asthma disease management requires self-management skills and personalized clinical interventions. Allergy and Asthma Network (AAN) collaborated with CurieAI and VitalFlo to monitor patient symptoms and spirometry as part of a personalized telehealth asthma education program. <h3>Methods</h3> The Not-One-More-Life telehealth AAN program enrolled participants with severe asthma between July and December 2021 for a 6-week virtual asthma telehealth coaching program. Participants were provided with a cellular-connected bedside tablet device for passive nighttime symptom monitoring. The CurieAI software running on the tablet device enabled daily overnight monitoring for objective assessment of audible symptoms; like cough, sneeze, throat-clearing, wheezing, obstructive-snoring, grunting. VitalFlo solution using a MIR spirometer was provided to measure FEV1, FVC, FEV1/FVC parameters. <h3>Results</h3> 22 participants used the two home monitoring devices. There were a total of 862 nights of monitoring for symptoms (39+ nights per participant in the 6 weeks). 20 high-level alerts were generated for severe or worsening symptoms. An asthma coach followed these symptoms with the participant, provided treatment plan guidance, and advised them to see the healthcare provider. Participants used VitalFlo solution for an average of 3.5 days per participant during the same 6-week period. 32% of participants experienced improvement in their FEV1 and FVC, and 27% improvement in FEV1/FVC. <h3>Conclusion</h3> Asthma disease management telehealth program with home monitoring devices successfully followed participants' health status. Participants who used the Vitalflo platform to document spirometry use indicated improvement between pre-and-post recordings and the nighttime monitoring identified worsening of symptoms for timely follow-up.

Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial.

Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children's Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children's Assessment of Participation and Enjoyment Active Physical Recreation-Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants' adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390.

Incorporation of Student Pharmacists into a Proton Pump Inhibitor Deprescribing Telehealth Program for Rural Veterans.

Background: Proton pump inhibitors (PPIs) are among the most widely prescribed class of medications in the United States. Although effective in the treatment of acid related disease, inappropriate PPI use is prevalent, and long-term PPI use has been associated with adverse effects. Objectives: This evaluation explores the novelty of a student-pharmacist directed PPI deprescribing telehealth program with the goals of (1) determining whether PPIs are appropriately prescribed in Veterans via remote student-led chart reviews, (2) identifying if a gap exists between urban and rural Veterans prescribed a PPI, and (3) assessing the feasibility of integrating student pharmacists into the PPI deprescribing process utilizing telehealth visits through a pilot study. Methods: Student pharmacists evaluated PPI appropriateness in Veterans at the William S. Middleton Veterans Hospital. Students collected data via remote chart reviews, compared appropriateness of PPI therapy in rural versus urban Veterans, and conducted a deprescribing pilot call study in rural Veterans with inappropriate PPI indications. Clinical decision-making was agreed upon in collaboration with pharmacist preceptors, however all means of communication with Veterans was performed by student pharmacists. Results: 51% of Veterans were found to have an inappropriate indication for their PPI, though comparison of inappropriate PPI use in rural versus urban Veterans was not statistically significant (n=170, p-value 0.34). 83% of Veterans agreed to proceed with PPI deprescribing and 71% of Veterans ended the pilot study with at least some degree of PPI dose reduction (n=33). Conclusion: Inappropriate PPI use among rural and urban Veterans is prevalent, however a significant difference was not observed between the two cohorts. Student pharmacists are capable of successful telehealth deprescribing interventions in collaboration with pharmacists.

Telehealth during the pandemic: Patient perceptions and policy implications.

Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID-19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID-19 pandemic and explore relevant policy implications. Researchers used a cross-sectional, non-experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID-19 pandemic has made me more open to using telehealth" on a 5-point Likert scale (1=strongly disagree; 5=strongly agree). Means of the different groups were analyzed using independent t-test and one-way ANOVA with Bonferroni post-hoc multiple comparisons. Of the total participants, 73% (n=366) either agreed or strongly agreed that the COVID-19 pandemic had made them more open to using telehealth. Significant differences existed by age (p=0.016), race/ethnicity (p=0.015), and sex (p < 0.001), however, groups did not differ by age during post-hoc analysis. A significant difference in the mean responses was observed between black participants (M=4.29) and white participants (M=3.91; p=0.011). In addition, female participants (M=4.11) rated the item higher than male participants (M=3.65). As access to telehealth increased due to the COVID-19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID-19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions.

Adapting a Telehealth Network for Emergency COVID-19 Pandemic Response, 2020-2021.

In March 2020, a tribal telehealth program—the Indian Country Extension for Community Health Outcomes (ECHO)—added emergency COVID-19 to its programming to support the pandemic response. A long-standing relationship with a network of Indian Health Service, tribal, and urban Indian clinicians supported a rapid launch of the COVID-19 telehealth program. This nationwide service offered primary care clinicians and staff serving American Indian/Alaska Native people access to virtual learning opportunities, expert clinical recommendations, technical assistance, and capacity building. From March 12, 2020, through April 30, 2021, the program provided 85 clinical sessions in 12 months, with an average participation of 120 attendees per clinic (N = 11 710). Attendees could complete a voluntary evaluation form for each session via an online link. A total of 2595 forms were completed. Attendees came from 33 states and 206 unique locations, primarily from the Pacific Northwest (n = 931, 35.9%). Most pharmacists (78.1%), providers (ie, medical doctor, doctor of osteopathy, advanced practice nurse, physician assistant, or clinical nurse midwife; 70.8%), and nurses (59.6%) gave the sessions the highest rating of “very satisfied.” The highest proportion of attendees indicating that they planned a change in practice were pharmacists (68.0%), nurses, (64.1%), and providers (61.3%). Most attendees (93.1%) said that the COVID-19 sessions gave them a sense of social support. Lessons learned were that (1) a telehealth platform can be quickly retasked for emergency response with no further delays, (2) a telehealth network can be scaled up quickly with participation from preexisting relationships, and (3) the platform is flexible and adaptable to the needs of participants. An existing telehealth program can be a key part of timely, relevant, large-scale emergency readiness and response efforts.

Telemedical monitoring and coaching improves survival and hospitalisation rates in heart failure

Abstract Aims To investigate the effectiveness of a combined telemonitoring and telecoaching programme for chronic heart failure patients at high risk for hospitalisation compared to usual care in a real life setting. The applied telehealth programme consisted of regular individualised telecoaching sessions as well as daily remote telemonitoring of heart failure signs and symptoms. Methods Between January 2018 and September 2020, 6,065 heart failure patients were enrolled in a combined telehealth programme and retrospectively compared to a propensity matched usual care group (n=6,065). All participants were members of a statutory health insurance. Median follow-up was 442 days (IQR 309–681). Endpoints were all cause mortality, number and duration of hospitalisations. Results After 1 year the combined telecoaching and telemonitoring programme significantly reduced all-cause mortality probability compared to usual care (11.0 vs. 5.8%, p&amp;lt;0.001). The corresponding number-needed to treat to prevent one death in one year was 19.3. In addition, the number of hospitalisations for heart failure (17.9 vs. 21.8 per 100 patient years, p&amp;lt;0.001) and all cause hospitalisations (129.0 vs. 133.2, p=0.015), as well as their duration (2.0 vs. 2.6 days per year p&amp;lt;0.001, and 12.0 vs. 13.4 days per year p&amp;gt;0.001, respectivel y) were significantly lower in the telehealth group than in the usual care group. Conclusion In ambulatory heart failure patients at high risk for hospitalisation, a combined telemonitoring and telecoaching programme led to a reduction of heart failure hospitalisations and all-cause mortality compared to standard care. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Health Care Systems GmbH (HCSG), Pullach i. Isartal

Headache Education Adaptation During the COVID-19 Pandemic: Impact on Undergraduate and Graduate Medical Education.

Purpose of ReviewOur goal was to describe the changes to headache and neurological education that occurred as a result of the COVID-19 pandemic, and the impact this had on medical learners. We also discuss subsequent implications for the future of education in the field of headache medicine.Recent FindingsBoth educators and learners faced many challenges during the pandemic. These include the following: cancellation of in-person educational meetings, limited in-person networking and wellness events, disengagement from virtual didactic curricula, limitations in procedure-based learning, redeployment to inpatient settings with a decrease in outpatient exposures, and blurred boundaries between home and work life due to more virtual collaboration and home computer use. The development of telehealth programs and trainee wellness initiatives, improved collaboration opportunities among geographically distant institutions, and greater access to conferences for learners are among the many improvements forged by these challenging times in medical education.SummaryGiven the high prevalence of headache disorders and the paucity of headache specialists, training new clinicians with competency in headache medicine is essential. There were many educational challenges and opportunities identified in the literature that resulted from the pressures of the pandemic. Educators need to develop assessments that capture any gaps in learning that may have occurred during this tumultuous time and be vigilant of remediation needs in our learners over the coming years. It is imperative to intentionally design curricula for the future by harnessing new pedagogical tools, innovations, and perspectives gleaned from our experience with the COVID-19 pandemic.

INTERSECTIONALITY-BASED REVIEW OF HEART FAILURE TELEHEALTH/ REMOTE MONITORING INTERVENTIONS FOR VULNERABLE POPULATIONS

INTERSECTIONALITY-BASED REVIEW OF HEART FAILURE TELEHEALTH/ REMOTE MONITORING INTERVENTIONS FOR VULNERABLE POPULATIONS

Implementation of telehealth for first-dose device teaching within a health-system specialty pharmacy.

To demonstrate how the integration of a pharmacist-led, telehealth-based first-dose device teaching (FDDT) workflow helped to improve the efficiency of the work system, expand access, and maintain the high quality of care. The telehealth program was designed utilizing existing specialty pharmacy infrastructure and a partnership with a dermatology clinic. The program includes patients receiving a self-injectable specialty medication (SISM) who require an FDDT and fill with our health system's specialty pharmacy. Patients complete a virtual FDDT with a specialty pharmacist following an initial pharmacist consult and medication shipment. Patient experience and program feedback were captured via a standardized 5-point Likert telephone survey. A total of 30 patients completed the FDDT program. Surveys following the FDDT visit completed by 19 patients showed that patients had high satisfaction with the quality and convenience of the telehealth visit (4.53 and 4.79, respectively). Overall care and education received from the pharmacist was also rated highly (5.00). Notable feedback captured in free responses emphasized the helpfulness of the pharmacist and the convenience of the visit. Areas to improve focused on technology difficulties. As SISMs continue to grow in utilization, telehealth services should be considered as part of the clinic workflow. Specialty pharmacists delivered high-quality and convenient care to patients through this patient education program. Expansion of this program into additional clinics may help improve specialty care access and increase the availability of nursing staff for additional clinical needs.

Effectiveness Of A Peer Guided Physical Activity Via Telehealth Program (PACT) In Adults With Autism: A Pilot Randomized Controlled Trial

PURPOSE: Adults with autism spectrum disorder (ASD) are at increased risk for obesity and cardiovascular disease as they face limited opportunities and access to physical activity (PA). Barriers to PA may include impairments with cognitive/social/communication, limited access due to transportation needs/costs, and more recently, the Covid-19 pandemic. The objective of this study is to determine whether a 10-week Physical Activity via Telehealth (PACT) program, a peer-guided telehealth + use of a wearable step activity device (Fitbit) would improve PA outcomes in adults with ASD. METHODS: Eighteen subjects (11-males), aged 18-32 diagnosed with ASD were randomized into either a PACT or Wait-list Control (WLC) group. Anthropometrics to determine Body Mass Index (BMI) and Waist to Height Ratio (WHtR) was collected via guided instruction. Self-report and steps/day PA data were collected utilizing the Godin Leisure Survey (GL), research-grade step activity monitor (StepWatch), and FitBit Inspire (FB). PACT included 10-weeks of peer-supported telehealth sessions + daily step activity self-monitoring with FB device. Data was analyzed and interpreted using descriptive statistics, repeated-measures ANOVA, and paired T-tests. RESULTS: All subjects completed PACT and were compliant with FB during PACT and WLC phases, and 9 completed the WLC prior to crossing over. Mean BMI, and WHtR was 28.6 kg/m2and .56. No differences in anthropometrics or steps/day PA between PACT and WLC group at baseline. Self-report of PA increased at 10-weeks for PACT group as per GL from 26.2 to 67.8, p = .002. Although not significant, StepWatch steps/day trended upwards from 6,700 to 7,756 for PACT only while trending downward by 1453 steps/day for WLC group. The effects of PACT over time for all participants following PACT revealed an increase in steps/day from 6,727 to 7,316, p = .048. CONCLUSIONS: Adults with ASD who completed PACT demonstrated improvements in self-report PA and a positive trend in steps/day. Although, a small cohort, study results support use of a Fitbit device and peer-supported telehealth for this population who face multiple barriers to participate in community-based PA programs and have greater propensity towards obesity and high-risk abdominal adiposity.

Telehealth Delivery Of Therapeutic Exercise For Musculoskeletal Disorders During A Global Pandemic

The COVID-19 pandemic has globally disrupted the delivery of healthcare services, particularly for interventions that traditionally require face-to-face interactions, such as manual techniques and therapeutic exercise. Telehealth provides a potential alternative to in-clinic care. However, it has not been well-studied for delivering therapeutic exercise in patients with musculoskeletal (MSK) disorders and little guidance is available on implementation. PURPOSE: The purpose of this paper was to describe the implementation process of a telehealth program for delivering therapeutic exercise in patients with MSK disorders during a global pandemic. METHODS: A quality project was conducted to implement a telehealth program in an outpatient physical therapy organization in the United States. Various implementation outcomes were assessed, such as adoption, adherence, barriers and facilitators, safety, and satisfaction. Representative cases of patients with MSK disorders were also reviewed to illustrate challenges and solutions when administering a telehealth plan of care including exercises. RESULTS: A telehealth program to deliver therapeutic exercise was successfully implemented for patients with MSK disorders presenting for outpatient physical therapy. Barriers, such as limited exercise equipment, technology difficulties, and fall risk safety, were addressed through creative approaches in the home setting. Adherence was high and no adverse events were reported. At its peak, approximately 900 patient visits per month were conducted via telehealth, representing approximately 7% of the total volume. Review of cases suggested good functional outcomes and high satisfaction. CONCLUSION: This project provided insight about implementing a telehealth program focusing on therapeutic exercise for the management of patients with MSK disorders. The findings of this project indicate that telehealth delivery in a physical therapy plan of care is safe, enhances patient access, and allows for continuity of care, which may result in improved functional outcomes. Research is needed to determine the effectiveness of telehealth and updated regulations are needed to clarify roles of providers who are qualified to deliver therapeutic exercises via telehealth.

Telehealth program: Effect of Physiotherapy Intervention on Dyspnea, Fatigue and Functional Status of Post COVID-19 Syndrome patients

Telehealth program: Effect of Physiotherapy Intervention on Dyspnea, Fatigue and Functional Status of Post COVID-19 Syndrome patients

Abstract P014: A Pilot Study To Develop A Telehealth Program For Self-Measured Blood Pressure Education And Assessment Within A Veterans Affairs Clinic

Background: Lack of education and assessment of self-measured blood pressure (BP) monitoring quality is a barrier to its widespread implementation. Objective: To develop a pilot Veterans Affairs (VA) Telehealth Program utilizing a tool to educate and assess competencies in self-measured BP technique. Methods: This pilot study was implemented in a single VA primary care clinic. Veterans aged 18 to 85 years old with an office-based BP measurement of ≥140/90 or ≥130/80 mmHg and high cardiovascular disease risk were eligible. Enrolled Veterans completed a four-week program whereby trained registered nurses (RNs) educated Veterans on self-measured BP techniques via video conferencing. At each visit, RNs conducted an 11-part assessment tool (Figure Top) adapted from the American Medical Association measurement skills assessment for patient self-measured BP technique. Results: Forty Veterans (mean age 66 years [SD 12.6], 100% male) were referred for enrollment and twenty completed the program. Veterans demonstrated overall high scores on self-BP measurement skills assessment at each time point (Figure Top), but most frequent skills with non-adherence included: avoiding stimulant use prior to BP measurement; emptying bladder; resting quietly for 3-5 minutes; and talking or using a personal device during measurement. Mean SBP and DBP generally declined over time from a baseline mean SBP and DBP of 147.9 and 81.7 mmHg at enrollment to a mean of 140.4 and 79.9 mmHg, respectively, at program completion (Figure Bottom). Conclusions: Education and assessment of self-measured BP technique may serve as a meaningful target for future education and quality improvement efforts.